Pakistan's Dilemma is Low Priority to Health Sector

By Azizullah Sharif

RENOWNED child specialist and Professor of Emeritus at the Aga Khan University, Prof A. Gaffar Billoo, regretted that the dilemma of Pakistan is that no government has ever accorded priority to the health sector.

In support of his contention, he deplored that all those who ruled the country since it came into being never earmarked more than two per cent budget for the health sector whereas recommended allocation for the sector is at least six (06) per cent.

Prof Gaffar Billoo, who was awarded Sitara-e-Imtiaz in 2007 by the government of Pakistan in recognition of his valuable services in the field of health, had earlier served as dean of Karachi University's faculty of medicine. He is currently Professor Emeritus at the Aga Khan University's Department of Paediatrics and Child Health, Faculty of Health Science, Medical College and founding chairman of the country's one of the largest non-profit organization called HANDS (Health And Nutrition Development Society) which he set up in 1979.

Discussing the issue of low priority to the health sector, Prof Billoo deplored that 40 per cent of the country’s population, living in rural areas, has no access even to primary healthcare. "Government must ensure whatever meager amount was being allocated for the health sector is utilized judiciously and in a transparent manner," he suggested.

ANTIBIOTIC ARMAGEDDON: About the ESCMI's (The European Society of Clinical Microbiology and Infectious Diseases) warning that Britain and Europe collectively could face more than a million deaths in an impending "Antibiotic Armageddon" by 2025 unless more is done to develop new cures, rapid diagnostics and preventive steps to combat the spread of drug resistant diseases, Prof Billoo, who is famous for avoiding antibiotics to children in seasonal diseases said that misuse of antibiotics is going to create serious problems for new and emerging infections in Pakistan also because of increased resistance to antibiotics.

"Doctors have to understand that more than 80 per cent of infections are of viral origins and thus require no antibiotics. In fact, viral infections are self-limiting and resolved in three to five (3 to 5) days and hence do not require antibiotics," he said, adding that cough and cold, influenza, G.I. infections like vomiting and diarrhea (commonest diseases affecting children and adults) don't need antibiotics.

Elaborating, Prof Billoo said that harmful side effects of antibiotics and emergence of resistance bacteria leads to untreatable bacterial diseases.

"Irrational use of antibiotics has led to emergence of multi-drug resistance, he warned, citing two major examples: one salmonella that causes typhoid fever and multi-drug resistance bacteria that causes tuberculosis (TB).

IMR: About the country's infants mortality rate, Dr Billoo said that it is 74 deaths per 1,000 live births and under-five mortality rate is 86 per 1000 live births whereas in developing countries it is below 20 per 1,000 live births. As far as province-wise IMR is concerned, it varies from province to province. Though the Punjab has lowest IMR as compared to Sindh, Khyber Pakhtunkhwa and Balochistan, still its figures are not acceptable, he added.

Asked about diseases against which vaccines are administered to children under the Expanded Programme of Immunization (EPI), he said these include tuberculosis, poliomyelitis, diphtheria, whooping cough, tetanus, haemophilus influenza, hepatitis B, pneumococcus and measles.

To a query whether vaccines against hepatitis A, typhoid and chickenpox are part of the EPI, he replied in the negative, suggesting vaccines against these diseases should also be included in the EPI.

When asked about percentage of coverage of the vaccines included in the EPI among children in Pakistan, Prof Billoo said it hardly ranges between 45 and 50 across the country.

Attributing increasing incidence of typhoid in the country in general and Karachi, in particular, to contaminated food and water, he regretted that government has not been able to ensure provision of safe drinking water to the citizens.

FAKE MEDICINES: To a question about shortage of several essential and life-saving drugs in the country, he said that there is no doubt it was a matter of concern for both the patients and medical practitioners, but the most disturbing aspect relates to the havoc created by the substandard and spurious quality medicines being unlawfully manufactured in every nook and cranny of the country and yet those playing with the lives of the citizens go unpunished.

In this regard, Prof Billoo criticized the Drug Regulatory Authority of Pakistan (Drap) for not doing enough to counter the sale and production of fake and spurious drugs in the country.

HANDS: Talking about his organization HANDS, Prof Billoo said the organization during its 37 years has emerged as one of the largest non-profit organization of the country with integrated development model and disaster management expertise. It started its journey with one room office from Karachi and, at present, has a network of 31 branch offices equipped with 1900 skilled staff. After registration as UK Charity (HANDS International) reached to Nepal and France in 2015.

Divulging into details, he said that this journey has enabled HANDS to gain rich experience in community development and disaster management. HANDS evolved more than hundred best practices model in health, education, livelihood and community infrastructure as well as disaster risk reduction.

Having access to more than 16.2 million population - nearly 20,274 villages/settlement - in 35 districts of Pakistan, the organization is involved in providing training to local matric pass females as midwife to provide antenatal, natal and postnatal services, reduce maternal and neonatal mortality rates through trained healthcare providers, train healthcare providers for reproductive health services.

Regarding the organisation's `Adopt a School Scheme', Prof Billoo said this model is for the population, where government school is available but is non-functional in terms of poor infrastructure or non-availability of quality education.

The objective behind the scheme, he added, is to provide and promote primary education for girls/ boys in underprivileged areas, increase the access and improve the quality of teaching/learning in community-based primary schools and build the capacity and commitment of parents towards their child's education.

AMBULANCES NETWORK: He said that the ambulance service is available in 12 different districts of Sindh and its coverage districts include Thatta, Hyderabad, Matiari, Dadu, Sanghar, Umerkot, Kashmore, Jacobabad, Ghotki, Sukkur, Badin and rural areas of Karachi.

HANDS strength is its volunteers, board members, more than 1700 full-time staff and nearly one million community-based volunteers of 5,205 medium and small-size organizations, he said and added that the organization is also accredited with European Union.