Can Pakistan compete with
India in Health Services?

This is with reference to your “Off the Record” column entitled “Can we compete with India in health services?” published in Pulse International recently. I would like to state that Pakistan can compete with India and other countries in the region like Bangladesh (former East Pakistan) which was far behind Pakistan (former West Pakistan) has now surpassed Pakistan in all the health metrics. Sadly Pakistan lags behind not only all the countries in this region but even lags behind war-torn Yemen, Syria and sub Saharan countries.

Country’s overall health is judged by the criteria laid down by the World Health Organization (WHO). Pakistan has the highest still-birth rate in the world. The prestigious Medical Journal the “LANCET” captioned. Pakistan is the most dangerous country for the women to become pregnant. Pakistan has the highest maternal, neonatal, child mortality etc. and the shortest lifespan. Sri Lanka excels in this region by following democratic policies of Universal health and education.

The cause is Pakistan’s rulers pursuing undemocratic rather anti- people policies. While other countries in this origin were pursuing health and education welfare policies, Pakistan’s rulers were doing luxurious infrastructure projects. Pakistan has meagre health budget. Due to undemocratic policies, the priorities are lop-sided. The money is spent on undemocratic, luxurious, debt creating infrastructure projects and also on luxurious, undemocratic, health projects. Prevention of Diseases and Health Promotion which received top priority in other countries gets the least priority in Pakistan. It is a well-known principle of health economy that “Prevention is not better than cure but is also the real cure - the only cost effective cure”. Pakistan’s population control, availability of potable water, sanitation immunization etc. are badly neglected- practically accorded no priority.

About the availability of life saving “Essential Medicines” list devised by the WHO drug expert committee for the low/ middle income countries, are not implemented in Pakistan- the only country in the low- middle income group not doing it. The Essential Drug system is fully operative in India since 1990 and also all other countries in the region. In Pakistan in spite of making the list much earlier, it is not being implemented even in the public sector. The reason is greed and corruption of the rulers and the industry. The non- availability of life saving” Essential Medicines” is one of the major causes of high mortality in Pakistan. Essential Medicine is by definition, efficacious, relatively safe, affordable, cost effective, fulfilling the needs of the majority of the population i.e. over 95% of the population. On the other hand, Pakistan markets are flooded with harmful irrational medicines robbing the gullible people of their health and meager financial resources of the people and the Nation. The definition of Essential Medicines says every-thing. It is a panacea for ill-health. In India and other countries Essential Medicines are even supplied free of cost to the poor population. As an example the first line anti-bacterial against urinary tract infections, Furadantin is available free of cost to the needy patients and available in the market at affordable price of a few paisa’s per tablets while in Pakistan it is sold in black with a price tag of Rs 60 to 90 per tablet. The situation with other lifesaving medicines like penicillin V, cloxacillin, flucloxacillin, iron supplement tablet, Folic acid tablet etc. is as bad .The reason is greed, corruption of rulers, industry and some professionals. In Pakistan more than 40% of children are suffering from stunting and micronutrient deficient diseases, jeopardizing not only their own future but also of the country. Twenty five million children are out of schools, one of the highest in the world, amongst them we are losing many geniuses like Iqbal, Jinnah, Abdul-Salam and Faiz etc.

The government has spent huge amounts on debt-ridden, heavily subsidized infrastructure projects like under- passes, over passes, Metro, instead of spending on health and education. Most of the money is spent on posh areas, gated luxurious communities in the cities, neglecting the real Pakistan living in slums, shanty towns in the cities, rural areas and backward areas like South Punjab, Sindh’s interior, and Baluchistan i.e. the real Pakistan. As an example the Punjab government has spent Rs 70,000 per person in developing Lahore’s posh areas while spending even less than 2000 rupees per person in Southern Punjab areas. The same is in the Sindh where Karachi get lions share and Sindh interior is totally neglected. The situation is even worse in Baluchistan regarding curative services, the countries in this region have spent money on creating a network of curative units all over the country .The outcomes of patient getting heart Attacks, strokes, etc. depends how quickly the patients receive treatment at the unit. In Pakistan there is emphasis on building luxurious institutes costing billions only catering to the posh areas. In rich countries institutes carry out high class doctoral or post-doctoral researches while in Pakistan practically no research work is done. In the private sector hospitals/ clinics even two to four room units are carrying out renal transplants, stenting, coronary bypass surgery etc. There is no reason why these procedure should not be done at 250 bedded district hospitals. These procedures are being done all over the countries in the region. Billions are spent on stand -alone expensive luxurious non- cost effective institutes for self -glorification. These can be better utilized in the network of cost effective curative units spread all over the country. The rulers are interested in their votes and corruption accruing from luxurious and undemocratic project. By adopting rational democratic pro- peoples polices, Pakistan can also solve self- created myriad problems and take lead in Health out-comes.

Quaid-e- Azam envisaged a democratic welfare state, not the undemocratic state of the elite by the elite and for the elite. It is high time that correct polices are adapted and Pakistan placed on the democratic path to serve the common people.

Prof. Emeritus Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General
Pakistan Army,
Rawalpindi - Pakistan.

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