PMA unhappy over the poor state of affairs of health delivery systems in Pakistan

KARACHI: The Pakistan Medical Association (PMA) considers 2020 as an unfortunate year not only for Pakistan but for the whole world due to the COVID-19 pandemic. Pakistan went through so many political and economic problems along with an increasing number of health issues, which have raised the burden of diseases more.

Although the PMA has always offered recommendations and placed a charter of demands for the government to implement to improve Pakistan's healthcare system, unfortunately, the state of affairs shows that the voice of the PMA always falls on deaf ears. Nothing has changed in the health sector during the year 2020. Instead of any improvement, things have gone from bad to worse.

Since the end of 2019, Pakistan and the whole world has been facing the pandemic, COVID-19. A novel coronavirus outbreak was first observed in Wuhan, Hubei Province, China, in December 2019. The pandemic reached Pakistan in February 2020, and the first case of COVID-19 was detected on 26th February 2020.

It has world widely affected 83,178,070 human beings, and the death toll of COVID-19 has reached 1,814,649, which is increasing day by day. Along with many other countries of the world, we have been facing the second wave of COVID–19. Presently the coronavirus has mutated into the third variety, which was initially detected in South Africa and has reached fifteen countries. The third variety is 60% more contagious and 70% more transmissible. Until today, the total confirmed cases in Pakistan have reached 479,715, and the death toll is 10,105.

The PMA was the first to sniff out the difficulties Pakistan is going to face due to the pandemic's spread in the coming days. From the very first day when the coronavirus erupted in China, and the number of death toll just rose to six, the PMA, through a press release on 22-01-2020, came out with the suggestion for the government to take up some urgent steps to avoid the spread of the coronavirus in Pakistan. We also suggested installing scanners at all airports, seaports, and at all border entries to check the suspected cases of the coronavirus.

The PMA also issued preventive measures for the public. Unfortunately, when we asked people to use masks and sanitizer, the prices of these items increased. Similarly, when few medicines, oxygen cylinders, and other medical devices were discussed in the media for treatment, their prices also became much higher. There was no proper guideline for the public to reach hospitals. Many people died on their way to reach the corona designated hospitals. Even doctors died in the same way.

Unfortunately, despite our regular warnings regarding the coronavirus, nobody acted upon our advice. Even the public has never followed the preventive measures seriously, and the government also seems to be failed in implementing SOPs. Now the second wave is proving to be more lethal and deadlier as the virus has mutated itself and has become more transmissible and infectious. It has been observed that people are not fully recovering even after being declared negative.  

The increasing burden of disease of the second wave in the community is proving to be more dangerous for doctors. Till now, 154 doctors have lost their lives due to COVID –19 in Pakistan. During this second wave, which started in November, 45 doctors have lost their lives (Punjab-16, Sindh-14, KPK-13, AJK-02).

The situation is very alarming. The government seems to be very careless about the welfare of the families of the deceased doctors. They announced Shuhda Package for these families but never implemented it.

The polio infection remains endemic despite over 100 rounds of vaccination being carried out in the past decade. Our polio program has deteriorated; in 2018 polio program seemed to be on the brink of eradicating the wild poliovirus transmission. Unfortunately, during the year 2019, as many as 117 cases were reported in 2020, the tally of polio cases reached 83.

Fifteen million people are affected by hepatitis B and C in Pakistan. Thousands of new patients are added every year due to a lack of prevention, testing, treatment resources, poorly screened blood transfusion, improperly sterilized invasive medical devices and unsafe injections. Hepatitis B and C are several times more lethal viral diseases than the coronavirus infection, resulting in around 300 to 325 deaths daily in Pakistan, while COVID-19 is causing far fewer casualties than viral hepatitis.

It is neither terrorism nor natural disasters but the unavailability of safe drinking water, leading to the highest number of deaths in Pakistan. The release of untreated industrial waste, unsafe sewage system, agriculture run-off, and unplanned urbanization has downgraded water quality over the years, especially in the big cities, depriving almost two-thirds of over 200 million Pakistanis of potable water.

In Pakistan, it is estimated that 30% of all diseases and 40% of all deaths are due to poor water quality. Diarrhea, a waterborne disease, is reported as the leading cause of death in infants and children in Pakistan, while every fifth citizen suffers from illness and disease caused by the polluted water. The outbreak of XDR-Typhoid cases in Karachi and interior Sindh reached thousands.

The number of HIV/AIDS patients in Pakistan currently stands at 183,000. The ratio of the spread of HIV/AIDS cases in Pakistan is at 57 percent, similar to the Philippines, which is very alarming. Out of a large number of estimated positive cases, only 25,000 cases are registered. This shows our poor performance. There is a dire need to increase testing capacity to check HIV/AIDS patients.

Different researches have revealed that most of the cancer cases in Pakistan (around 60%) were diagnosed in women compared to men. The most common cancer among women is breast cancer, followed by oral and then esophageal cancer, while in men, it is oral cancer. Research indicates that cancer, often a hereditary malady, is also linked to environmental factors and poor dietary habits, as in the case of oral cancer that affects those who regularly consume tobacco products, paan, and betel nut, and naswar. The increasing incidence of cancer in Pakistan has made it the second leading cause of death; every year, around 148,000 new cancer cases are reported in Pakistan.  

Pakistan ranks first in Asia for most deaths caused by traffic accidents. According to the latest WHO data published in 2018, Road Traffic Accidents Deaths in Pakistan reached 30,046 or 2.42% of total deaths.  

The World Bank estimates that Pakistan's annual burden of disease due to outdoor air pollution accounts for 22 000 premature adult deaths and 163 432 DALYS lost, while that for indoor pollution accounts for 40 million cases of acute respiratory infections and 28 000 deaths/year. This is the worst situation due to air pollution, but again no significant change has been observed.

The PMA has been very vocal on the increasing tendency of aerial firing in our society during weddings or other celebrations. This practice is an open violation of the law, which often kills innocent people. Unfortunately, this bloody practice has never been stopped, and these horrifying incidents take place regularly.

The year 2020 will also be remembered as critical for medical education because instead of the opposition of all the stakeholders, the Federal Government established the Pakistan Medical Commission (PMC). The stakeholders never accepted it due to its grave defect; they consider it to be disastrous for the medical education and health delivery system in Pakistan.

Now the PMC seems to be a mess and under bad governance. Instead of improving, the situation is continuously deteriorating, and doctors and medical students are facing huge problems. Both the medical education and health delivery system is worsening.

We have been raising our voice for years for doctors and paramedics' security, but our rulers never heard us. So many incidents of violence against healthcare workers took place in 2020 also.  

The PMA has been advocating for investing more in the prevention of diseases rather than the curative side, but nothing has been done, and as a result, the burden of diseases is increasing day by day. By just providing clean water to all the citizens of Pakistan, we can prevent 60% of diseases. If we eliminate mosquitoes, we can prevent all mosquito-borne diseases, which are 40% of our total burden.

According to WHO recommendations, any country's health budget should at least be 6% of the national GDP. In our case, the health budget, despite repeated the PMA pleas and reminders to the government, has remained less than 1%.

The PMA believes that proper planning, political will, honesty, an increase of health budget and its proper allocation, and above all, the consolidated preventive measure can improve the health delivery system in 2021.