After the political turmoil, a democratic government has developed. Pakistan has been under the spotlight recently and eyes from all sides are watching closely. However, the political pitch isn’t the only area where the political players should have played very well there are other areas which require their full attention.
Under the surface of political ice berg, more problems are fermenting in the sixth most populous country in the world. Although some of the challenges are fueled by the country’s political turmoil but not all. In other parts of the world; turmoil usually happens but resolved and it doesn’t effect the overall situation at micro level of state.
There are lots of areas needed to discuss but health status is one of the main concerns of every human being living on earth. The health statistics are promising this year “if “, valid and reliable but much more needed to be done. For example progress has been made towards the target of reducing under-five mortality rates by two thirds. However the rate of change will need to be accelerated to meet the targets and the rates are still high compared to the rest of South Asia.
Some progress has been made towards the standard proxy indicators, although overall levels remain low. The percentage of births attended by skilled health professionals doubled from around 20% in 2000 to around 40% currently. Less than a third of married women use any form of contraception.
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Furthermore, while the infant mortality rate dropped from 91 infant deaths per 1,000 live births to 78 deaths per 1,000 between 1990 and 2007; it is still high by world standards. Pakistan’s infant mortality rate is well above the world average of 52 infant deaths per 1,000 live births and the infant mortality rate of 57 in all less developed countries.
Pakistan has the 6th highest burden of TB disease in the world; although DOTS case detection and cure rates have improved significantly since 2000, and are on track to meet WHO targets for 2010. Polio is almost eradicated although a few isolated cases remain; 39 cases were reported in 2006, up slightly from 28 in 2005. There are around half a million cases of malaria a year still alarming the situation.
What’s at the back of the poor performance? Off course, equipped to handle basic maternal health needs, supplies, and drugs, are often lacking but there are more reasons for a low level of health status.
Actually the health care system in Pakistan is more urban oriented, curative in nature and accessible to small part of people. However, the system should provide services to individuals or communities by health service professionals for purpose of promoting, maintaining, monitoring, restoring health but this is not the case.
The solution of problem has been given years back by WHO and defined that the essential health care should be based on practical, scientifically sound and socially acceptable. The methods and technology in health care made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at each stage of their development, in the spirit of self-reliance and self-determination.
Since the Alma-Ata declaration announced by WHO, we have developed little bit good infrastructure of primary health care, however we are failed to run in its true sense. The primary health care physicians just after finishing studies, all of a sudden found themselves in the position of primary care center, without having a formal training at primary health care. Although steps have been taken at undergraduate level to promote problem based learning (PBL) through community oriented medical education (COME) but after graduation; the government doesn’t have a good plan for training as “Family Physicians”.
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The developed world now fully based on family practice settings. Off course, while comparing with any developed country we as developing country always talk about the resources. Nevertheless the countries like Sri Lanka, Bangladesh, India, and Nepal have similar economic problems but significant health policy reforms have been happened and gave major importance to “Family Practice Training” at postgraduate level. Even in Cuba; tremendous improvement in the last 30 years has been seen through the training and placement based system of family physicians. Why is it so?
In Pakistan, the system allows unrestricted and independent General Practice after completion of MBBS and internship, without the need of proper training in family practice or primary care. The rising costs of hospital-based medical care leave little for essential clinical and public health services for the public at large. No concept of health insurance from the government side, adding to elegance.
A team of surgeons and physicians purely hospital based rose like a mushroom in thousands and captured the whole health care system in Pakistan. There are mainly two institutions which are working for the postgraduate training in family medicine, i.e., College of Physicians and surgeons of Pakistan (CPSP) and Aga Khan University. Is this enough for whole Pakistan??????
The trained Family physicians, communities’ involvement, information technology and infrastructure investment could have ripple effect in enhancement of health care.. Interdisciplinary, team-based care should continue to evolve in the primary care setting. A concerted effort must be made on the part of the medical profession, communities and governments to reach out to high school students in rural communities and underrepresented groups and encourage them to consider a career in medicine. Medical student recruitment and admissions policies should aim to bring in students with generalist backgrounds who may be more suited to a career in family medicine. The government should encourage the existing medical universities to develop training programs for family medicine and remove the all hindrance and should also break the monopoly of one or two institutions.
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This is the time and opportunity for leaders to prove that they are very much concerned about improvement in health care system. Although we are in need of state of the art hospitals but without the bases we cannot build the high rise buildings, thus there is an urgent need to produce more and more primary health care physicians in order to rectify our health problems.