Health is seen as an essential component of the socio-economic development of a country. A nation can never progress until it improves its health care system and lets its people enjoy a free and healthy life.
Pakistan is among the least developed countries of the world where the health sector has not yet taken its roots despite of generous donor funding and other improvement efforts. Almost sixty five years after its existence, the country has not yet come up with a standardized and recognized national health policy that can ensure access to equitable and high quality health care for all. Furthermore, the gap in health services between urban and rural areas has widened to an unbelievable extent.
Our neighboring country Afghanistan in partnership with the international community has achieved a major milestone in developing a standardized health policy and strategy for the country despite two decades of devastating war and instability. Today, Ministry of Public Health in Afghanistan is considered as one of the best ministries. On the other hand, the situation in Pakistan is incredibly sad and doleful. A little over a year ago, the Government abolished the Health Ministry and transferred power from the central government to provincial governments under the 18th constitutional amendment. Pakistan probably is the only country in the world that delivers health services without a central health ministry or similar institutional structure.
The health services decentralization can improve the efficiency and quality of services and ensure equity in health care provided if it is accompanied by strong accountability mechanisms, evidence based planning, good financial management and effective human resources planning. Otherwise it will neither benefit the people nor lead to any positive outcome. However process of decentralization of health care services in Pakistan was started hurriedly. The real situation on the ground was neither assessed nor analyzed. No in depth discussions were held among health professionals and policy makers. Provincial governments were not taken into confidence to see if their provincial health departments have the required capacity and enough resources to provide essential health care services to the people as per the international guidelines.
It was indeed a big and dicey step that was taken at a time when the entire country has plunged deep into turmoil. Terrorism, target killing, corruption, political instability and financial crisis remain key and difficult challenges for the government to tackle with. Poor Provinces like Baluchistan Gilgit Baltistan and Azad Kashmir do not have their own resources and are mostly dependent on the central government. How will the provincial governments provide quality health care services if they are not even self-sufficient and autonomous?
In the light of the current economic and political situation in Pakistan, the devolution of health services seems to be less practical and more problematic. It is neither improving the health status of the population nor building the capacity of the provincial health ministries. The health indicators are declining. The processes of making standardized health policies and national guidelines have come to a standstill. International health agencies, donors and non-governmental organizations are having a hard time fighting against infectious and non-infectious diseases because of unavailability of uniform policies and standardized national health guidelines, lack of a clear national vision for health and absence of a centralized regulator or institutional structure in Pakistan.
Lack of an effective financial management system at the provincial level has increased the health care costs. Due to poor monitoring mechanism, vaccine preventable and other communicable diseases like polio cases have resurfaced. The absence of strong accountability system at the provincial level has resulted in increased prevalence of substandard and counterfeit drugs. In January 2012, seventy patients of the Punjab Institute of Cardiology lost their lives after consuming substandard medicine and in November 2012, another eighteen people died after drinking a toxic cough syrup in Shahdra Town in Lahore.
In addition to this, the provincial health ministries are neither prepared nor have the required resources to cope with emergencies if an epidemic or a natural disaster strikes their region. The outbreak of dengue fever in Lahore Punjab in 2011 and the Attabad Lake disaster in Gilgit Baltistan in 2010 are the two worst incidents that the nation has witnessed in the last few years. Even today, 25,000 people in Gojal Hunza do not have access to formal emergency medical services. Who is to blame for the situation as the central government has transferred its power to the provincial government and the provincial government points the finger at the central government for not providing it with enough resources? I honestly believe that the blame game will neither end nor the country’s health situation will improve until the federal government steps in and assists the provincial health ministries by establishing a central health ministry or similar regulatory authority in Islamabad.