Universal Challenge

Human life is unpredictable. We cannot fully control it but influence it. Our awareness, habitat, activities, and surroundings dictate how we live in different parts of life. Our genetics also dictates many things we face during various stages of life. What matters most is the quality of time an individual spends in this world.

We cannot change destiny or fate but can control our activities and habits to live a better quality of life that enables a focused, healthier, and happier livelihood. To achieve this, we need a constant pulse on our physical existence from birth to death.

The most significant barrier to living abetter quality of life is our healthcare. Healthcare today is reactive, retrospective, bureaucratic, and expensive. It's sick care, not healthcare, that is changing exponentially. The advancements in technology, digitization, big data, and artificial intelligence over the past decade have unlocked many opportunities to improve the overall quality of life, specifically healthcare, aging, and longevity. A lot is still under research, development, and clinical trials to understand human anatomy and physiology.

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Healthcare Delivery System

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The healthcare delivery system of Pakistan (تحفّظصحتِ عامّہ ، پاکستان) is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private-sector healthcare systems.

Healthcare delivery has traditionally been jointly administered by the federal and provincial governments, with districts mainly responsible for implementation. Under the constitution, health is a primary responsibility of the provincial government, except in federally administered areas. Service delivery is organized through preventive, promotive, curative, and rehabilitative services. The curative and rehabilitative services are mainly provided at the secondary and tertiary care facilities. On the other hand, preventive and promotive services are primarily offered through various national programs and community health workers interfacing with the communities through primary healthcare facilities and outreach activities.

The state provides healthcare through a three-tiered healthcare delivery system and a range of public health interventions.

Some government/semi-government organizations like the armed forces and parastatals such as Sui Gas, WAPDA, Railways, Fauji Foundation, and the Employees Social Security Institution provide health services to their employees and their dependents through their system. However, these collectively cover about 10% of the population.

The private health sector comprises doctors, nurses, pharmacists, traditional healers, drug vendors, laboratory technicians, shopkeepers, and unqualified practitioners.

This link has solid data: https://en.wikipedia.org/wiki/Healthcare_in_Pakistan

Public sector

The public sector endeavors to deliver healthcare through a three-level healthcare delivery system and a range of public health interventions. The first level includes basic Health Units (BHUs) and Rural Health Centers (RHCs), founding the fundamental of the primary healthcare model, secondary care encompasses first and second referral facilities providing acute, ambulatory, and inpatient care through Tehsil Headquarter Hospitals (THQs) and District Headquarter Hospitals(DHQs) and tertiary care including teaching hospitals.

Public health activities have persistently increased in terms of physical infrastructure and workforce. The national health infrastructure comprises 1,201 hospitals, 5,518Basic Health Units, 683 Rural Health Centers, 5,802 Dispensaries, 731 Maternity& Child Health Centers, and 347 TB centers, and the total availability of beds in these health facilities is estimated at 123,394. In addition, more than 95,000 Lady Health Workers provide primary health care services to the community through the health houses.

The numbers of doctors, dentists, nurses, and LHVs have increased, and the availability of one doctor, dentist, nurse, and one hospital bed versus population has gradually improved.

Despite an elaborate and extensive health infrastructure, healthcare delivery suffers from critical issues like high population growth, uneven distribution of health professionals, deficient workforce, insufficient funding, and limited access to quality healthcare services.

Private sector

The rising population pressure on state health institutions has allowed the private sector to bridge the gap between rising demand and limited public health facilities. The number of private hospitals, clinics, and diagnostic labs has increased considerably and is contributing to health services in the country. Most private sector hospitals have a sole proprietorship or a partnership organization model. Stand-alone clinics across Pakistan are the primary providers of out-patient care the majority of these clinics fall in the sole proprietorship category.

Challenges

Public healthcare has insufficient resources, especially when 65% of the rural population depends on it entirely. The private healthcare System is comparatively better. However, it is expensive, and not everyone can afford it, even within urban or near urban areas. The population in rural or near urban areas also has a lower literacy rate and is living in a complete bubble of healthcare ignorance.

Overall, half of the country’s population(~120 million) lives below the poverty line. Due to a lack of resources, education, awareness, and access, they have no idea about their mental and physical health problems.

Despite the increase in public health facilities, Pakistan's population growth has generated an unmet need for healthcare. Public healthcare institutions that address critical health issues are often only located in major towns and cities. Due to the absence of these institutions and the cost associated with transportation, impoverished people living in rural and remote areas tend to consult private doctors. Studies have shown that Pakistan's private-sector healthcare system is outperforming the public-sector healthcare system in terms of service quality and patient satisfaction, with 70% of the population being served by the private health sector. The private health sector operates through a fee-for-service system of unregulated hospitals, medical practitioners, homeopathic doctors, hakeems, and other spiritual healers. In urban areas, some public-private partnerships exist for franchising private sector outlets and contributing to service delivery. Very few mechanisms exist to regulate the quality, standards, protocols, ethics, or prices within the private health sector, which results in disparities in health services.

Even though nurses play a vital role in any country's healthcare field, Pakistan has only 121,245 nurses to service a population of 237 million, leaving a shortfall of nurses asper world health organization estimates.

The current life expectancy for Pakistan in 2022 stands at 67.64 years, a 0.23% increase from 2021. The citizens of India (70.42 years), Bangladesh (73.57), Bhutan (72.77), Nepal (71.74), and Sri Lanka (77.56) live longer.

The major causes of death include:

●      Ischemic Heart Disease - 8%

●      Cancer - 8%

●      Lower-Respiratory Infections - 8%

●      Stroke - 6%

●      Diarrheal Diseases - 6%

●      Neonatal Encephalopathy - 5%

●      Chronic Obstructive Pulmonary Disease - 5%

●      TB - 5%

●      Preterm Birth Complications - 4%

●      Diabetes - 3%

UnsettlingFacts

The majority of the above causes and lower life expectancy are directly linked to the non-existent preventative healthcare ecosystem in Pakistan:

1. Most of the population does not see a doctor unless they are sick.
2. There is no concept of annual medical checkups.
3. A typical government hospital lacks sufficient doctors, nurses, and personnel.
4. Hospitals are unhygienic, lack security, patient care is unheard of, and medicines and consumables are frequently in low supply.
5. Except for a few major private hospitals, the doctors' prescriptions and notes are never digitally recorded.
6. Even if the record is captured, the technology systems are not built to analyze and send alerts to patients for follow-ups (even when 83% of the population has a mobile phone).
7. The private healthcare ecosystem runs on a transactional basis.
8. A decent percentage of the population dies while traveling to far-off hospitals in cities.
9. No research facilities for doctors to up skill.
10. Medical history must be shared and accessible among practitioners (GP and specialist), so the records would be linked.
11. In Pakistan, doctors directly prescribe medicines; however,     practitioners must diagnose the disease, and pharmacists should prepare the medicine accordingly.

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