Published in The News International on November 05, 2006: The explosive outbreak of Dengue raises several important policy questions for long term public health planning in Paksitan. Dengue is making headlines with widespread public attention and political response. True that Dengue and its potentially lethal complication, Dengue Hemorrhagic fever should be a national public health concern – as they are. By way of contextualizing however, here is a disease that does not spread from person to person and therefore does not require patient isolation and barrier nursing and fortunately its vector (the mosquito) will not be able to survive and breed in the forthcoming winter season. On the other hand many other equally serious infectious diseases (such as Multiple Drug Resistant Tuberculosis) often go largely unnoticed by the general public and decision makers as they do not produce explosive epidemics. This notwithstanding, the recent mayhem that Dengue has caused and the attention that it has generated, should provide an opportunity to put systems in place to address such epidemics in the future. The Dengue outbreak and the turmoil created earlier by the expectation...
Published in The News International on October 01, 2006: The Economic Coordination Committee of the Cabinet on Wednesday the 27th decided to allow foreign companies to invest in the insurance business in Pakistan on the premise that this would help attract Foreign Direct Investment (FDI). There can be no two opinions about this being a right assumption if the necessary regulatory environment is secured. But then the other important factor critical to the success of this approach has to do with the issue of demand, which depends on the real disposable income of the prospective policy holder and the individual's perceptions about the need for financial security. In Pakistan's case where 67.% of the population lives in the rural areas and given the low per capita income – the recent increases notwithstanding – the question of demand is all the more relevant and one that needs to be factored into expectations. Then again to put things in context, FDI assume importance as it can impact macroeconomic indicators and again there is no arguing about the importance of the latter, but what...
Published in The News International on September 30, 2006: We have a history of starting things denovo in this country. Individually and institutionally, we must scrap past initiatives, create silos, never build on efforts underway and whenever the adage "we have never learnt from the past" is referred to it is often with a negative connotation. Why should the case of social protection be any different? But perhaps in the given context of 'never having learnt from the past', social protection is unique since the most substantive example of social protection in the country is neither cited nor quoted or referred to in any of the Government of Pakistan documents nor has it ever been referred to by any of the myriad of outputs on the subject by development agencies, with particular reference to World Bank and Asian Development Bank assessments. Furthermore, the example has also been glaringly absent form the recent Social Protection Strategy of the Government of Pakistan released recently by the Ministry of Social Welfare. But perhaps a discussion of this should be preceded by an articulation of...
Published in The News International on September 10, 2006: The configuration of the four health projects presented to August the 23rd's Executive Committee of the National Economic Council (ECNEC) meeting raise some broader issues that need to be the substrate of contemporaneous conceptual thinking with reference to health and health sector allocations in Pakistan. Agreed that there can be no generalizations with respect to the patterns observed in the presentation of health cases to ECNEC; accepted that ECNEC also sees – and approves – the likes of mega budgeted primary health care and preventive interventions and acknowledged that the four projects presented must have been reflective of provincial and district health needs. The purpose here is not to debate the merit of these but to galvanize a thought process and flag the broader questions of priorities for resource allocations in the health sector, the manner in which these priorities are set and the criteria according to which these priorities are determined. Clarity in addressing these questions is a priority now more than ever given the recent increase in budgetary...
Published in The News International on August 27, 2006: Why does technology get spotlighted in the discourse over health outcomes and the discussion on health sector reform? For the simple reason that health and technology have shared agendas. It is well established that in addition to serving as a sine-qua-non of therapeutics and diagnostics in the medial field, technology can not only reduce health-related costs but also medical errors, which are the fifth leading cause of death in countries such as Pakistan. This realization has lent impetus to the emergence of a number of institutional, individual and group professional efforts, in the country, over the last two decades aimed at mainstreaming technology into public health and health systems. Although these are steps in the right direction these need to be strategized and their objectives honed to ensure that they are in line with meeting priority health objectives. Within this context, several examples can be quoted of pilots within Pakistan from which evidence can be gathered relevant to the feasibility and cost-effectiveness of up-scaling particularly in the areas of telemedicine, e-solutions in...
Published in The News International on August 06, 2006: Perhaps no other health policy intervention in recent times has been the substrate of a greater controversy compared with restructuring the mode of primary health care service delivery in Rahim Yar Khan (RYK) as part of which the management of Basic Health Units, in twelve districts of the country, was handed over to the Punjab Rural Support Program in Punjab, beginning 2003. True that an overview of health policy and regulation in Pakistan can highlight many sore spots; the generic drug scheme of 1973, partial deregulation of prices of drugs in 1993, the institutional based private practice fiasco in NWFP in 2002 and the more recent PMDC scuffle are examples of contentious policy issues. However what makes the RYK initiative unique is the length of time for which the controversy prevailed, the utter discord in professional opinion on envisaged merits and demerits, the lack of consensus over how the initiative needs to be contextualized in the overall context of health reforms within the country, lack of full ownership of the State's...
Published in The News International on July 02, 2006: 'Playing health' with a new stack of cards The planet earth's environmental and ecological transformation is a subject of much ado as are the contemporary concerns around the power dynamics, which will determine the global epicenter economically, militarily and politically over next two to three decades. This is justifiably a subject of critical thinking and planning. But sadly, the implications of this makeover for the social sector remain largely unrecognized. In the health sector more specifically, the thinking that health needs to be delivered as a public good – modeled on the Alma Ata ethos – still holds ethical merit backed by constitutional legitimacy and state commitment as in many developing countries; this model is also being followed in Pakistan where the delivery of health is seen as a state prerogative with the state attempting to provide health for all. How the booming market dynamics play into this calculation, how vested interests, profit margins and the omnipresent role of the private sector cut across this paradigm, how a globalized world impacts...
Published in The News International on June 30, 2006: Flagging a 21.3% increase in the budgetary allocation for health as part of the unprecedented increase in the development expenditure in the fiscal budget of 2006-07, the recital of June 5, 2006 made a reference to health as being a provincial subject. True that health is a provincial subject and true that the provinces – and now under the Local Government Ordinance of 2001, the Districts – have legal responsibility to deliver services. But then the federal government has constitutional prerogatives relating to health, which have important fiscal implications both at the provincial and district levels as well as within the overall ambit of federal programs in the health sector. Evidently, increases in budgetary allocations are a sine-qua-non of improving health outcomes. But clearly not the only! As the most complex of the social sectors, health necessitates in tandem systems and financing restructuring, for which budgetary allocations can act as the key tool in addition to being the critical input. With this as a context, three questions have been addressed within the...
Published in The News International on June 06, 2006: Budget 2006 is just around the corner with an indication that there would, both, be aggregate as well as program-specific enhanced allocations for health. This raises the question of whether these can translate into improved health outcomes over the short term. Here it must be understood that the relationship of health indictors does not necessarily parallel the level of resource inputs particularly if considerations relating to the utilization of funds and a reconfiguration of the health system are not brought to bear. Within this context, three questions emerge: how should we interpret and analyze the current allocations – per se; do we need to focus on how budgets can be utilized better and do we need alternate modes of health financing, and if so, why? Firstly, interpreting the ballpark figures: the Government of Pakistan has been spending 0.6 to 1.19% of its GDP and 5.1 to 11.6% of its development expenditure on health over the last 10 years. However, these figures reflect spending by the Ministry of Health and the departments...
Published in The News International on May 28, 2006: Changes in public-private roles are interlinked with broader changes in the macro-economy. Limitations of centrally planned economies, the resultant privatization of State-owned enterprise accentuated by fiscal constraints and donor conditionalities have continued to promote a package of measures in the developing countries, which make private sector the engine of growth. The current Government of Pakistan polices hinge on this concept and have forged 'partnerships' with the private sector in order to finance infrastructure needs of the country and open new sectors on the premise that the role of the State is to provide a policy, regulatory and legal environment. Within this context the recent title of Pakistan's Development Forum "Drivers of Economic Growth: Unleashing the Potential of the Private Sector" was relevant given that it underscored the realization that many considerations have – and will continue to – automatically move back the borders of the State, reshaping the way the government does business. However, it must be recognized that these considerations also impact the discourse over public goods and the role...
Nishtar S, Perry M, Lammare MC, Ritchie J. Global Consortium on Community Health Promotion. Promotion and Education...