The Sustainable Development Goals (SDGs) are a collection of 17 goals set by the United Nations. The third goal listed by the United Nation pertains to health and seeks better quality of public health through prevention and treatment of non-communicable diseases. Goal eight of the SGDs hopes to achieve, by 2030, full and productive employment for people with disabilities. Pakistan has ratified these international covenants, yet it lags in enforcing these commitments. Non-communicable diseases remain a major cause of morbidity and mortality in Pakistan.
Perhaps due to the sedentary lifestyles and unhealthy diets of the people of Pakistan, the incidence of non-communicable diseases is increasing. Pakistan is ranked number seven globally for the prevalence of diabetes. One in four adults is hypertensive and nearly 25 percent of the population faces cardiovascular disease and 30 percent have critically high levels of cholesterol. Economic hardships force rural populations to move to urban areas, placing a disproportionate load on the existing civic infrastructure and public healthcare facilities of the cities.
Despite the availability of affordable, cost-effective and feasible interventions, about 50 percent of all deaths in Pakistan are attributable to non-communicable diseases
Although the country’s political commitment to improving child health is visible through the National Vision 2016–2025, disability in children complemented with a compromised quality of life is still a major concern. According to the United Nations Children’s Fund (UNICEF) data for 2015, nearly 5,500,000 infants were born in Pakistan, with 14,900 daily births. Yet, the public healthcare system is failing to provide quality healthcare.
Although the World Health Organisation (WHO) has appreciated the progress made by the Punjab in implementing health reforms, the province is far from achieving any success in combating non-communicable diseases. Similarly, the only Sindh has passed comprehensive legislation for the Universal Neonatal Hearing Screening Programme, a strategy for early detection of permanent congenital hearing loss.
Although a great show is made of the Official Donor Assistance (ODA), it hovers at around two percent of the total health expenditure in Pakistan, which is insufficient for the health needs of the country.
As reported in the World Bank Country Cooperation Strategy, the overall outlay in the health services sector of Pakistan in 2009 was $4.853 billion, comprising of 24 percent input by the government of Pakistan, while donor support stood at six percent. The role of ODA in combating non-communicable diseases and rehabilitation of disabled persons leaves much to be desired. The balance of health expenditure is funded by individual citizens of Pakistan from their personal resources. According to a Country Cooperation Strategy for the WHO and Pakistan, in the year 2007, Pakistan received more than $2 billion in ODA.
Lady health workers are indispensible but they are overburdened
Labour productivity in Pakistan remains lower compared to other countries in the region and a major cause of this is lack of good nutrition, stunted growth, frequent illness with the malnourished population being susceptible to disease. Inculcation of an appropriate work ethos is possible only if health conditions improve.
The Centre for Disease Control and Prevention lists the top causes of non-communicable diseases as Ischemic Heart Disease (eight percent), cancer (eight percent), stroke (six percent) and diarrheal diseases (six percent). In numeric terms, approximately 100,000 people die each year from cancer in Pakistan. Lung cancer is a common cause of death in Pakistan, with an estimated 6,013 deaths occurring in 2012. Tobacco use is a major risk factor for deaths caused by cardiovascular diseases, cancers and respiratory diseases even though Pakistan is a signatory to the World Health Organization Framework Convention on Tobacco Control.
The Global Burden of Disease 2010 data suggests that there will be about four million premature deaths by 2025 from non-communicable diseases in Pakistan which will have serious socio-economic consequences. Pakistan could achieve 20 percent reduction in the number of these deaths by 2025 by targeting major risk factors of non-communicable diseases. Legislation and health system interventions, if galvanized, can prevent non-communicable diseases and disabilities in Pakistan.
Pakistan has an extensive network of 100,000 lady health workers (LHWs) providing door-to-door primary health care services. These women are seen as the cure for all health concerns, even though they are overburdened and often recruited for a specific objective. Although LHWs are indispensible, a parallel support cadre of technicians is needed to cater to the rising trend in disabilities, warranting early intervention and rehabilitation. This will gainfully employ the educated youth and enable technically-qualified support from the grassroots to tertiary care, besides developing an exportable surplus of trained health workforce, resulting in a win-win situation.
Despite the availability of affordable, cost-effective and feasible interventions, about 50 percent of all deaths in Pakistan are attributable to non-communicable diseases. Yet, we remain in denial and are not shifting focus of our health policy to preventing premature deaths through treatment. The rising prevalence of disability with its accompanying social cost calls for early intervention and rehabilitation. Our health priorities appear to take their cues from the policies of donor countries to minimize the chance of any infectious disease entering their shores. Although this is a laudable goal, the scope and pervasiveness of non-communicable diseases and disability in Pakistan calls for redefining national health goals in tandem with international commitments while walking the delicate tightrope in balancing priorities.
