Health care in Pakistan

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Healthcare in Pakistan is administered mainly in the private sector which accounts for approximately 80% of all outpatient visits. The public sector was until recently led by the Ministry of Health, however the Ministry was abolished in June 2011 and all health responsibilities (mainly planning and fund allocation) were devolved to provincial Health Departments which had until now been the main implementers of public sector health programs. Like other South Asian countries, health and sanitation infrastructure is adequate in urban areas but is generally poor in rural areas. About 19% of the population and 30% of children under age of five are malnourished.[citation needed]

Ministry of Health of Pakistan states that health expenditure of period 2007-08 was 3.791 billion Pakistani rupees while that spent on development was 14.272 billion.[1]

Basic health indicators [1]
Fertility rate 4.1%
Contraceptive prévalence rate 30%
Population growth rate 1.8
Malarial parasite incidence 0.07%
Incidence of tuberculosis 0.18%

Health concerns[edit]

Infectious diseases[edit]

Infectious diseases in Pakistan by proportion (2006)

Priority diseases[edit]

Most common and lethal diseases in Pakistan include:

  • Acute respiratory infection (51%): Among the victims of ARI, most vulnerable are children whose immune systems have been weakened by malnutrition. In 1990, National ARI Control Programme was started in order to reduce the mortality concerned with pneumonia and other respiratory diseases. In following three years, death rates among victims under age of five in Islamabad had been reduced to half.[2] In 2006, there were 16,056,000 reported cases of ARI, out of which 25.6% were children under age of five.[3]
  • Viral hepatitis (7.5%): Viral Hepatitis, particularly that caused by types B and C are major epidemics in Pakistan with nearly 12 million individuals infected with either of the virus. The main cause remains massive overuse of therapeutic injections and reuse of syringes during these injections in the private sector healthcare.
  • Malaria (16%): It is a problem faced by the lower-class people in Pakistan. The unsanitary conditions and stagnant water bodies in the rural areas and city slums provide excellent breeding grounds for mosquitoes. Use of nets and mosquito repellents is becoming more common. A programme initiated by the government aims to bring down malarial incidence below 0.01% by the year 2011. In Pakistan, malarial incidence reaches its peak in September.1000 Million people has been died from Malaria since Pakistan came into being till December 2012.[4] In 2006, there were around 4,390,000 new reported cases of fever.[3]
  • Diarrhea (15%): There were around 4,500,000 reported cases in 2006, 14% of which were children under the age of five.[3]
  • Dysentery (8%) and Scabies (7%)
  • Others: goitre, hepatitis and tuberculosis

Controllable diseases[edit]

  • Cholera: As of 2006, there were a total of 4,610 cases of suspected cholera.[3] However, the floods of 2010 suggested that cholera transmission may be more prevalent than previously understood. Furthermore, research from the Aga Khan University suggests that cholera may account for a quarter of all childhood diarrhea in some parts of rural Sindh.
  • Dengue fever: An outbreak of dengue fever occurred in October 2006 in Pakistan. Several deaths occurred due to misdiagnosis, late treatment and lack of awareness in the local population. But overall, steps were taken to kill vectors for the fever and the disease was controlled later, with minimal casualties.
  • Measles: As of 2008, there were a total of 441 reported cases of measles in Pakistan.[5]
  • Meningococcal meningitis: As of 2006, there were a total of 724 suspected cases of Meningococcal meningitis.[3]

Poliomyelitis[edit]

Pakistan is one of the few countries in which poliomyelitis has not been eradicated. As of 2008, there were a total of 89 reported cases of polio in Pakistan.[5] Polio cases may be on an increase. The year 2010 saw an increase in the number of cases as well identification of polio from new locations. Experts from the national program and the WHO felt that the new cases identified from southern Punjab and northern Sindh may have resulted from importation of infections from other locations in Pakistan. Locations in FATA and Khyber Pakhtunkhwa remain hosts for year round persistence of infection and environmental sampling by the national program and WHO suggests that polio remains endemic in many other parts of the country.

HIV/AIDS[edit]

Main article: HIV/AIDS in Pakistan

The AIDS epidemic is well established and may even be expanding Pakistan. Risk factors are high rates of commercial sex and non-marital sex,[6][7] high levels of therapeutic injections (often with non-sterile equipment),[8][9] and low use of condoms [10] The former National AIDS Control Programme (it was devolved with the Health Ministry) and the UNAIDS state that there are an estimated 97,000 HIV positive individuals in Pakistan. However, these figures are based on dated opinions and inaccurate assumptions; and are inconsistent with available national surveillance data which suggest that the overall number may closer to 40,000.[11]

Family planning[edit]

"The government of Pakistan wants to stabilize the population (achieve zero growth rate) by 2020. And maximizing the usage of family planning methods is one of the pillars of the population program".[12] The latest Pakistan Demographic and Health Survey (PDHS) conducted by Macro International with partnership of National Institute of Population Studies (NIPS) registered family planning usage in Pakistan to be 30 percent. While this shows an overall increase from 12 percent in 1990-91 (PDHS 1990-91), 8% of these are users of traditional methods. Approximately 7 million women use any form of family planning and the number of urban family planning users have remained nearly static between 1990 and 2007. Since a many of contraception users are sterilized (38%), the actual number of women accessing any family planning services in a given year are closer to 3 million with over half buying either condoms or pills from stores directly. Government programs by either the Health or Population ministries together combine to reach less than 1 million users annually.[13] Thus, fertility remains high, at 4.1 births per woman. Owing to such high fertility levels, Pakistan's overall population growth rate is much higher than elsewhere in South Asia (1.9 percent per year).

Some of the main factors that account for this lack of progress with Family Planning include inadequate programs that don't meet the needs of women who desire family planning or counsel users of family planning about potential side effects, a lack of effective campaign to convince women and their families about the value of smaller families and the overall social mores of a society where women seldom control decisions about their own fertility or families. However the single most important factor that has confounded efforts to promote family planning in Pakistan is the lack of consistent supply of commodities and services.[14] Indeed, the unmet need for contraception has remained high at around 25% of all married women of reproductive age (higher than the proportion that are using a modern contraceptive and twice as high as the number of women being served with family planning services in any given year[15]) and historically any attempt to supply commodities has been met with extremely rapid rise (over 10% per annum) in contraception users compared with the 0.5% increase in national CPR over the past 50 years.

Currently the government contributes about a third of all FP services and the private sector including NGOs the rest. Within the private sector, franchised clinics offer higher quality health care than unfranchised clinics but there is no discernible difference between costs per client and proportion of poorest clients across franchised and unfranchised private clinics.[16] Government programs are run by both the Ministries of Populaition Welfare and Health. The most common method used is female sterilization which accounts for over a third of all modern method users. Unfortunately this happens too late for most women as sterilized women are over 30 years of age and have 4 or more children. Condoms are the next most popular method.

Maternal and child health[edit]

In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Pakistan is 260. This is compared with 376.5 in 2008 and 541.2 in 1990. The under 5 mortality rate, per 1,000 births is 89 and the neonatal mortality as a percentage of under 5's mortality is 48. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Pakistan the number of midwives per 1,000 live births is 10 and the lifetime risk of death for pregnant women is 1 in 93.[17]

There is a huge imbalance in these figures. In Balochistan, for instance, the maternal mortality is 785 deaths per 100,000 live births which is nearly triple the national rate. It should be noted here that in rural Pakistan, maternal mortality is nearly twice than that in cities. The sad reality is that 80 per cent of maternal deaths are preventable.[18]

Cancer care[edit]

Cancer information on Pakistan [19] Approximately one in every 9 Pakistani women is likely to suffer from breast cancer which is one of the highest incidence rates in Asia.[20]

Obesity[edit]

Main article: Obesity in Pakistan

Malnutrition[edit]

Smoking[edit]

Main article: Smoking in Pakistan

Drug addiction[edit]

Suicide[edit]

Main article: Suicide in Pakistan

Resources[edit]

Personnel (source)
Doctors (2009) 139,555
Dentists (2009) 9,822
Nurses (2009) 69,313
Midwives (2009) 26,225
Health visitors (2009) 10,731
Registered vets (2009) 4,800
Health facilities in 2009 (source)
Total Health Facilities 13,937 103,708 beds
Hospitals 968 84,257 beds
Dispensaries 4,813 2,845 beds
Rural health centers 572 9,612 beds
Tuberculosis clinic 293 184 beds
Basic health units 5,345 6,555 beds
M.C.H. centers 906 256 beds

Personnel[edit]

According to official data, there are 127,859 doctors and 12,804 health facilities in the country to cater for over 170 million people.[21]

Many Pakistani doctors and medical professionals choose to migrate to other countries, contributing to a brain drain and chronic skills shortage in the country. In the United States alone, there are over 17,000 doctors of Pakistani origin.[22] Pakistan is the fourth highest source of International medical graduate doctors in the U.S[23] as well as the fourth highest source of foreign dentists licensed in the United States.[24]

Facilities[edit]

Professional institutes[edit]

As of 2007, there were 48 medical colleges and 21 dental colleges in the country.[1]

Services[edit]

Nursing[edit]

Main article: Nursing in Pakistan

According to Dr.Shaikh Tanveer Ahmed Nursing is a major component of health care in Pakistan. The topic has been the subject of extensive historical studies,[25] is as of 2009 a major issue in that country,[26] and has been the subject of much scholarly discussion amongst academics and practitioners.[27] In 2009, Pakistan’s government stated its intent to improve the country's nursing care.[28]

Dentistry[edit]

Main article: Dentistry in Pakistan

At present there are upwards of 70 dental schools (public and private) throughout Pakistan, according to the Pakistan Medical and Dental Council the state regulatory body has upwards of 11500 registered dentists. The four year training culminates in achieving a Bachelor of Dental Surgery (BDS) degree, which requires a further one year compulsory internship to be a registered dentist in Pakistan.

Pharmacy[edit]

Medical tourism[edit]

Veterinary medicine[edit]

Community medicine[edit]

Pakistan is committed to the goal of making its population healthier, as evidenced by the continuing strong support for the Social Action Program (SAP) and by the new vision for health, nutrition, and population outlined in the National Health Policy Guidelines published by the government.

  • Lady health workers: A recent initiative, lady health worker, has turned out to be a promising community-based health worker program. These workers bring health information, some basic health care and family planning services to doorsteps of women. Presently, 96,000 women are serving as in this initiative in their home villages.[29]

Nuclear medicine[edit]

See also[edit]

References[edit]

  1. ^ a b c "Health facts". Ministry of Health, Pakistan. Retrieved 7 September 2010. 
  2. ^ "Pakistan acts to reduce child deaths from pneumonia". who.int. World Health Organization (WHO), International. Retrieved August 1, 1982. 
  3. ^ a b c d e "Priority disease report (2005-06)". Ministry of Health, Pakistan. Retrieved 7 September 2010. 
  4. ^ "National Malaria Control Programme". Ministry of Health, Pakistan. Retrieved 7 September 2010. 
  5. ^ a b "Country Profiles (Pakistan)". World Health Organization. Retrieved 7 September 2010. 
  6. ^ Migrant men: a priority for HIV control in Pakistan? Faisel A, Cleland J. Sex Transm Infect. 2006;82:307-310
  7. ^ National AIDS Control Programme and Population Council of Pakistan. Study of Sexually Transmitted Infections: Survey of the Bridging Population. 2007 [1]
  8. ^ Pasha O, Luby SP, Khan AJ, Shah SA, McCormick JB, Fisher-Hoch SP. Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infection by injections from health care providers. Epidemiol Infect. 1999;123:515-518.
  9. ^ Khan AJ, Luby SP, Fikree F et al. Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bull World Health Organ. 2000;78:956-963
  10. ^ National AIDS Control Programme and HIV/AIDS Surveillance Project. [HIV/AIDS Surveillance Project of Pakistan: Round 3. 2008]http://www.nacp.gov.pk/library/reports/HIV%20Second%20Generation%20Surveillance%20in%20Pakistan%20-%20National%20report%20Round%20III%20%202008.pdf.
  11. ^ Burki T. New government in Pakistan faces old challenges. Lancet Infect Dis. 2008;8:217-218 and Shah, SA. Tropical Medicine Symposium, The Aga Khan University and the Royal Society of Tropical Medicine, 2008.
  12. ^ http://www.mopw.gov.pk/event3.html Population Policy of Government of Pakistan
  13. ^ http://resdev.org/Docs/01fpoverview.pdf Overview of Family Planning in Pakistan
  14. ^ http://resdev.org/Docs/01fpservices.pdf Family Planning Services in Pakistan
  15. ^ http://resdev.org/Docs/06umn.pdf What unmet need for family planning means in Pakistan
  16. ^ Shah, Nirali; et al (2011). "Comparing Private Sector Family Planning Services To Government And NGO Services In Ethiopia And Pakistan: How Do Social Franchises Compare Across Quality, Equity And Cost?". Health Policy Plan 26 (Suppl 1): i63 – i71. doi:10.1093/heapol/czr027. Retrieved 26 May 2012. 
  17. ^ "The State Of The World's Midwifery". United Nations Population Fund. Retrieved August 2011. 
  18. ^ http://www.measuredhs.com/pubs/pub_details.cfm?ID=783&srchTp=advanced Pakistan Demographic and Health Survey 2006-07
  19. ^ [2] Cancer in Pakistan
  20. ^ College of Physicians and Surgeons Pakistan Journal, Editorial 2007 http://www.cpsp.edu.pk/jcpsp/ARCHIEVE/JCPSP-2007/dec07/Editorial1.pdf
  21. ^ http://southasia.oneworld.net/todaysheadlines/healthcare-in-pakistan-too-expensive-to-afford
  22. ^ US should apologise to Pakistan, NATO pay reparations to soldiers: Congressman Kucinich
  23. ^ IMGs by Country of Origin
  24. ^ Foreign-trained dentists licensed in the United States Retrieved 08-07-2011
  25. ^ History of Nursing in Pakistan search at Google. Accessed December 10, 2009.
  26. ^ "Nursing in Pakistan" search at Google. Accessed December 10, 2009.
  27. ^ "Nursing in Pakistan" search at Google Scholar. Accessed December 10, 2009.
  28. ^ "Press Information Department". Government of Pakistan. Retrieved 2009-12-12. 
  29. ^ [3] National Programme for Family Planning & Primary Health Care (LHW Programme, MOH Pakistan)

Further reading[edit]

External links[edit]