General elections are coming soon in Pakistan. This July 25th, Pakistani people will choose from about 11000 thousand candidates the 849 general seats of Pakistan´s national and four provincial assemblies.
A new government is an opportunity for country to develop and an extraordinary occasion to approach problems with a fresh perspective.
Since independence Pakistan has improved in many areas, including the economy and social sectors. Nevertheless, despite the reforms made to public health policies and the intents of achieving Millennium Development goals, key health indicators have shown that the country is still behind the international targets in relation to its fast population growth.
The new incoming government has many challenges in relation to the health sector. Despite the list of issues being very long and multifactored, we can classify them in major categories:
Lack of trust in health governance
The health sector administration has passed through many transition states. After the 18th Constitutional amendment the mandate of the system was placed under each province’s government without a central structure of health. Pakistan is the only federal country in this situation. So, its federal government that rules about the major health policies and provincial government are only able to implement those policies. This lends to the existence of gaps in communication among provinces and federal government. There is waste of resources there are cases of wide-spread corruption while implementation of policies. This has a negative impact in the quality and efficiency of the system and people stop trusting it.
Lack of equity in the access to health services
Difference between rich and poor people in relation to health service access is very marked. The social and economic positions are determining factors in health service coverage and mortality rate. Around 40% of the population lives in extreme poverty. During disease or injury, poor people need can’t often afford to pay a private health service. Since the public health service does not offer a satisfactory care, this exposes them to high health expenditure which makes their financial situation worse.
On the other hand, there is the fact of the unequal distribution of health infrastructure between urban and rural districts. Most of the hospitals are located in urban zones very far from rural populations. So, the latter needs to depend on Rural Health Centers and Basic Health Units. It is important to highlight that there are not enough rural health centers to take care of the growing population.
Lack of adequate infrastructure and resources
Because of the reasons mentioned above, people of rural areas who cannot be treated in their local healthcare services need to move to tertiary care hospitals. The long distances to be covered increase the probability of death during the transportation or causes their health to worsen. Added to this, lack of transportation means further complicates the process.
On the other hand, the health delivery system is composed of many institutions that are not commonly governed. These institutions finance health in different manners to specific populations. Sadly, more than 78% of the population does not have access to this kind of financial support and have to pay for their health care.
As it was briefly summarized, the new government has to face a multi-focal problem. Health sector has been plaguing and affecting the Pakistani population over the last five decades. Well planned and thought out national reforms could strongly help to improve the dire situation.