WHAT AILS PUNJAB. THE NEWS. Sep. 07. 2013 It’s hardly news that Punjab’s public healthcare system is in a bleak state – with overcrowded and non-functional hospitals and poor basic health indicators. The official claims of making big strides in the health sector are shocking since ground realities tell an entirely different story. Chief Minister Punjab Shahbaz Sharif keeps saying that his administration has made record increases in the health budget. In its manifesto for the May general elections, the PML-N boasted of the huge allocations it had made for Punjab’s health sector during the past five years of its rule. The real picture, however, belies these claims. The Punjab government receives a huge amount of funds for the improvement of healthcare from DfID, the Asian Development Bank and the World Bank. Under compulsion to satisfy donors, it shows high allocations for the health sector in the provincial annual budget, but in practice, however, spends much less. During the last three years spending on the health sector’s development has been less than half of the original budgetary allocations – Rs23.8 billion against an allocation of Rs48 billion. In FY 2012-13, the government spent only Rs10 billion against an allocation of Rs16.5 billion, in FY 2011-12 Rs8.1 billion against Rs16 billion and in 2010-11 just Rs5.8 billion against an allocation of Rs16 billion. The provincial government, instead, has been diverting funds from the health sector to build roads and flyovers. For instance, in FY 2012-13, the budget allocation for the urban development was Rs5.3 billion but the spending shot up several times to Rs39 billion. The PML-N’s manifesto promised to increase the health budget by three times of what it was, but in reality raised the health sector’s funds by only 2.5 percent this fiscal year, the impact of which can be seen in the vacant positions of doctors, low immunisation and shortage of medicines and equipment in public hospitals. During the last five years, Punjab’s basic health indicators – like infant mortality and maternal mortality rate – have shown little progress despite extensive financial support from foreign donors to improve meet the targets of the Millennium Development Goals (MDGs). According to the latest Multiple Indicator Cluster Survey (MICS-2011) released early this year, the province’s infant mortality rate is 82 children per 1,000 births while under-5 infant mortality rate ratio is 104 per 1,000 births. The MDG-4 target is to reduce these numbers to 40 and 52 per 1,000 births till 2015. Obviously, the progress has been quite slow and the MDG targets are likely to be missed. A disappointing indicator of Punjab’s health is maternal mortality ratio; that is, 300 per 100,000 live births, while the MDG-5 aims to bring it down to 140. It seems highly unlikely that the province will slash this ratio to half in the remaining next two years. Health Secretary Punjab Ahsan Iqbal has been reported as saying that improving maternal mortality rate was a big challenge, an implicit admission that the provincial government failed to deliver during the last five years. The government’s utter neglect of health facilities in small cities and rural areas is a major cause of this situation. Likewise, early this year, the authorities were caught napping when measles broke out though they were forewarned because of its spread in Sindh earlier. At that time, the provincial government did not have a vaccine for the disease. This epidemic has so far affected 22,000 children in the province, including more than 5,000 in Lahore. In panic, the government launched an immunisation drive but could immunise only seven million children out of 30 million. Research by the Institute of Public Health, Lahore later showed that the immunisation coverage at the time of measles’ outbreak in the province was as low as 57.5 percent when at least 80 percent coverage was required to stop the transmission of communicable diseases. In certain backward districts like Rajanpur, the immunisation rate was found to be merely 21 percent. Work on several key public projects has virtually come to a halt owing to the non-availability of funds. Five years ago, the government started building the Fatima Jinnah Institute of Dental Sciences in Lahore and the Punjab Institute of Neuro Sciences, but both are way behind schedule for want of funds. The government recently built a much-publicised 200-bed hospital in Lahore’s low-income suburb, Shahdara, but it did not have a single general surgeon for more than a year. There are dozens of such examples. A large number of posts of drug inspectors have not been filled for long. Lengthy bureaucratic procedures for procuring medicines and for repair of equipment have also helped in the deterioration of public health facilities. No effort has ever been made to simplify these procedures. The laser machine to treat kidney stones at the Jinnah Hospital remains non-functional for several months. The Children’s Hospital’s MRI machine had been in disrepair for 10 months; its generator remained out of order for almost three months. Public hospitals in a big city like Lahore seem more like emergency camps during World War 11 with two or more patients lying on one bed. One has to wait in line for three to four hours to get the official slip (parchi) to see a doctor. Doctors treat patients so rudely and with such contempt that no self-respecting individual would ever like to see them if it weren’t a matter of survival. One major reason the hospitals in big cities like Lahore are overcrowded is lack of adequate facilities in the district and tehsil hospitals, which suffer from an acute shortage of not only doctors but paramedics, dispensers and nurses. More than 1,000 specialist seats at district/tehsil hospitals are vacant. The government officers argue that specialist doctors do not want to work in small cities, but they do not explain what alternative policy the government has come up with to make specialists serve in these hospitals. The situation is getting alarming as hundreds of doctors are leaving for other countries where they receive ten times more salaries than in Pakistan. The systems of check and balance and supervision have grown weak and almost non-existent leading to a kind of anarchy in public healthcare. The strikes of junior doctors in Punjab have become a routine affair. A number of senior serving doctors are running their own private hospitals in partnership with each other or with businessmen. Some are running wholesale business of medical supplies while holding key positions in hospitals or other government offices. Nursing, a key area of healthcare, has been deprived much attention. At present, one nurse is available for two doctors in the province while according to the World Health Organisation standards there should be three nurses for one doctor. Not a single project has been initiated to address this issue. Not only is the situation of healthcare grim, there are no signs that the government is serious about improving it. Consultants and committees keep making power-point presentations to the chief minister, but the political will to invest in public healthcare is lacking. The focus is on showy projects that are visible and can be used for political publicity such as expressways and distribution of laptops.
Posted on: Mon, 16 Sep 2013 07:49:56 +0000
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