Nisar A. Memon
30-March- 2020 – Pakistan Observer
NEVER before in our 73-year history, the need to review our Public Health System have been felt more than now. In the past; we were confronted by epidemics and diseases like: Dengue, Malaria, HIV/AIDS, Tuberculosis etc. and we took measures to combat them. But the Coronavirus being pandemic, quick spreading, sprawling, new without any known vaccine or medicines, and a national security concern; assumes the greatest challenge we ever faced. We have therefore seen the extent of discussion, media coverage, attention and actions of our governments propelled by this threat to human life. One thing is crystal clear that by and large the citizens, including the leadership, do not clearly comprehend the difference between the medical care and the public health care.
Understanding the difference between the two will bring adequate focus on the quantum of efforts required in terms of planning, funding, human resource and services, speed of response, efforts in deployment of resources, and preparedness needed to save the lives of citizens. The public health system deals with health from the perspective of populations, while medical system deals with health from the perspective of individuals. In medical system, the patient is the individual person while in public health, the patient is the entire community. Public Health is defined as “the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society by improving the health of a population and preventing health problems before they happen.” It covers a range of areas such as: pollution, epidemiology, communicable disease control, risk assessment and health promotion.
In Pakistan, our attention has been on medical care and not on public health care with the result each time an epidemic or a disease surfaces t shakes the society and governments. This is the time to bring needed reforms in various aspects of our public health care system such as: policy, education programs, research, regulations, enforcement, revamping institutions, investing in building hospitals, ICU beds, machines, equipment, supplies, human capacity, and allocate funding with domestic budget allocations.
The plan should be able to deal with diseases and behaviors that increase the risk of identifiable preventable disease, disability and death. United Nations (U.N.) Secretary General rightly says that today there should be only one war i.e. war against Coronavirus. Therefore; at present every single resource and time should be diverting to arresting the spread of COVID-19, creating awareness for prevention, testing, treating and saving the patients. In this unprecedented national emergency, how do we go about addressing our public health system? It can and must be handled by moving from denial to reality and from political to apolitical mode, to unite the nation.
While various federal government ministries are busy handling current situation, the Inter Provincial Coordination (IPC) Ministry can be tasked to work on public health system in liaison with provinces and experts to prepare and present to government a focused strategy of reform plan, for discussion in Council of Common Interests for national adoption with endorsement of parliament. This can help bring all political and technical professionals together for nation building. If government has better plan instead of engaging IPC and its Reform team, they should bring it to parliament. This is not the time for rhetoric and interviews but plans and actions in service of people to strengthen the federation. The people of Pakistan are looking to see the vision of the leadership in announcing a new Public Healthcare System based on lessons learnt from current situation. The citizens would like to know the model of the public health system from various global systems government selects to suit the genius of our people.
The responsibilities of public health must be brought in line with Constitution and 18th Amendment, and if needed spell out the changes required. The plan should identify the lead Institute of public health in each federating unit, Gilgit Baltistan and Azad Jammu & Kashmir. It should indicate designated hospitals with adequate equipment, medicines and staff for improved public health delivery; better appreciation of epidemiology; public private partnership with business and industry; an effective communication system for greater awareness and transparency; and of course, the increased budget. Public health is a social good; therefore, the government spending on health from domestic sources is an important indicator of a government’s commitment to the health of its people and reflects the priority that the policy makers attach to provision of social good. The plan shall address the gaps in our system visible in current crisis and identify the real needs.
If it is not done now, after the crisis is over the public health will once again be forgotten jeopardizing sovereignty of country which cannot be achieved without a robust public health system with special focus on role and contribution of women in health care system whether as doctors, paramedics, health workers or health volunteers. U.N. is considered as the global guardian of public health and The World Health Organization (WHO) is a specialized agency of the U.N. responsible for international public health and is part of the U.N. Sustainable Development Group.
The Sustainable Development Goal (SDG) number 3 – Good Health and Wellbeing, ensures healthy lives and promotes wellbeing for all at all ages. SDG 3 is supported specially by SDG 4- Quality Education, SDG 6 – Clean Water and Sanitation, SDG 11 – Sustainable Cities and Communities. The World Health Day falls on 7th April each year, the minimum we can announce this time is our commitment for renewed focus on public health and announcing strategic direction and governments key milestones of the public health policy and programs.
The All Parties Conference and the government should sit together and put up a united front and announce how public health system will be reformed to face current and future devastating events and create hope for public good instead of despondency.
—Nisar A. Memonformer federal minister &senator