KARACHI - Pakistan Medical Association (PMA) Centre has sent Health Reforms and Recommendations by PMA to the members of the cabinets, national and provincial, all the parliamentarians, all the leaders of the political parties for consideration and compliance.
According to PMA Centre Secretary General Dr Mirza Ali Azhar, who sent these recommendations to legislators, Pakistan, having a population of around 180 million with an annual growth of 2 percent, is the 6th most populous country in the world. It ranks 145th on the 2011 United Nations Development Index.
He mentioned, “According to PDHS 2006-2007, an estimated 276 Pakistani women die against every 100,000 live births. More than 65 per cent of women in Pakistan deliver their babies at home, mostly assisted by untrained traditional birth attendants, or ‘Dais’, with increased risk of birth complications, especially in rural areas of Pakistan. Only 22 per cent of married women received professional postnatal care for the last birth within 24 hours. With total fertility rate of 4.1 children per woman and low CPR, 22 per cent women in Pakistan continuously expose themselves to increased risks of mortality and morbidity 2. Illiteracy, poverty, gender inequality along with conservative mind-set of society suppress women’s voice and resist their participation in decision-making regarding their health and life.
Further, 15 per cent deaths of children under five years of age contribute to 50 per cent of overall mortality in Pakistan which is significantly very high compared to 8-10 per cent in the developed countries.
About 298,000 neonatal deaths annually occur in Pakistan and with reported neonatal mortality rate of 49 per 1000 live-births, Pakistan accounts for 7 per cent of global neonatal deaths. About 19 per cent of the population in Pakistan is malnourished — a higher rate than the 17 per cent average for developing countries — and 30 per cent of children under age five are malnourished. It is also unfortunate that Pakistan is among four countries of the world, and at top of the list, having an increased number of polio cases.
The other preventable diseases, TB, Typhoid, Hepatitis, Malaria, Gastroenteritis, Malnutrition, Diarrhoea, Pneumonia and some forms of cancer, are also on the rise. Very little effort is required, like educating the masses and creating awareness to minimise the spread of diseases. Hepatitis B and C are also rampant, with approximately 3 million cases of each in the country.”
As per recommendations by the PMA, “Health is a basic human right and the government should accept this as priority. It should be a priority area for the government, which should formulate and implement effective patient-friendly health policy to improve the overall health situation in Pakistan. All political parties must include health issues in their manifestoes with clear commitment in this regard.
The allocated budget of health should be increased. PMA demands that 6 per cent of GDP should be given to the health sector. We realise that we don’t have the structure to utilize this kind of funding, so PMA asks the government to develop infrastructure or to appoint a supervisory body to implement the utilizations of these funds according to the actual health need, and by following the rule of equity rather than equality so that wastage of funds could be avoided. There should be an independent autonomous and corruption-free Federal Drug Regularity Authority having reasonable participations from all key stakeholders from all provinces. Basic healthcare services should be available at all levels of the health delivery system.
All basic health facilities including dispensaries, BHUs and RHCs all over country, must be functional. Basic healthcare and emergency obstetrical care should be available for all pregnant women. Antenatal care is the right of every pregnant woman. Provision of antenatal care should be uniform and optimal for all concerned. Availability of Emergency Obstetrical care for all women round the clock, up-gradation of Taluka and district level hospital and ensure the availability of health specialists and encourage them through justifiable remuneration according to their education, experience and designation. There should be a system of annual audit for every maternal death in Pakistan.
Legislation should be passed about maternal mortality and a system of enquiry should be established to find out the cause of each maternal death. Reproductive Health is the basic health right. Abortion care, Family Planning (Birth Spacing) and other Reproductive Health Services should be available in all parts of country. Inclusion of EmOC including post abortion care in the curriculum of medical colleges, nursing schools and paramedics training centres. So that health care providers could be trained to competently deal with the situation and provide quality RH services at community level. Availability of free screening programs against breast, cervix and ovarian cancer in all government hospitals. A massive programme to produce nurses, midwives, paramedics and nursing midwifery tutors to face the challenge of healthcare in Pakistan.
Shortage of doctors at basic health facilities in rural and far-flung areas should be managed and it could be fulfilled with competent mid-level healthcare providers, including paramedics and midwives through a process of task shifting. Availability of free screening programs in all government hospitals. A complete overhauling of the medical education system in the country. Corrupt practices in this regard should be stopped.
PMA asks the government to restructure an autonomous, independent and powerful Pakistan Medical and Dental Council (PMDC) and the Pakistan Nursing Council (PNC), and to ensure that the election of the PMDC’s new members was transparent and from all over the country.
PMA recommends that all universities should be functional on a full-time basis with no one faculty working part-time and the post-graduate programs should only be allowed if the institution has proper faculty and infrastructure. Aggressive campaign to improve the availability of basic health needs like clean water and sanitation to the entire nation. Development of national prevention policy/strategy to improve the health of the nation and the quality of life for people by moving from a focus on sickness and disease to one based on prevention and wellness.
Promoting education in the country and enabling people to adopt healthy behaviours and to make better informed choices for themselves and their families.