In 2024, “My Health, My Right” stands as the theme for the Global World Day celebrated annually on April 7th under the auspices of the UN agency, WHO. The three keywords, “My,” “Health,” and “Right,” prompt me to share some long-suppressed thoughts. Over the years, seasoned practitioners, who do not cater to popular sentiment, have raised concerns, but there seems to be little attention paid to their voices. Discussion on health agendas rarely includes professionals without conflicts of interest. This piece, however, refrains from lamenting the portrayal of health in mainstream media or the intellectual value attached to the health business. Instead, it aims to gather essential information and reminders this April, with dwindling hope that someone in Pakistani policymaking circles might take notice. My thoughts resonate with the concerns of many like-minded individuals – patients, providers, payers, suppliers, and policymakers – who collectively shape the dynamics of health systems in our sector.
Below is a snippet, grounded in evidence rather than emotions, addressing two major queries: What is the status of healthcare in Pakistan, and what are the underlying problems? Additionally, a supplementary question arises: where do these problems lie?
140 countries have health as a constitutional right, and Pakistan is not among them. According to a WHO survey in 2023, Pakistan currently ranks 124th out of 169 countries, indicating that 73.37% of the world has better medical systems than Pakistan. Countries such as India, Bangladesh, Nepal, and Sri Lanka outperformed us. In 2023, Singapore led the world’s health rankings, followed by Japan and South Korea.
In 2022, news reports citing Transparency International labeled the healthcare sector in Pakistan as the most corrupt, with 78% of the population bearing healthcare expenses themselves. Within the framework of health system development, there exists a frightening absence of skilled and qualified healthcare professionals, with a ratio of one doctor for every 1764 patients. This shortage, paired with persistent inequities in resource distribution between rural and urban healthcare domains, exacerbates the burden on urban infrastructure, resulting in inadequate provision of health facilities, physician shortages, inaccessibility to senior and skilled doctors, and patient dissatisfaction.
If these anomalies were to be given a name or diagnosis, none would be more fitting than “Corruption,” defined as the “abuse of entrusted power for private gain.” This is a global issue. Various research-based statistics suggest that worldwide, over 7% of healthcare expenditure is lost to corruption, amounting to over US$500 billion annually. In developed nations like the United States and Canada, losses are estimated at up to 10% of public health expenditure, while in Europe, it amounts to 56 billion euros annually, and $75 billion in the United States for Medicare and Medicaid payments alone. The situation is even more dire in developing nations where corruption thrives.
The unique nature of corruption in the Pakistani health sectors arises from the normative significance attached to it and the tendency to avoid discussing this topic due to its political implications. The criminal, immoral, and ultimate betrayal of public trust manifests in at least three keyways in the health sector: the destruction of the healthcare system’s ability to deliver high-quality and effective care, a blockade to the development of a robust private sector due to corruption within the public sector and reduced economic growth and private sector investments. During a lecture titled “Health for All” at Karachi University in 2022, prominent health expert and civil society activist Prof. Dr. Tipu Sultan stated unequivocally that corruption has been institutionalized in the health department, with regulatory bodies creating obstacles for qualified doctors and patients. He described a situation where a mafia in the guise of medical professionals prioritizes monetary gain over the dignity and sanctity of the profession, resulting in long queues of patients outside major tertiary healthcare hospitals, while taluka and district healthcare facilities lack surgical facilities and doctors. In January 2024, the Pakistan Medical Association presented a report titled “Health of the Nation 2024” based on WHO rankings.
Despite numerous calls to action, these issues fail to make headlines or capture the attention of those responsible for establishing equitable health systems. It is not solely our mammoth population that poses a challenge, but also the inequalities and injustices of various origins. However, there are solutions to this problematic spectrum. Instead of scapegoating the population issue, attention should be directed toward our suffering people, dedicating and directing resources to those who need it most, to effectively enhance health outcomes for individuals who are often overlooked, while improving efficiencies and lessening overall costs.
The real challenge lies in the fact that those mandated to address these issues are too often complicit in the mismanagement of resources through embezzlement, misappropriation of funds, and wastage of meager capital. Thus, the question arises: who should undertake the task of accounting and auditing? There seems to be no inclination toward initiating visible collaboration between civil society, professional auditors, regulatory bodies, and law enforcement agencies to ensure effective oversight and accountability without compromising democratic principles. Should this agenda be referred to the army?
