An apology for health concerns

2017-01-01T21:46:55+05:00 Agha Baqir

Towards the end of the year, 2016, I asked the secretary of Health, Najam Ahmed Shah why he did not recruit at least four ‘Edhis’ if he really wished to revamp the health sector in Punjab. “Give me four Edhis”, he spontaneously reacted. “Admittedly, I cannot find someone like Edhi but, yes, I can definitely give you four like him”, I safely offered.

The Chief Minister of Punjab raised eyebrows in one of his articles on the subject published in another esteemed newspaper, inviting the readers to imagine how ‘scores of patients were suffering for months due to the absence of a commonly used medicine called Flagyl, with demand falling on deaf ears and money lying in the bank, unutilised?’

While both the chief minister and the secretary seemed to be on the same page and pitch by chanting catchy slogans, ‘patient care’ and ‘patient first’ respectively, it raises certain queries such as whether both the political as well as administrative heads are truly apologetic of situation? The secretary, for instance, felt handicapped by chains of possible strikes by all the senior doctors if he opted to remove a delinquent senior professor by way of disciplinary proceedings against him and hence giving him rather a safe exit by offering the option of retirement despite having incriminating evidence against him.

Certain other queries are so floating on the surface which need to be addressed if we really intend to redress our apology for the health situation. These can precisely be enumerated as to first, whether there are any policy irritants afflicting the targeted growth in the health sector? Second, are we lacking those real measures which may lead to a better infrastructure, technology and capacity building? Third, whether we are really running short of funds and unable to tap the contributions of foreign funded and monitored projects vis-à-vis other South Asian countries? Fourth, whether the mal-administration and the lethargic attitude of the medical, paramedical and bureaucratic human resource is the sole problem behind this health syndrome? Fifth, can there be any other defence to this apology about why the government cannot purchase health for the people and convert the wealth mines to those of health mines? Sixth, whether the successful health models of Singapore, Australia and other countries like Turkey could suit our indigenous culture? And last, whether the health sector is sincerely our first priority as claimed by the policy makers under jargons of ‘patient care’ or ‘patient first?’

While representing the government of Pakistan at an important international exhibition and conference at Dubai called Arab Health and in a subsequent international health exhibition-cum-conference, ‘Medika’ coordinated by myself at Lahore, I closely observed the best healthcare models of Australia and Singapore which, though cannot be completely replicated in our country but can fairly be modelled to our health systems. Contrary to ours, the first and foremost characteristic of their health systems is that they really look at health as a priority and a fundamental human right incumbent towards growth of other sectors of society such as education and economy. In principle, both these states rely upon offering medical facilities to the people matching to their relevant financial capacity. Under state run hospitals, people are offered facilities both at their declared affording and non-affording status. Those who can afford are charged accordingly whereas those non-affording are also charged accordingly but subsidised out of the resources generated from the affording as well as contributed by the state. Whereas under our health systems, a clear divide is seen for the ‘haves’ and the ‘have nots’ in the form of state-of-the art hospitals for the affording and state run hospitals with meagre infrastructure and poorly managed but still best catering to the non-affording.

The Pakistan Kidney and Liver Institute, PKLI, at Bedian Road, Lahore proposed to be run by a Trust under a private-public scheme of management is acclaimed to be such a state-of-the art hospital providing international standard medical facilities to all irrespective of their financial status, rich or the poor. But still we have to see how on its completion in the new year, 2017, it works for the down-trodden, especially the lower ranked government employs which constitutes a major part of target beneficiaries of our society. Its management has to take care that it should not work like some other notable state-of-the-art cancer hospitals in the town where clinical reports cost the poor higher than their monthly income.

Policy irritants are often seen to be in play amongst policymakers and the executants marring all their efforts to minimise demand and supply gap by introducing a matching mechanism of post-graduate-ship both. It has stiffly been contested even on the roads by the Young Doctors’ Association (YDA) on certain, prima facie, rational as well as irrational grounds. Simply put, it is true that young doctors’ careers should be safeguarded on rational grounds but how can they be justified on their stance of opposing even merit-based central induction?

Similarly, the chief minister maintains that funds are not a problem but mal-administration is. However, the fact remains that we have not been able to utilise even the infrastructure, technology and capacity-building offered and made available to us by local and international donors so much so that certain inventories and funds were withdrawn by international donors whereas these were best utilised by other South Asian countries like India, Bangladesh and even Afghanistan. It, therefore, seems more a question of priority of the policymakers as well as the executants.

Conclusively, ruling out scanty of public funds for health sector is not digestible, therefore, a reasonable portion of taxes and duties deducted from the pharmaceutical industry may be utilised for the public sector on advance instead of a reimbursement basis for sustainable support. The corporate sector may be encouraged or bound to establish distant hospitals under corporate social responsibility laws to provide corporate-like facilities to the labour and agrarian communities near their doorsteps. The construction of new state-run hospitals, which with shortcomings, are time tested to cater to the health needs of the masses at large, are urgently needed.

On the whole, it is still believed that we have abundant health mines in the form of medical and non-medical philanthropists, land lords, businessmen and non-profit organisations like the Sindh Institute of Urology and Transplant which can be replicated as role model in other parts of the country. What is primarily required is merely to identify, honour and authorise them to run the systems in various pockets of the country and that may be one short answer to address the issues in the health sector.

 

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