“Pakistan is among the countries in the region which despite having qualified medical human resource and sufficient resources, have not made sufficient progress towards providing adequate healthcare to every citizen, mainly due to policy and implementation failures,” says Dr Ather Ahmad Saeed, coordinator to King Edward Medical College Alumni Association of the UK, in an interview with The News on Sunday.
Dr Ather Ahmad Saeed, a consultant physician in gastroenterology working in the UK, is a former graduate of King Edward Medical College, Lahore. He was in Pakistan this week to coordinate between the UK and US chapters of King Edward Medical College Alumni Association (KEMCAA) and King Edward Medical University and for a two-day International Universal Healthcare Symposium at his alma mater in Lahore.
Pakistan is struggling to provide universal healthcare, which some of its Asian counterparts, including Sri Lanka, Bangladesh and Turkey, are delivering with almost similar levels of expertise, resources and capability. Universal healthcare means provision of comprehensive medical services to all citizens irrespective of age, gender, social status and the ability to pay.
In developed countries, Dr Saeed says, various strategies have been adopted to achieve the objective of universal healthcare. UK has implemented perhaps the best healthcare system to provide free quality health services to every citizen in government-run hospitals. Even general practitioners in the UK, he says, provide free treatment to patients. They are paid by the government under a formula for every patient they treat.
In Canada, Dr Saeed continues, doctors work independently, yet treatment of patients is free and the government reimburses the patient for the payment made for treatment. In the US, he says, health services are very expensive and most of the people seek treatment through private insurance. “Doctors offer private healthcare to people, except for the armed forces. The poor and the elderly get treatment through government-financed insurance.”
Dr Saeed maintains that Pakistan must adopt a strategy of prevention and focus more on primary healthcare. That way, he says, Pakistan can save its people from many diseases at much less expense through the provision of basic education, clean drinking water, nutrition and vaccination. “An illness, when it occurs, puts a massive financial burden on the individual, family, society and the government,” he adds.
Dr Saeed believes that among South Asian countries, the best model of healthcare is in place in Sri Lanka. Pakistan can learn from the success of healthcare provision in Sri Lanka, Turkey and Bangladesh to provide universal healthcare in the country.
He says public healthcare indicators in Sri Lanka can be compared with those of Europe and America despite the much smaller per capita income, nearly equal to that of Pakistan’s. Infant mortality rate in Sri Lanka is 8 per 1,000, while it’s 33 per 1,000 in Bangladesh and 70 per 1000 in Pakistan. “These indicators are a matter of shame and a food for thought for Pakistan,” he adds.
Best model of healthcare is in place in Sri Lanka. Pakistan can learn from the success of healthcare provision in Sri Lanka, Turkey and Bangladesh to provide universal healthcare in the country. He says public healthcare indicators in Sri Lanka can be compared with those of Europe and America
While Sri Lanka has also been through internal conflicts and extremism, Dr Saeed says, it has maintained its services delivery in health and education sectors. “The literacy rate in Sri Lanka is 93 percent against Pakistan’s 56 percent. Pakistan must work hard to improve its literacy rate to improve healthcare in the country.”
Besides focusing on education, Sri Lanka has paid special attention to basic health centres and gradually improved diagnostic facilities with particular focus on chronic diseases like diabetes and high blood pressure.
In Bangladesh, he notes, the dividends of social welfare have been achieved through women’s protection and empowerment by providing them small loans, which have produced very positive results in healthcare as well. In Turkey, he says, the Health Card System was launched to provide universal healthcare to all citizens. It is mentioned by World Health Organisation (WHO) as a model of success. “All this progress has been made in the last 15 years and Turkish government’s initiatives enjoy full public support,” he adds.
He maintains that it must be understood that health is a basic human right and nowhere in the world can the patients be treated through charity alone. The government and the society cannot be absolved of their responsibility to provide affordable healthcare to patients. “Public representatives work for the welfare of the people and provide necessary facilities,” he emphasises, adding that the people must support their representatives and also hold them accountable.
Dr Saeed says that expatriate Pakistani medical experts, who attended the Universal Healthcare Symposium in KEMU, had sound knowledge of foreign countries’ healthcare systems. They can be very helpful in providing guidance to Pakistani doctors to help achieve the goal of universal healthcare in Pakistan.
Pakistani doctors, he believes, working in developed countries, especially in the UK and US, want to play their part in improving the health sector in their own country. “The most effective contribution by them is to train Pakistani doctors,” he says. He adds that expatriate Pakistani doctors can also help in making a policy framework to improve the health sector.
He says many expatriate Pakistani doctors, are proactively working to provide relief to patients in Pakistan in their individual capacity. Some of these doctors have started endoscopy courses in Lahore, Multan and Peshawar to impart training to the local doctors in accordance with British standards. “Although these doctors continue to organise such courses, it will be better to streamline such efforts for training of health providers in an effective manner. Such training courses help save a lot of time, effort and energy to meet the desired targets and reap long-term dividends.”
The doctor believes that the goal of providing universal healthcare is attainable in Pakistan where healthcare services are available currently to only 22 percent of the population. “This includes health facilities provided by the armed forces’ institutions, labourers’ treatment under social security projects, charity projects in Pakistan and insurance by large corporations and local business communities.”
He says Pakistan’s armed forces have the most efficient system of healthcare in the country. Building on such successful models, he recommends, the health authorities need to devise strategies to extend the services to all the citizens of Pakistan. With available funds and resources, he says, Pakistan needs to concentrate all specialised intellectual and material resources on achieving these targets. “We must identify our priorities and create a consensus to aggressively work towards achieving them.”
Dr Saeed favours autonomy for public sector hospitals through legislation. He says it must start with teaching hospitals. He also proposes establishing health authorities at the district level. “Regional authorities must also be established to oversee the performance of at least three to five district health authorities and report it to the provincial government,” he adds.
He believes the next five years would be vital in transforming the health sector in Pakistan. “If we work with honesty and dedication, Pakistan will be able to achieve universal healthcare in the next five years,” he concludes.