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PMA report roasts health policy, practice

By Waqar Gillani

LAHORE: The Pakistan Medical Association (PMA) has revealed in its 2003 annual report that there are more than 10.2 thousands unemployed MBBS doctors in Pakistan, who need urgent attention from the government.

Released at a recent meeting and available with Daily Times, the report says the mortality rate is high, hepatitis B vaccinations are unavailable for the whole country, pregnancy complications have increased, there is no national health policy, drug policy and an accountability procedure to motivate doctors. According to the report, it might be claimed that more money was spent on healthcare but a majority of people still have no access to primary healthcare, emergency obstetrical care or emergency healthcare in Pakistan.

Facts and figures: According to the figure, quoted from the international and national agencies, the population soared to 141.50 million in 2003. At least one-third of the population lives below the poverty line and the annual fertility rate is 4.7 percent with a life expectancy of 63 years.

According to government sources, the report says, more than 78,000 people were infected with the Human Immunodeficiency Virus (HIV) virus and yet there is no immediate plan to fight the disease. Two percent of the population is blind and 11 percent suffer from diabetes with a 90 percent chance of developing retinopathy in later life.

Health spending levels of 0.9 percent of the Gross Domestic Product (GDP) in the public sector and 3.2 percent of GDP in the private sector were extremely low. Political stability, economic growth and eradication of corruption were needed for a successful healthcare system in Pakistan. The PMA believes the government should spend at least six percent of the GDP on public health to make the system work effectively.

Jobless rate: More than 5,000 doctors in the Punjab, 3,000 in Sindh, 1,200 in Balochistan and 1,000 in the North West Frontier Province were jobless and the government has no immediate plan to recruit them into the Health Department with the result that most of the health units in the country were without doctors because provincial governments have a policy to recruit doctors on contract only if they pass the Public Service Commission examination.

Healthcare facilities: A large proportion of the population is unable to drink clean water or access to proper sanitation facilities. The water-borne bacterial problem is the main cause of mortality in children and adults. About 78 percent one-year-old babies were immunised against tuberculosis and only 54 against measles. But the hepatitis B vaccination was not available for all people. The number of hepatitis B and hepatitis C patients increased gradually.

It is important to note that despite more than 40 rounds of polio vaccination Pakistan continues to report new polio cases. A majority of adults with diabetes have no access to medical treatment, especially with a blindness problem. Most of the government eye hospitals do not have working a laser therapy unit working there. Sindh and Balochistan had no laser equipment in government hospitals.

According to government figures, more than 340 per 100,000 women die in Pakistan during pregnancy due to the unavailability of emergency obstetrical care. More than 80 percent of women give birth with the help of Traditional Birth Attendants (TBAs). Pregnancy complications (fistula, infertility, loss of uterus etc) is on the rise due to a lack of healthcare facilities for under-privileged women in cities and rural areas.

Medical education: The provincial governments’ policy regarding admissions to medical colleges remains poor. More women doctors are being trained with a long-term impact on the health delivery system. At the same time, provincial governments have a liberal policy regarding private medical colleges in all the four provinces. Low-quality medical education is available for high fees. In a small number of medical colleges in the government sector, especially in Balochistan, Sindh and NWFP, medical education is below standard and these colleges require immediate intervention.

No structured postgraduate teaching: Teaching hospitals in the public sector with the exception of a few departments had no structured postgraduate teaching programme and a majority of postgraduate students work unsupervised or with little supervision. Provincial health departments have no plans, understanding or a vision to solve chronic problems related to medical education and the postgraduate training. On the intervention of the College of Physicians and Surgeons of Pakistan (CPSP), the government fixed stipends for doctors but hospitals did not pay for obligatory training workshops and examinations.

The report demanded that postgraduate training centres in private and public sectors pay for all workshops and examinations held for their staff.

Private sector: With the exception of a few private hospitals, a majority of hospitals do not provide standard healthcare and they exploit young doctors by paying them low salaries and forcing them to work in unhealthy conditions. A majority of teaching hospitals in the private sector also have no structured programmes for training and work on the principle of self-learning. Private sector hospitals have also failed to develop a code of conduct for healthcare.

Drugs and drug policy: The government failed to produce a drug policy to control the use of ‘wonder drugs’ to treat cancer or sexual dysfunction. While many essential drugs are not available in the market, it is full of copied and substandard versions. There is a need for a system in which essential drugs are available for reasonable prices round the year.

Lack of vision: The report said the federal Health Ministry and provincial health departments work without direction and the government has not shown the commitment or the will to address health problems in Pakistan. According to figures, Pakistan produces one nurse for eight doctors and only one doctor is available to treat 2,300 patients. Federal and provincial governments have no understanding or plans to produce a sufficient number of nurses and paramedical staff.

The federal government’s plan to train midwives is not well thought out and the suggested one-year midwifery training course in the absence of trained teachers would not produce efficient health workers. The government has also failed to understand the role of paramedical staff in the healthcare system. An army of paramedical staff is required to run Basic Health Units, Rural Health Centres, Taluka Headquarters, District Headquarters and the Tertiary Health Care system. None of the governments has a policy to produce professionals and neither is there an appropriate career structure for them.

Accountability: Because of this policy, lack of accountability and the politicisation of the health departments, a great many doctors are under-motivated. A system of accountability, audit, punishment and reward is required to motivate doctors. No provincial government is ready to develop a career structure for doctors working in non-teaching health units in the country. Like previous democratic governments the present set-up is also not ready to address these issues to improve healthcare facilities for the poor and needy in Pakistan.

The report said a strong accountability system is required to deal with cases of unethical medical practice in government and private healthcare units. According to the report, no practical measures have been taken to rid the country of more than 6,000,00 quacks. Over the last two years the Pakistan Medical and Dental Council (PMDC) played a vital role in Pakistan asserting the rules and regulations. The government should not interfere in the PMDC’s working and the PMDC should continue to play its role independently to monitor healthcare, medical education and training.

Role of district governments: District governments should create a system through which healthcare facilities should have the minimum staff. Private hospitals, laboratories, clinics and nursing homes should be held answerable in case of negligence on the part of doctors.

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