Healthcare System of Pakistan: Strengths and Weaknesses

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Advances in Research

22(2): 45-49, 2021; Article no.AIR.68407 ISSN: 2348-0394, NLM ID: 101666096

Akhtar Ali1*, Farah Ahmad1, Syed Hasan Danish1, Nisha Zahid1, Noor Israr1, and Sidra Farooq1

1Department of Healthcare Management, Ziauddin University, Karachi, Pakistan.

Authors’ contributions

The study was carried out with the collaboration among all authors. Author AA framed the concept, author NZ, NI and SF helped in literature search. Authors FA and SHD critically reviewed and approved the final document.

Article Information

DOI: 10.9734/AIR/2021/v22i230297 Editor(s): (1) Dr. Nebi Bilir, Suleyman Demirel University, Turkey. (2) Dr. Francisco Marquez-Linares, Universidad Ana G. Méndez-Gurabo Campus, USA. Reviewers: (1) Imad Salih Mehdy, Iraq. (2) Mruthyanjaya Rao Mangipudi, Malla Reddy University, India. (3) Gayatri Gautam Varma, Mumbai University, India. (4) Shatrughan Pareek, Indian Railway Health Services, India. Complete Peer review History: http://www.sdiarticle4.com/review-history/68407

Received 17 March 2021 Review Article Accepted 23 May 2021 Published 28 May 2021

ABSTRACT

Each country of the world has its own health care system to follow, Pakistan has followed the healthcare system designed by British rulers since 1947. Primary healthcare, Secondary Healthcare and tertiary healthcare are the major parts of the defined healthcare system that are been practiced across the country. Pakistan has always participated and encouraged health promotion and delivery participating in Millennium Development Goal (MDG) program, encouraging public private partnership, investing in improvement of human resources and skills, introducing Basic Health Units (BHUs) and Rural Health centers. Though investment and inputs are set at achieving health for all but many weaknesses have slowed down the process of development. Poor governance and monitory policy, political influence and budget allocation issues have made it difficult to provide health on equal basis. The current review is aimed to discuss the strengths and weaknesses of healthcare system of Pakistan.

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*Corresponding author: E-mail: [email protected];

Ali et al.; AIR, 22(2): 45-49, 2021; Article no.AIR.68407

Keywords: Healthcare systems; strengths weaknesses; Pakistan.

1. INTRODUCTION participating in Millennium Development Goal (MDG) program, encouraging public private There are 195 countries across the globe partnership, investing in improvement of human delivering the health care to their citizens through resources and skills, introducing Basic Health their healthcare systems, the aim of all the Units (BHUs) and Rural Health centers [8]. healthcare systems in the world is to satisfy the Though the indicators are reflecting that these need of the patient and to provide better services programs are effective and beneficial but overall to promote the health and to reduce the disease the scope of these programs is limited and burden [1]. Since the day of inception Pakistan inefficient. The weaknesses which are apparent followed the Bhore Commission report very in our system revolves around poor governance, similar to the 1978 Alma Ata declaration; that is lack of stable leadership, corruption, health to be delivered through three tiers inappropriate use of resources, inefficient HMIS Primary, secondary and tertiary. Unfortunately, in and poor monitoring policies [9]. The Aim of this 73 years in spite of a sound blueprint on papers review is to discuss the strengths and for the public healthcare system major burden weaknesses of healthcare system of Pakistan to was always brunt by the Private sector [2]. In help in development of better healthcare policies Pakistan the major health care providers are to improve the health status. public and private sector hospitals [3]. However, as observed in most of the developing countries 2. METHODOLOGY in Pakistan the public sector healthcare system is beleaguered but the private sector is trying to The literature review was carried out by using deliver the best and has been seemed to satisfy Medscape, Medline, Pakmedinet, PubMed and the patient needs [4]. google scholar data base engines. There was no language or date restriction in search. The key According to a review nearly 70% of the words used in literature search were “Healthcare population in Pakistan seek treatment in private system of Pakistan”, “Comparison of healthcare sector hospitals and only 30% uses public sector systems”, “Advances in health care system of hospitals [2]. This is quite alarming data which is Pakistan” and “Deficiencies in healthcare system showing the failure of healthcare delivery by the of Pakistan”. government and promoting the private hospital culture in the country. But if a country wants to change the healthcare delivery and want to 3. DISCUSSION provide better health care to its population it needs reforms and require major changes [5]. 3.1 Initiatives in Strengthening the The changes and decisions can be made Healthcare System of Pakistan according to factors which satisfy patient`s need or, are related to their dissatisfaction. Globally Since the independence Pakistan has started the the comparison of different healthcare system journey of development with limited resources performance is used to identify the gaps, to and has tried best to deliver the world class develop the new healthcare policies and to healthcare services to the population. The provide the better health to population however concept of health care delivery shifted in Alma the weakness in our system is deficiency of this Ata conference and become more focused on comparison policy which is one of the reason of primary healthcare (PHC). To deal with that better health care delivery by private sector and change the government of Pakistan worked to poor performance of public sector hospital [6]. improve the infra structure and provide primary health care to population. This covered almost It has been identified in recent times that 70% of rural population and healthcare facility Pakistan is working for betterment of health was provided to them within their vicinity. The through introducing and strict implementation of reforms and change not only covered the PHC the vertical programs for immunization, by but in 1990 the health policy was introduced providing awareness for maternal and child which focused on the overall wellbeing of an health care and by investment in lady health individual and social, physical and mental health worker and visitor program [7]. Pakistan is taking were added as measures of quality of life [10,11]. interest and trying to provide better health to its In year 2000 Pakistan became the member population by developing new health policies, country in achieving MDG goals with United

Ali et al.; AIR, 22(2): 45-49, 2021; Article no.AIR.68407

nations (UN) and accepted to improve the health healthcare which has been followed by indicators defined by UN. The Pakistani government of province Sindh. Though these are Government has taken initiative and has set listed as public sector entities but the governance seven goals to achieve till 2030 out of that seven, and monitory policy is designed by the board health and nutrition interventions, population members and strictly implemented by the welfare, water supply & sanitation and managers and there is no any political influence sustainable development are of primary interests in hiring and firing in mentioned autonomous in improving the overall health status of the bodies [21]. nation [12,13]. Pakistan has been the pioneer country in encouraging public-private partnership 3.2 Weaknesses of Healthcare System of (PPP), by PPP Pakistan has worked with various Pakistan bodies to serve the nation and the outcome has been the fruitful specifically for National TB The major failure in the healthcare system of control program, family planning program and Pakistan is lack of governance and monitoring school nutrition program [14,15]. A model policy in public sector hospitals due to which example of PPP held in a district of Pakistan i.e. government has introduced autonomous bodies, Rahim Yar Khan where Management of Basic (NICVD, SIUT, GIMS, SMBB Trauma center) to Health Units was delegated to non-governmental serve the population [22]. Monitoring in private organization (NGOs) in that model the health sector hospital is a critical process which is care providers were given extra increments in followed by the firm on equal basis there is no their salary and monitory policy was strictly external or internal influence in in hiring or firing, followed due to that the model Worked efficiently there is no compromise on patient health and the and 100% results were delivered by PPP [16,17]. staff trained they are supposed to obey the rules Another example of PPP in Pakistan was to in serving the community on the other hand in initiate the child and maternal health awareness public sector hospitals the scenario is vice versa program it was supported and financed by [23]. Provinces work under the federal foreign AID and NGOs. These programs are government and are supposed to follow the considered to work in a collaborative way such national commands, however there is no as resources of government are utilized but the participation of stakeholders, local communities medicines and required material is provided by and individual groups in development of the Private organization. This is not only limited healthcare policies which is the prime weakness to Child and maternal healthcare but it also of healthcare system as the ones who are involves Expanded Program on Immunization supposed be served have not given their (EPI) which was started in 1978 that focused the feedback [24]. Along with that the hallmark of the prevention of six preventable diseases by this time is the policy makers who are not related to child mortality has been decreased and vaccine health sciences, they do not know about coverage has been improved from 65% to 88%, healthcare systems and are unaware of global however the set benchmarks have not been transformations in healthcare systems. reached yet but Government of Pakistan along Furthermore, the policies are supposed to be with partners is taking measures to achieve the implemented by health care providers still they targeted goals [18,19]. Furthermore the initiative do not have authority to take initiative against taken for starting the lady health worker program corruption, against ghost employees or against by government of Pakistan was a milestone that the people who are delivering very poor services promises the delivery of PHC at door step of intentionally [25]. Beside governance and underserved people, volunteer females from monitory policy, the infrastructure and absence of communities were recruited and trained to equality has weakened the healthcare system of educate the population to improve the health of Pakistan. Shortage of staff at distant areas, poor mother and child and to spread awareness about resources, underdeveloped roads and poor endemic diseases [20]. From beginning till date quality of services at BHUs have made poor the government has put inputs in strengthening population to pay high costs to get health the healthcare systems of Pakistan, establishing services. The tehsil hospitals are distant from free of cost hospitals for treating cancers, remote areas and the facility and services mostly diabetes, cardiovascular diseases, renal and are rendered to nearer population [26]. Lack of hepatic diseases are few examples of its own human resources and skilled staff in public sector kind. Introducing autonomous bodies (NICVD, hospital is another debate. People who reach SIUT, GIMS, SMBB Trauma center) to serve the public sector hospital to seek treatment are population is another way of delivering treated an under privileged manner due to over

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