Health-Care in Pakistan


Health-Care in Pakistan
Prof. Emeritus, Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General Pak Armed Forces

The Health Care in a country is evaluated on the well-known criteria set by the World Health Organization (WHO) and the Scientific Community. These are the mortality rates, life span of the population- the health care facilities available to the people of the country to prevent disease, promote health, diagnose disease early, treat early prevent disability and early rehabilitation. It is not based on having islands of excellence i.e. having ‘Disease Palaces’ to treat ‘illnesses of elite’.

Let us compare mortality rates, life span and health care facilities available to the people of Pakistan. Pakistan has the highest mortality rate and one of the lowest life spans in the world. Comparing Pakistan (formerly West Pakistan) with Bangla Desh (former East Pakistan). Population control: Pakistan’s population is roughly 220 million, Bangla Desh’s 160 million- huge difference. On the emergence of East Pakistan its population was much more than the West Pakistan. Pakistan has the highest fertility rate meaning thereby total failure to control population- having Population Explosion. Iran our neighbor has reduced the population enormously a record in the shortest period- has the same religion, culture. Pakistan has the highest miscarriage rate in the world. This conclusion is based on the research paper published by the world’s oldest and most prestigious medical journal ‘The Lancet’.

Lt. Gen. (R) Mahmud Ahmad Akhtar

The Lancet said “Pakistan is the worst place in the world for a woman to become pregnant.”

Pakistan has the highest Maternal and Newborn mortality rates in the World.

Infant Mortality Rate: Pakistan has the highest infant mortality rate in the SAARC, 60 to 70 per thousand. Taking an example Sri Lanka has only 11 infant deaths under one year for 1000 births, BanglaDesh has reduced to below 36 per 1000, Nepal, Maldives, Bhuttan, India below 40 per 1000. It is pertinent to point out that Cuba has reduced to 4 per 1000(very poor resource country under heavy sanctions by the world super power the USA)

Likewise Pakistan’s child mortality is extremely high. Pakistan’s life span is the shortest in the region, approximately 64 Years, Sri Lanka the highest 76.6 Years, nearing the progressive Nations. Bangla Desh has considerably improved its life span nearly 69 Years. It is pertinent to point out that the Cuban’s life expectancy is 79 Years, the same as of the white community of the USA. Cuba spends less than $ 800 per person per year on health care compared to $1100 in USA. Cuba has the most density of physicians/population in the world. Its ratio of medical professionals is roughly three times of the USA.

Prevention is extremely poor in Pakistan, having the highest incidence of diarrheas, gastroenteritis, typhoid, hepatitis etc. 40% deaths are due to water borne diseases.

Potable water is a fundamental human right, enshrined in the constitution, not available to over 40% of the people. Water is contaminated by viruses, bacteria, metals etc. Recently Pakistan had an epidemic of extended resistant typhoid fever due to misconnection of sewers with drinking water pipes. Even about 40% of people of Pakistan have not got clean water for washing hands. People are advised to wash their hands frequently for the prevention of spread of Corona virus. Pakistan has the highest incidence of hepatitis B and C in the region and polio is still endemic –Afghanistan and Pakistan are the only two countries.

The governments of Pakistan have pursued lopsided priorities spending money on luxurious projects like grand underpasses, over passes, metros, motor ways and express ways serving well off segment of the population. Of course roads are important but water is the top priority followed by cost effective infrastructure not luxurious transits. A family first caters for water, hygiene, sanitation, health etc. On the curative side the priorities are also misplaced. As an example a patient suffering from a heart attack/stroke need emergency facility should be available within 1-2 hours to save life. Pakistan has built luxurious institutes in the cities. For example there are luxurious institutes, in the public and private sectors at Rawalpindi/Islamabad, Lahore, Karachi mostly also at Wazir Abad and Multan. On the way, over a long stretch including the interiors of the country, there are no units to treat emergencies. Heart attacks, angioplasties, kidney transplants etc. are being done in small two room private clinics then there is no reason to not to have these facilities at 250 bedded district hospitals. Progressive countries first build a network of coronary care, stroke care units in general hospitals then build very few institutes for carrying out high level research. As an example London has scores of hospitals doing all emergency work and hardly a few institutes in the whole of UK. Billions of rupees have been spent in liver and kidney institute at Lahore. At its cost, a network of coronary/stroke, kidney transplant units could have been raised in the whole of province saving hundreds of thousands of lives. Prof Bernard the pioneer of cardiac transplant said “I have saved 150 lives by doing cardiac transplant with that money, I could have saved 150 million lives by doing Prevention”.

Lone standing institutes are very expensive and suffer from the lack of rational integrated practice of Medicine. Mayo hospital at Lahore has an efficient Cardiac Department. For the time being liver operations could be left to private hospitals like Shifa etc. – later can be built in the main hospitals.

Agha Khan Hospital is a world class facility imparting 1st class medical, nursing, technology education providing high standard research work-also affordable and cost effective high standard heath care. It is a good example to emulate. The institution allows controlled medical practice to its doctors with referral system etc. not affecting patient care, education and research. Our public sector is in confusion. Unfortunately health and education are given negligible priority.


WHO devised Essential Medicine System for the lower/middle income countries? The system was initiated in 1977 when the 1st list was prepared and the last one, the 21st in 2019. Sadly Pakistan is the only middle – low income country not practicing the system although even many National lists have been prepared but not implemented- the reason is corruption, greed.

In 2018 the Federal Ombudsman on getting public complaints constituted a committee which after one year’s deliberation prepared recommendations presented to the President of Pakistan which was sent to the governments but not implemented. Although the president belonged to the same political party.

By definition, an Essential drug is an efficacious, relatively safe, cost effective, meets the needs of the large majority of the population i.e. over 95%. The definition says everything. The countries in the region are not only practicing the system in the Public sector but also providing a large number of drugs free of cost to the poor people. On the other hand Pakistan’s markets are flooded with irrational harmful drugs robbing people’s health, also people’s and Nation’s meagre finances. This is also the major cause of Pakistan’s high morbidity, mortality and shorter life span.

As an example one of the common cause of life destroying diseases is anaemia- iron and folic acid deficiency. Essential iron and folic acid tablets cost a few paisa’s well within the reach of common people and philanthropic organizations. These are not available but expensive tablets costing rupees containing unnecessary costly and harmful ingredients are sold in the market. Many lifesaving medicines like first line anti-microbial drugs nitrofurantoin, penicillin V, cloxacillin, fluvocloxacillin, dicloxacillin etc. are not available. It is harming people. The list is long. The cause is corruption and greed.

The British left a good standard of medical education. Pakistani degree was recognized everywhere in the world. By promoting commercialization, doing corruption etc., the medical education has been destroyed- endangering people’s lives. In the USA there was crises of the medical education, Flexner Commission was set up to correct it. The commission closed over one hundred medical colleges- fixing the system.

Pakistan is called the Islamic Republic of Pakistan. Politics and Islam had differences but not socio economic and never commercialized the education. Our leaders had their treatments abroad at the luxurious institutes on poor people’s expenses. Quaid e Azam and his lieutenants had their treatments in the country- they didn’t spend public money on themselves. The leaders of this region get treated in their own countries.

Sri Lanka has universal health care and education free of cost, same education for the President’s and chauffer’s children. The other SAARC are increasing the Universal Health Care of their people. In Pakistan, health and education gets the least priority. Prevention of diseases and promotion of health are neglected. On the curative side the priorities are lopsided. It is based on elitism-non cost effective, for the elites neglecting rural areas, slums, shanty towns etc. The Covid19 pandemic has exposed the brittleness of Pakistan’s health care system. Quaid e Azam envisaged a democratic welfare state- not a elitist state for the elites.

In conclusion fault lies with the policies made by the rulers. It can be fixed, Bangla Desh is a vivid example. Pakistan should not follow the USA elitist system by the elites for the elites, neglecting the lower strata.

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