Trauma Center
In 2008 , I got a chance to ro review the need the for a Trauma center for Pakistan with two of my supervisors. One was the director general health Pakistan. The short communication was published in the Journal of Pakistan Medical Association Vol. 58, No. 10, October 2008. The need for a 24 hours available trauma team was highlighted.
However, even today in a city like hyderabad the Trauma center is lying locked and vacant. The facility is not under use and patients are being directed to other hospitals.
I found this clip whihc takes us through the trauma center lying in a state of dormancy .
http://www.youtube.com/watch?v=Bhc0IlOGgtc
What can be done to change this , so that this facility becomes operable.
Saturday, April 16, 2011
Friday, April 8, 2011
New Delhi metallo-beta-lactamase-1 - also affecting Pakistan
Concern for Pakistan and India: Anti biotic Resistance due to NDM-1 enzyme (New Delhi metallo-beta-lactamase-1) - the presence of which in a bacteria makes it a 'super bug' and resistant to antibiotics.
Misuse of antibiotics , which may also result from the resistance to anti biotics, is undermining the International fight against the infectious ailments.(World Health Organization ). After reading this issue in KWGHPR 4/8 , my concern is since there is evidence based data from India and research also considers this problem to be similar in Pakistan.
In a study published in Lancet: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70059-7/fulltext?_eventId=login by walsh et el : "Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study", it is found that scientists had detected the gene that makes NDM-1, "an enzyme that can be incorporated into bacteria and inactivate a wide range of antibiotics, in New Delhi, India, water supplies used for drinking, washing and cooking" , Reuters report( kelland 4/7).
Lancet paper interpreted : "The presence of NDM-1 β-lactamase-producing bacteria in environmental samples in New Delhi has important implications for people living in the city who are reliant on public water and sanitation facilities. International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority".
KWGHPR 4/8 discusses this further. "NDM-1-positive bacteria have already turned up in the United Kingdom and elsewhere in patients, some of whom had previously been in hospitals in India and Pakistan, but this is the first report to find NDM-1 in environmental samples unconnected to hospitals or infected patients," Nature News reports (Lubick, 4/7). Researchers say the study suggests NDM-1 "is widely circulating in the environment – and could potentially spread to the rest of the world," Associated Press/Seattle Times reports (Cheng, 4/6)
Researchers found the gene in 11 different types of bacteria, including those that cause dysentery and cholera.
Note:
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/abstract#
"Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study"
Research identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.
Misuse of antibiotics , which may also result from the resistance to anti biotics, is undermining the International fight against the infectious ailments.(World Health Organization ). After reading this issue in KWGHPR 4/8 , my concern is since there is evidence based data from India and research also considers this problem to be similar in Pakistan.
In a study published in Lancet: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70059-7/fulltext?_eventId=login by walsh et el : "Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study", it is found that scientists had detected the gene that makes NDM-1, "an enzyme that can be incorporated into bacteria and inactivate a wide range of antibiotics, in New Delhi, India, water supplies used for drinking, washing and cooking" , Reuters report( kelland 4/7).
Lancet paper interpreted : "The presence of NDM-1 β-lactamase-producing bacteria in environmental samples in New Delhi has important implications for people living in the city who are reliant on public water and sanitation facilities. International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority".
KWGHPR 4/8 discusses this further. "NDM-1-positive bacteria have already turned up in the United Kingdom and elsewhere in patients, some of whom had previously been in hospitals in India and Pakistan, but this is the first report to find NDM-1 in environmental samples unconnected to hospitals or infected patients," Nature News reports (Lubick, 4/7). Researchers say the study suggests NDM-1 "is widely circulating in the environment – and could potentially spread to the rest of the world," Associated Press/Seattle Times reports (Cheng, 4/6)
Researchers found the gene in 11 different types of bacteria, including those that cause dysentery and cholera.
Note:
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/abstract#
"Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study"
Research identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.
Monday, March 28, 2011
Reviewing the UAE healthcare
My article published in Khaleej Times: 26 March 2011 The UAE stands at number 27th in world health systems ranking of the World Health Organization (WHO). While reading the WHO report on healthcare in the UAE, I was struck by the progressive manner in which it has taken its place among the developed nations of the world. The oil-fuelled surge in economic growth over the past years has seen the UAE’s total population grow at an average annual rate of 10 per cent to just over 4 million by the end of 2003, according to official figures from the Ministry of Planning. The attainment of an integrated health systems is actually the attainment of three goals: health, responsiveness and fairness of financial contribution. The UAE has seen notable growth in its health care. Over the past years government health strategies have focused on the welfare of the citizens who are considered to be the country’s major resource and integral to national development. Comprehensive health programmes have been adopted to meet the needs of the UAE society. Currently, the UAE has a comprehensive, government-funded health service and a developing private health sector. The private sector in recent years has become a significant partner in providing comprehensive health care to the people of the UAE. It is now contributing efficiently to curative and preventive services through the hospitals, polyclinics and diagnostic and medical centers and private clinics. According to the Regional Health System Observatory of EMRO’s published report of 2006, the Ministry of Health’s budget as a percentage of the governmental budget has remained relatively constant at about 7.7 per cent over the years (1982-2001). The 1999 Ministry of Health federal budget amounted to Dh1.44 billion dirhams. Health insurance companies have also made their entry in the last few years; some are national companies whereas others are branches of international organisations. The largest part of the budget specified for health goes to curative services, whereas little goes to the preventive and the primary health care services. Castro’s article on health care in Dubai notes the most common infectious disease in Dubai is chicken pox with 3,472 reported incidences in 2006. This is followed by Viral Hepatitis B with 392 cases and Pulmonary Tuberculosis with about 312 cases. Heat stroke is also rampant in Dubai due to very scorching summers. EMRO Report in 2006 said that communicable diseases still pose a problem to the United Arab Emirates despite the fact that the incidence of many communicable diseases has declined sharply in recent years. Viral hepatitis, tuberculosis and meningococcal meningitis are still considered an important public health problem. In recent years, non-communicable diseases, notably cardiovascular diseases, cancers and diabetes, as well as accidents, have been the leading causes of mortality. This is indicative that life style changes are mandatory. One wonders if the UAE needs a private national company for the management and delivery of health services and health-related programmes? Also, would nationalisation of health professionals help in improving quality of care? One does see an increase in employer-based health insurance market since individual health insurance is quite expensive. Recent studies of health systems internationally, have shown that using a broker in selecting your health insurance may help, though experts have argued that in the long run some sort of standardisation of rates would be much better. Using electronic medical records more widely across the UAE, would be very useful in registering all patients – the nationals and expats. Switching to the use of generic drugs would also cut huge costs. This should be supervised with a regulatory body to ensure quality and efficiency, perhaps something like the national institute of clinical effectiveness in UK could be set up in the UAE. source :http://www.khaleejtimes.com/DisplayArticleNew.asp?section=opinion&xfile=data%2Fopinion%2F2011%2Fmarch%2Fopinion_march124.xml
Sunday, March 20, 2011
Care for a puff, can you pay the price?
SOURCE: http://www.khaleejtimes.com/DisplayArticleNew.asp?section=opinion&xfile=data/opinion/2011/march/opinion_march53.xml
My Article for The Khaleej Times
Care for a puff, can you pay the price?
11 March 2011: " A fun night out, an easy way to keep the weight under control, the fun flavours of Shisha, peer pressure to appear “in” – keeping aside these reasons, one faces an increased risk of cancer for one’s own self and for others. In 1957, the US Public Health Service confirmed that data suggested a causal relationship between smoking and lung cancer. And since then America has seen a drastic decline in their smoking habits. Cigarette smoking is a leading preventable cause of death in USA (CDC). As the west is focused on eliminating this health hazard, the tobacco companies are focusing on Asia to be their major tobacco market.
The World Health Organization (WHO) statistics show that tobacco is the chief preventable cause of death in the world. It causes 1 in 10 deaths among adults worldwide and kills up to half of all users. 100 million deaths were caused by tobacco in the last century, and if current trends continue, there will be up to one billion deaths in this century.
So what is the rationale for calling smoking ‘not cool’? The Center for Disease control and prevention (CDC) states that when non smokers were compared with smokers, data showed that there was an increase risk of:
· coronary heart disease by 2 to 4 times
· stroke by 2 to 4 times
· men developing lung cancer by 23 time
· women developing lung cancer by 13 times, and
· dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times.
Cigarette smoking is known to be the main cause of mouth, esophagus, pharynx and bladder cancers. It also has a role in the development of cancers of stomach, kidney, pancreas, and some forms of leukemia (CDC). The harmful effects of tobacco do not end with smoking cigarettes. That beautiful Shisha is not as harmless as many of us may like it to be- it would not be wrong if it was classified as a fatal attraction!
Babies born to mothers who smoke are 1.5 - 3.5 times more likely to be of low birth weight and are 33 per cent are more likely to be stillborn or die during the neonatal period (Schroeder). Furthermore, the adverse health effects of smoking during pregnancy extend into childhood, increasing the risk of impaired growth and educational achievement (Bartecchi et al.). Second hand smoke increases risk of heart disease by 25–30 per cent, and of lung cancer by 20–30 per cent (CDC 2002), and in children increases the risk of SIDS and acute asthma exacerbations (West and Cohen).
According to Center of Disease Control and Prevention (CDC), the UAE Global youth tobacco survey ( GYTS) 2005 showed the about 25 per cent of grade 7th,8th , 9th and 10th students smoked. And about 32 per cent use other tobacco products. About 40 per cent of these students bought the cigarette at a store and majority had no difficulty buying them. According to the global school based student health survey (CDC 2010), about 82.1 per cent of the students who smoked cigarettes did it before the age of 14 years!
In the UAE, the WHO Report on the Global Tobacco Epidemic 2008 estimates that over one quarter (27.2 per cent) of the male population smoke tobacco, compared to only 2.4 per cent of the female population. The report says that “among smokers who are aware of the dangers of tobacco, three out of four want to quit.” But like people dependent on any addictive drug, it is difficult for most tobacco users to quit on their own, and they benefit from help and support to overcome their dependence.” According to an article by Peter Harrison, “UAE health officials say 14 per cent of all cancer cases in the nation are lung cancer and most are smoking related.”
If you were a smoker and decide to quit: Smoking cessation reduces the risk of developing and slows the progression of established tobacco-related diseases, and increases life expectancy (Office of the Surgeon General). Quitting by age 30 eliminates nearly all excess risk associated with smoking, and smoker s who quit smoking before age 50 half their risk of dying in the next 15 years (CDC 2002). A place which believes in dreaming big and achieving, a healthier smoke free environment is an aspiration that desires to be fulfilled. "
'The best way to break a bad habit is to drop it.' ~Leo Aikman
My Article for The Khaleej Times
Care for a puff, can you pay the price?
11 March 2011: " A fun night out, an easy way to keep the weight under control, the fun flavours of Shisha, peer pressure to appear “in” – keeping aside these reasons, one faces an increased risk of cancer for one’s own self and for others. In 1957, the US Public Health Service confirmed that data suggested a causal relationship between smoking and lung cancer. And since then America has seen a drastic decline in their smoking habits. Cigarette smoking is a leading preventable cause of death in USA (CDC). As the west is focused on eliminating this health hazard, the tobacco companies are focusing on Asia to be their major tobacco market.
The World Health Organization (WHO) statistics show that tobacco is the chief preventable cause of death in the world. It causes 1 in 10 deaths among adults worldwide and kills up to half of all users. 100 million deaths were caused by tobacco in the last century, and if current trends continue, there will be up to one billion deaths in this century.
So what is the rationale for calling smoking ‘not cool’? The Center for Disease control and prevention (CDC) states that when non smokers were compared with smokers, data showed that there was an increase risk of:
· coronary heart disease by 2 to 4 times
· stroke by 2 to 4 times
· men developing lung cancer by 23 time
· women developing lung cancer by 13 times, and
· dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times.
Cigarette smoking is known to be the main cause of mouth, esophagus, pharynx and bladder cancers. It also has a role in the development of cancers of stomach, kidney, pancreas, and some forms of leukemia (CDC). The harmful effects of tobacco do not end with smoking cigarettes. That beautiful Shisha is not as harmless as many of us may like it to be- it would not be wrong if it was classified as a fatal attraction!
Babies born to mothers who smoke are 1.5 - 3.5 times more likely to be of low birth weight and are 33 per cent are more likely to be stillborn or die during the neonatal period (Schroeder). Furthermore, the adverse health effects of smoking during pregnancy extend into childhood, increasing the risk of impaired growth and educational achievement (Bartecchi et al.). Second hand smoke increases risk of heart disease by 25–30 per cent, and of lung cancer by 20–30 per cent (CDC 2002), and in children increases the risk of SIDS and acute asthma exacerbations (West and Cohen).
According to Center of Disease Control and Prevention (CDC), the UAE Global youth tobacco survey ( GYTS) 2005 showed the about 25 per cent of grade 7th,8th , 9th and 10th students smoked. And about 32 per cent use other tobacco products. About 40 per cent of these students bought the cigarette at a store and majority had no difficulty buying them. According to the global school based student health survey (CDC 2010), about 82.1 per cent of the students who smoked cigarettes did it before the age of 14 years!
In the UAE, the WHO Report on the Global Tobacco Epidemic 2008 estimates that over one quarter (27.2 per cent) of the male population smoke tobacco, compared to only 2.4 per cent of the female population. The report says that “among smokers who are aware of the dangers of tobacco, three out of four want to quit.” But like people dependent on any addictive drug, it is difficult for most tobacco users to quit on their own, and they benefit from help and support to overcome their dependence.” According to an article by Peter Harrison, “UAE health officials say 14 per cent of all cancer cases in the nation are lung cancer and most are smoking related.”
If you were a smoker and decide to quit: Smoking cessation reduces the risk of developing and slows the progression of established tobacco-related diseases, and increases life expectancy (Office of the Surgeon General). Quitting by age 30 eliminates nearly all excess risk associated with smoking, and smoker s who quit smoking before age 50 half their risk of dying in the next 15 years (CDC 2002). A place which believes in dreaming big and achieving, a healthier smoke free environment is an aspiration that desires to be fulfilled. "
'The best way to break a bad habit is to drop it.' ~Leo Aikman
Sunday, October 17, 2010
What is on your Plate?
There was a time when the greek men had the longest life expectancy... but with the fast food industry growing , things have changed for the worse. I was reading a very interesting article on the NPR : ' few Americans finish their vegetables. 'Recent report by the Centers for Disease Control and Prevention says two-thirds of Americans don't get the recommended two servings of fruit a day; three-quarters miss the target for vegetables. But how do you convince all these people, everybody, all of us, to trade in their fries for a carrot salad or pack an apple with lunch? Obviously, knowledge is not enough. USA has that national dietary guideline. And we are reminded of the food pyramid? How many of the Americans actually consult this before every meal?
NPR article discusses further: So maybe we need some new ideas. Remember home ec classes? Maybe we should bring it back. We should teach kids, all kids, boys and girls, the joys of veggies. Or how about vending machines for baby carrots instead of chips and soda? Some schools are trying this. And there's always the pocketbook approach. Should we tax doughnuts, give credits - tax credits for your broccoli? (On a lighter note: My economics Prof would be happy to see econ being applied here ).
Quoting Dr. Walter Willett's interview. He's chairman of the Nutrition Department at Harvard School of Public Health in Boston . "First of all, you have to look and see what's being promoted. For example, the Kaiser Family Foundation did a study a few years ago looking at the ads that children would see on television, and it's amazing. The average child sees about five or 6,000 ads per year. And in an evaluation of these ads, out of five or 6,000, there was not a single one that was promoting fruits and vegetables. It was almost all junk food ."
The article talks about Michael Bloomberg proposing a two-year trial where people on food stamps will not be able to buy sugary sodas, and, in fact, may get extra dollars if they spend their food stamps on fruits and vegetables. Dr Willett feels, "I think that's a very sensible idea. It's something we've been suggesting for several years. It just doesn't make any sense at all, what we're doing. The cost of the food stamp program is over $80 billion a year, and I think that's important money. People really do need that as a safety net. But we're writing checks for - paying for Cokes with one hand, and on the other hand, we're writing checks to pay for treating diabetes caused by the Coke. That just doesn't make any sense. So sugary beverages have many adverse effects, and it just doesn't make sense that we're essentially contributing to their consumption through federal food programs."
Eating habits are very different in Pakistan. Poverty and inflation has increased the poverty burden. Many live below the poverty line and are under nourished. For middle and upper classes ...however, people do have access to fresh vegetables , lentils. The trend is to over fry every food item, which renders the caloric value high and compromises the nutritional value. The way a normal every day meat/chicken or fish curry is cooked - it is soaking in oil or ghee.
An article published in Am J Public Health. in 2001 compared the health profiles of Pakistani population and American! Yes and the study was: "Health status of the Pakistani population: a health profile and comparison with the United States." Results from the National Health Survey of Pakistan (n = 18,315) and the US National Health and Nutrition Examination Survey (n = 31,311) were compared. Standardized and comparable methods were used in both surveys.
Indicators of undernutrition among children were high throughout Pakistan. Among adults, there were urban-rural differences and economic gradients in indicators of undernutrition and risk factors for heart disease and cancer. In comparison with the US population, the Pakistani population has a higher rate of undernutrition, a lower rate of high cholesterol, and an approximately equal rate of high blood pressure.
Overweight and obesity are a global pandemic. According to a WHO report, there are 1 billion overweight people in the world, of whom 300 million are obese. Findings of the National Health Survey, Pakistan, 1990–1994, found that the prevalence of obesity for adults aged 25–64 from low, middle to high socioeconomic status (SES) was 9%, 15% and 27% for rural areas and 21%, 27% and 42% for urban areas respectively.
In another study PLoS One. 2009. "Prevalence of obesity in school-going children of Karachi" . Obesity and undernutrition co-exist in Pakistani school-children. The study showed that socio-economic factors are important since obesity and overweight increase with SES. Higher SES groups should be targeted for overweight while underweight is a problem of lower SES. Meat intake and lack of physical activity are some of the other factors that have been highlighted .
Concerns:
WHO ranks Pakistan 7th on diabetes prevalence list. In Pakistan, 6.9 million people are affected by diabetes with the International Diabetes Federation estimating that this number will grow to 11.5 million by 2025 unless measures are taken to control the disease. USA is at number 3rd on the same diabetes prevalence list with 19.2 million people being affected by diabetes. Studies have shown that Central obesity or apple shape of the body and insulin resistance is the main reason for diabetes increase in Indians.
So watch what is on your plate.
Monday, October 11, 2010
Photo Essay- Flood Relief Medical Camp in Thatta.
Thatta- the historic town of the province os Sindh in Pakistan. Between 1592-1739, it was governed in the name of the Moghul Emperors of Dehli. In August 2010 floods , Thatta was one of the worst affected areas of Pakistan. By August 28, 175,000 had left their homes and were camping along side roads , under the open sky. These are pictures from the medical camp conducted by the Pakistan Navy and Aga Khan University Hospital Doctors. This camp site has 1000 tents; generator provides light at night; school for childree, vocational training for women , medical camp and free medicines; three free meals a day and drinking water.
The Pharmacy section of the camp, providing free medicines.
A child getting nebulized.
A patient being referred to the Tertiary care hospital several Km away - the Civil hospital. Navy ambulance takes the patients free of cost.
Peads consultation.
A PCM- failure to thrive case. Maina , one and a half year old baby girl.
Saturday, October 9, 2010
We're no. 122......Curable or not?!
Pakistan's healthy life expectancy ( HALE) is 55 years for males and 56.8 years for females ( WHO) , making us 125th . According to our health performance , we are ranked 85th ; where as the over all health system performance , bestows us a rank of 122 nd ! Pakistan has one of the largest populations ( within top 10) within the developing world. Hence, the population has a greater prediposition to certain diseases and hence, health systems may find limitations along several issues.
In order to achieve better quality outcomes we will need a improved quality of access to a better quality system. In order to measure quality accurately we will need access to accurate data.
So safe to say: we need a health sector reform. The overall goals of Health Sector reform are to enhance efficiency of the health care system, both technical and allocative; to improve the quality of services; and/or to generate new resources for the system. Pakistan has so far introduced little fundamental change in its health care system.
The extremely precarious and deteriorating economic reality in Pakistan alone demands such restructuring and reorganization of its health care system. Basic performance indicators of the health system also point to this need.
The goals of health sector reform are to improve the technical and/or allocative efficiency of the health care system, enhance the quality of services, and make the system more equitable. It has numerous dimensions - from financing to organization of services to the package of services to be delivered.A policy, legislative, regulatory and institutional overhaul in health has been long overdue.
(According to Dr Sania Nishter's published comment 2008) , it is important to recognise that the health status of populations has a direct correlation with the level of public spending on health. However, it is not just the aggregate level of spending, but the percentage of GDP allocated for health adjusted for inflation and population growth, and its translation into per-capita public expenditures relative to private expenditures that gives a somewhat truer picture of the state’s investments in health. Here, it is acknowledged that Pakistan’s aggregate level of allocation for health has increased considerably over the last decade, with further increases in this budget representing a positive trend. However, changes in health allocations as a percentage of the GDP have remained unremarkable; over the last 10 years this has ranged from 0.67 percent to 0.8 percent. The internationally recommended number is 4 percent of the GDP.
In 2008 , the public sector spends $4 per capita on health annually, as opposed to the internationally recommended $34 per capita, the minimum required to provide essential health services in developing countries. Clearly, this huge gap needs to be bridged.
Approximately 70 percent ( in 2008) of healthcare in the country is financed through out-of-pocket payments made to health providers at the point of care. This is the most inefficient and inequitable way of financing healthcare. Ideally, health should be funded through public sources, which include revenues, social health insurance or other means of pooling, such as social protection.
The classical budgetary disparity evidenced in priorities for allocating resources for preventive healthcare is obvious. According to the Federal Bureau of Statistics’ Pakistan Demographic Survey, it is documented that more than 50 percent of deaths are due to non-communicable diseases (NCDs). However, as opposed to this, only 0.66 percent of the total healthcare budget has been allocated for the prevention of these diseases. NCDs, a collective name given to the diseases of the heart, diabetes and some lung conditions and cancer, incur significant costs in healthcare, undermine income-generating capacities of the productive workforce and have the potential to perpetuate acute poverty crises.
Hence, as we see ,there's many factors well beyond the quality of the health care system that contribute to these lagging rank: persistent poverty in the country ; chronic un- and underemployment; high levels of income and status inequality; and high levels of social stress and insecurity.
In order to achieve better quality outcomes we will need a improved quality of access to a better quality system. In order to measure quality accurately we will need access to accurate data.
So safe to say: we need a health sector reform. The overall goals of Health Sector reform are to enhance efficiency of the health care system, both technical and allocative; to improve the quality of services; and/or to generate new resources for the system. Pakistan has so far introduced little fundamental change in its health care system.
The extremely precarious and deteriorating economic reality in Pakistan alone demands such restructuring and reorganization of its health care system. Basic performance indicators of the health system also point to this need.
The goals of health sector reform are to improve the technical and/or allocative efficiency of the health care system, enhance the quality of services, and make the system more equitable. It has numerous dimensions - from financing to organization of services to the package of services to be delivered.A policy, legislative, regulatory and institutional overhaul in health has been long overdue.
(According to Dr Sania Nishter's published comment 2008) , it is important to recognise that the health status of populations has a direct correlation with the level of public spending on health. However, it is not just the aggregate level of spending, but the percentage of GDP allocated for health adjusted for inflation and population growth, and its translation into per-capita public expenditures relative to private expenditures that gives a somewhat truer picture of the state’s investments in health. Here, it is acknowledged that Pakistan’s aggregate level of allocation for health has increased considerably over the last decade, with further increases in this budget representing a positive trend. However, changes in health allocations as a percentage of the GDP have remained unremarkable; over the last 10 years this has ranged from 0.67 percent to 0.8 percent. The internationally recommended number is 4 percent of the GDP.
In 2008 , the public sector spends $4 per capita on health annually, as opposed to the internationally recommended $34 per capita, the minimum required to provide essential health services in developing countries. Clearly, this huge gap needs to be bridged.
Approximately 70 percent ( in 2008) of healthcare in the country is financed through out-of-pocket payments made to health providers at the point of care. This is the most inefficient and inequitable way of financing healthcare. Ideally, health should be funded through public sources, which include revenues, social health insurance or other means of pooling, such as social protection.
The classical budgetary disparity evidenced in priorities for allocating resources for preventive healthcare is obvious. According to the Federal Bureau of Statistics’ Pakistan Demographic Survey, it is documented that more than 50 percent of deaths are due to non-communicable diseases (NCDs). However, as opposed to this, only 0.66 percent of the total healthcare budget has been allocated for the prevention of these diseases. NCDs, a collective name given to the diseases of the heart, diabetes and some lung conditions and cancer, incur significant costs in healthcare, undermine income-generating capacities of the productive workforce and have the potential to perpetuate acute poverty crises.
Hence, as we see ,there's many factors well beyond the quality of the health care system that contribute to these lagging rank: persistent poverty in the country ; chronic un- and underemployment; high levels of income and status inequality; and high levels of social stress and insecurity.
Subscribe to:
Posts (Atom)