IT is quite obvious that our health system is in deep crisis on all fronts. No wonder it is unravelling in full public view, unable to cope with growing demands being placed on its limited capacity and funding. Take Punjab as a case in point, where gaping deficiencies in the health system have been exposed through several tragedies in the past few years.
The most recent was the avoidable tragedy of newborn deaths in Sargodha and Vehari district hospitals. During the provincial government’s previous term, scandals such as those involving spurious and substandard medicine at the Punjab Institute of Cardiology and over-ingestion of Tyno syrup in the Shahdra Town area and the resultant loss of hundreds of lives, still rankle in public memory. In the above cases, public outcry led to inquiries being launched by the government. Yet the reports have not yet been released. This has not helped the closure of wounds nor the lesson-learning exercise.
However, in the wake of the Sargodha and Vehari incidents, apart from local level inquiries and suo motu action taken by the Supreme Court, a new, wide-ranging body of experts was constituted in November to recommend ways to fix an increasingly malfunctioning health system. In December the committee finalised a range of recommendations, which can be seen as a positive step towards tackling health-sector problems.
Of its many laudable recommendations, the one pertaining to the need for a mortality audit as well as an audit of medico-legal cases at governmental hospitals is long overdue. These recommendations are tied to third-party evaluations of government hospitals. Together these inter-connected issues go to the heart of long-ignored problems of patient safety and the quality of healthcare on offer in these hospitals. Such steps are important to revive confidence in the public health system.
Part of the problem of high mortality and morbidity figures owes to shortage of staffing at all levels. Nowhere is this more apparent than in the shortage of nurses. In this regard, the committee has focused on the issue of streamlining nursing education. Pakistan produces more doctors than nurses. The nurse-patient ratio in Pakistan is reportedly 1: 50 which is extremely low.
The committee has recommended upgrading nursing schools into colleges which will presumably enhance intake, in addition to improving standards. There is also a need to bring more balance to the female-male ratio among nurses. Currently, there are overwhelmingly more female nurses than male, a fact largely attributed to the dominant perception of females as caregivers. This perception must be radically readjusted to fill the growing gap in nurse’s supply and demand.
In line with the Punjab government’s enhanced budgetary allocations for district hospitals, there appears to be renewed emphasis on upgrading and improving hospitals at district level and sub district level. To address workforce shortage at district level, it is proposed that newly qualified doctors from state medical colleges serve at least two years at the district headquarters hospitals. This recommendation should be followed through while keeping in mind lessons learnt from a largely failed experiment in the 1990s of making newly qualified doctors serve for a number of years in rural areas. Most of the basic health units in Punjab are without doctors.
In the committee report there seems a reinforced focus on newborn and child health. As the Sargodha and Vehari incidents have demonstrated, there is an urgent need to tackle the growing problem of newborn and infant death as part of broader provision for mother and child health wraparound services. What makes the committee’s recommendations on this front different from a lengthy focus on these areas with no tangible results is not clear from the press accounts.
Another good point included in the ‘must-do list’ is the introduction of an essential drugs list and improvement and transparency in the drug procurement procedures. These measures, if implemented, can prove effective in the provision of safe and affordable drugs to public health system users.
The committee has done well to quickly produce its final report, despite its long wish lists with no costs attached. The concern here is that the report may suffer the fate of similar exercises of spelling out ‘must-dos’ and ‘game changers’ without allocation of resources and sustained political will. The hope is that this time round it would be different and that this report will form the basis of an implementation plan and a wider public conversation on the vision for affordable, safe and efficient healthcare. If the government is serious about reforming the health sector, it should not allow the recent healthcare crises to have been in vain, and instead work assiduously to fix the system and make it fit for the 21st century.
The writer is a development consultant and policy analyst.
drarifazad@gmail.com
Twitter @arifazad5
Published in Dawn, February 17th, 2015
No comments:
Post a Comment