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ISLAMABAD: The health-related expenditure increased by 14.3 percent from Rs421.8 billion in 2018-19 to Rs482.3 billion in 2019-20, says the Pakistan Economic Survey 2020-21.

Public sector expenditure on health was estimated at 1.2 percent of the GDP in 2019-20, as compared to 1.1 percent in 2018-19. It further said that health expenditures have increased gradually since 2011-12.

According to the survey, Pakistan has shown improvement in health indicators over the last three years. Life expectancy has increased from 66.9 years in 2017 to 67.3 years in 2019, but is still behind in the region. The infant mortality rate, maternal mortality, and population growth rate have decreased during the last three years.

Afghanistan is the only South Asian country lagging behind Pakistan on account of life expectancy where it is 64.8, while the rest of the regional countries are ahead of Pakistan as life expectancy in China is 76.9 years, in Bhutan 71.8 years, Nepal 70.8 years, Sri Lanka 77 years, Bangladesh 72.6 years, and in India 69.7 years.

Pakistan is behind all the regional countries on account of infant mortality rate as in Pakistan it is 55.7 to 1,000 lives, while in India it is 28.23, in Bangladesh 25.6, Sri Lanka 6.1, and Afghanistan 46.5.

Maternal mortality rate in Pakistan stands at 140 per 100,000, while in Afghanistan it is 638, India 145, Bangladesh 173, and Sri Lanka 36.

Under 5 years of mortality rate is highest in Pakistan with 67.2 per 1,000, while in India it is 34.3, in Afghanistan 60.3, in Bangladesh 30.8 and Sri Lanka 7.1.

With over 1.9 percent population growth, Pakistan is only behind Afghanistan which has 2.3 percent population growth in the region, while population growth in India is one percent, Bangladesh one percent, and Sri Lanka 0.6 percent.

By the year 2020, national health infrastructure comprised of 1,282 hospitals, 5,472 Basic Health Units (BHUs), 670 Rural Health Centres (RHCs), 5,743 Dispensaries, 752 Maternity and Child Health Centres and 412 TB centres, while the total availability of beds in these health facilities have been estimated at 133,707.

There are 245,987 registered doctors, 27,360 registered dentists, and 116,659 registered nurses in these facilities altogether.

The survey said that although after the passage of 18th constitutional amendment, provision of health services is the mandate of the provincial governments; however, the federal government has supported various health-related projects through the Public Sector Development Programme (PSDP), for fulfillment of Sustainable Development Goals (SDGs) and overall health status in the country.

During FY2021, the PSDP allocations of Rs20,193.9 million were made for 71 health sector projects. In addition, the government has introduced a special programme with an outlay of Rs70 billion to mitigate the impact of the Covid-19 pandemic. The programme is focusing on upgrading health care facilities, sewerage system, solid waste management, clean drinking water, and education.

Under federal PSDP, the government is funding following projects: (i) Sehat Sahulat Programme is being implemented in phases and its first phase (2016-2018) was implemented in 38 districts, covering 3.2 million families.

In second phase (2019-2020) the programme is being implemented in 91 districts, providing services to 8.5 million families and the number of beneficiaries of the programme is growing each year.

(ii) “Ehsaas” Programme, Family Planning and Primary Healthcare Programme (FP&PHC) coupled with Ehsaas Programme, is striving to control population growth.

Pakistan has a Total Fertility Rate (TFR) of 3.7 percent and Contraceptive Prevalence Rate (CPR) of 34.0 percent (PSLM, 2018-19). Pakistan has demonstrated ongoing efforts towards the promotion of family planning. Each province has drafted its plan for family planning. Family planning task forces comprising public and private sector stakeholders have been constituted.

The government is committed to ensure easily accessible range of methods in the country and has trained mid-level service providers in public and private sectors to provide Intra Uterine Devices (IUDs) and implants.

Additionally, to promote acceptability of family planning, the government is collaborating with family elders and religious leaders as part of its social mobilisation efforts.

Punjab, Sindh, and Khyber-Pakhtunkhwa governments have established health centres specifically for adolescents.

To continue promoting strong government commitment, government is making its efforts to strengthen collaboration among regions, in order to reach 6.7 million additional users of contraception and increase CPR to 50 percent.

(iii) Expanded Programme for Immunization: Pakistan became the first country in the world to include Typhoid Conjugate Vaccine (TCV) in its compulsory Expanded Programme for Immunization (EPI).

The EPI is now providing immunisation to children against eight vaccine-preventable diseases i.e., childhood tuberculosis, poliomyelitis, diphtheria, pertussis, neonatal tetanus, measles, hepatitis B, and typhoid.

The government is committed to address hurdles for improving vaccine coverage programme through better management, effective monitoring and evaluation (M&E), upgraded performance management in service delivery, logistics control, Human Resource Management (HRM), and financing.

It is quite encouraging that the proxy indicator for fully immunised-child i.e. coverage for measles-1 is currently at 88 percent in the country.

For EPI, the government has allocated an amount of Rs2.2 billion in the PSDP.

(iv) Polio Eradication Initiative (PEI) Programme: almost 38 million children were vaccinated during March, 2021 through the National Immunization Day (NID) campaign across the country.

Pakistan is one of only two remaining countries in the world with ongoing wild poliovirus transmission, along with Afghanistan.

The number of polio cases declined from 306 in 2014 to 54 in 2015, 20 in 2016, eight in 2017, and 12 in 2018.

However, in 2019, the programme witnessed a significant spread of the virus and reported 147 polio cases across the country.

In 2020, 84 cases have been reported (Punjab 14, Sindh 22, Khyber-Pakhtunkhwa 22, and Balochistan 26).

(v) National Health Emergency Preparedness and Response Network (NHEP&RN) established in 2011 with the aim to: (i) coordinate and liaison with other national stakeholders to maximise efficiency, (ii) formulate and disseminate health related updates and information, (iii) coordinate need-based delivery, (iv) coordinate with provinces/districts for collection of information on essential medicines, (v) coordinate with WHO/provinces/districts for collection of disease data on daily basis.

During 2020, the NHEP&RN in collaboration with JHPIEGO (Johns Hopkins Programme for International Education in Gynecology and Obstetrics) conducted training sessions of quarantine facilities staff on infection prevention and standard precautionary measures regarding Covid-19.

(vi) Safe Blood Transfusion Services (SBTS) Programme was established by the Ministry of Health, with the collaboration from the Government of Germany, to restructure the blood transfusion system and to promote a modern national blood transfusion system.

The strategy involved gradually replacing the existing unsafe fragmented system with the internationally recommended centralised model.

In this regard, the government has allocated Rs235 million in the PSDP 2020-21 for ongoing SBTS project, entitled, “Establishment of Safe Blood Transfusion Services in ICT”.

(vii) Malaria Control Programme: According to the Directorate of Malaria Control, Pakistan remains one of the highest burden sharing countries in Eastern Mediterranean Region (EMR), with an estimated one million malaria cases annually.

Efforts were made to reduce malaria burden particularly in 60 high-risk districts of the country (mostly from Balochistan and Khyber-Pakhtunkhwa), by providing free of cost diagnostic and treatment services in more than 5,000 health care centres, distribution of Long Lasting Insecticide Treated Nets (LLITN) among people, capacity building of the health care personnel, spraying in outbreak situation and epidemic prone areas and raising awareness campaign about malaria in the community.

Around seven million suspects are screened for malaria every year. Whereas around 350,000 confirmed malaria cases are treated as per national treatment guidelines. More than six million LLITNs have been distributed in Balochistan, Khyber-Pakhtunkhwa (including merged tribal areas), and Sindh province to prevent population from malaria.

(viii) Tuberculosis (TB) Control Programme: According to the WHO, Pakistan ranked fifth highest burden country of tuberculosis worldwide, with an estimated 510,000 new TB cases emerging every year.

The incidence and mortality per 100,000 population per year from TB in Pakistan is 263 and 19 respectively. With the guidance of the WHO, Pakistan has developed a National TB Control Programme (NTP) to prevent population from TB.

The programme includes universal access to quality TB care in the country, expanding partnerships and multi-sectoral approaches by engaging all stakeholders.

The NTP strives for TB free Pakistan by reducing 50 percent prevalence of TB in general population by 2025 in comparison to 2012, through universal access to quality TB care and achieving Zero TB death.

Copyright Business Recorder, 2021

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