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Health and health facilities need attention.

Health and Health Facilities Need Attention

The health and demographic situation in Pakistan is characterised by a high birth rate, a comparatively low death rate and a consequent rapid growth in population. The crude death rate is estimated at 11.0 per 1,000. Since the early part of the century, when the death rate was around 40 per 1,000, there has been a steady decline. By 1950 the death rate had come down to 30 per 1,000. By 1960 mortality had declined to 19 after which there has been a slow decline to the present rate of 10 per 1,000. The target for 1993 has been fixed at 9 per 1,000. The infant mortality rate of 107.70 per 1,000 live births is still very high. In the beginning of the 1960s, the rate appears to have been 130 per 1,000 live births and has gone down gradually to 110. But after that there has been increase in the infant mortality rate to 142 in 1971 and declined to 119.8 in 1985. The benchmark for 1988 was 126.7 against which achievement is 107.70. The target for 1993 is 60 per 1,000.

Reliable data on the incidence of diseases is not available. Hospital statistics provide, however, a fair indication of the pattern of morbidity. It would appear that 25 to 30 per cent of the total diseases are due to disorders of gastrointestinal system of which 1/2 to 3/4th are due to dysenteries and diarrhoeas which are mainly waterborne. The incidence of tuberculosis and malaria is between 7-1/2 to 13 per cent. The total morbidity due to communicable diseases is estimated at 30 per cent.

Some of the structural weaknesses of the present health system may be briefly noted. The distribution of health facilities between urban and rural areas is unsatisfactory. Inadequate health cover for rural areas, where the majority of the population resides, is one of the principal weaknesses of the present system. The problem of health cover for the villages is aggravated by the tendency of private doctors who prefer practice in cities. The Government also faces difficulty in recruiting doctors for rural posts. Funds earmarked for preventive measures are relatively inadequate. The bias in the health programmes has been towards provision of curative services. Furthermore availability of foreign aid and other considerations have tended to favour vertical programmes for combating particular diseases at the expense of strengthening the general health services. As a result, while success has been achieved in controlling major epidemic diseases, the overall incidence of communicable and preventable diseases remains very high.


Pakistan comes under very high U 5 MR (under 5 Mortality Rate per 1,000 live births). Its U 5 MR in 1989 was 162; infant mortality rate (under 1) 106 annual number of births 5,452,000 and deaths 883,000. The causes of mortality seems pretty similar to other developing countries. Diarrhoea, malnutrition and respiratory infections take the highest toll. Tetanus and low birth weight play an important role in neonatal mortality. It is worth mentioning that the majority of the deliveries are conducted by untrained, traditional "dais" and the reporting of deaths in the first few days of life is quite unlikely. Therefore if proper data are obtained and mortality is broken down into neonatal deaths, most probably the new statistics would show the greater number of deaths in the neonatal period which has its own significance in reflecting the quality of health.

Maternal death rate is a sensitive indicator for the coverage and quality of primary health care. Coverage of the population relating to maternal care is extremely poor (not greater than 15%) in Pakistan and reflects in the high death rates of mothers. About 90 per cent of the women are delivered by traditional untrained birth attendants ("dias") in Pakistan. The expectant mothers are generally weak and anaemic and prone to complications of pregnancy and labour because of high parity, close spacing, and low nutritional status. All these factors, in addition to unhygienic methods practiced by dais, result in a maternal mortality rate of 2-4/ 1,000. However, this summary measure is not entirely reflective of the actual situation.

Health Services

At present there is one doctor in the country for 1923 people, one nurse for 5,873 persons and one hospital bed for 1535 persons. The health expenditure per head is little below three US dollar. Because of high emigration of physicians and nurses, there was always discrepancy between the registered personnel and the number who are actively working in patient care. Public health system of Pakistan is oriented towards urban areas, and has never reached more than 15 per cent of the total population of the country. It suffers from lack of coordination and administrative weaknesses. The federal health department controls the facilities and resources and provincial and local authorities are expected to promote services where needed.

Uneven distribution of health resources is evident from the difference in urban and rural physician/population ratios. The ratio is known to be ten times higher in former case in comparison to the latter. Also, there is overall severe shortage of health auxiliaries in the country, e.g. 1 nurse per 23,000 people in rural areas. Health care investment is extremely low and secondary health facilities absorb the largest share. Out of the total expenditure in the health sector in Pakistan during 1970-75 only 14 per cent was allocated to rural health programmes and 10 per cent was used on the most serious problems such as control of communicable diseases. 1978 data show an estimate of 47,481 traditional medical practitioners. These include Hakims, Vaids and Homeopath. Most of the deliveries also are conducted by traditional birth attendants. However, there are also several thousand quacks who illegally practice western medicine. Since these self-made doctors share common cultural values with the poor masses and charge significantly less than registered medical practitioners, they do not face any resistance. Out of the total hospitals in Pakistan, 450 are in the public sector and 202 in the private sector. The private health care market concentrated in urban areas provides services to the individuals and families according to their wealth rather than their health needs.

A nationwide primary health care plan has been in place for some period of time which consists of a basic health unit (BHU) to look after every 5,000 to 10,000 people. Each unit is designed to provide comprehensive health care, including midwifery, child care, immunization, malaria control and family planning.

Furthermore, BHUs will be linked with rural health centers, Taluka (borough) hospitals and districts hospitals. According to the current policy, a network of BHUs will be established during the coming years. Although the foundation of this plan was laid in 1972, but due to political turmoils and changes in government a very limited success was achieved.

World Health Versus

Pakistan Health

The general health of an average Pakistani citizen can only be compared with a citizen of a less developed country. We find that the Government expenditure of health in developed countries is high as against financial health allocation in the developing countries, the latter is very low. Many developing countries spend in the range of $ 1 to $ 10 per capita on health services. As against this the average per capita expenditure on health in the developed countries like USA, Sweden, etc. is around $ 500 and the same in Japan is $ 200. The difference is because there is no paucity of funds in the developed countries. Pakistan's expenditure on health is less than 1 per cent of the GNP which is very low. The rate of infant mortality also varies among the various nations of the world: for Afghanistan it is as high as 173 (for every 1000 live births 205 children die before attaining the age of one) and is as low as 9 in Israel. High Infant mortality coupled with low life expectancy is a feature with some exceptions of the countries of South Asia and many of the African states. Medium mortality along with a higher life expectancy is typical of countries as Burma, India, Kenya and Ghana. Whereas low infant mortality with 10 or less infants dying per 1,000 live births with much higher life expectancy is applicable in case of countries as France, Finland, Germany, Japan and Luxembourg. The availability of medical staff also varies among nations. The range of population per physician ratio varies from as high as 20,356 in Nepal and as low as 1,150 in Singapore. In Burma the ratio is 4,660, India's ratio is 3,690, Sri Lanka has 7,170.

The worldwide total of Hospital beds is estimated at 15.00 million: an average of one bed for 290 persons. But the disparity is immense; the last country has 315 times more people to a bed than the top nation and so is the

geographical distribution, the majority of hospitals being concentrated in urban areas.

Pakistan has the highest per capita income among the South Asian countries, but spends almost the lowest on health facilities. Even in comparison with the developing countries which have much lower state of development and per capita income, Pakistan's vital health statistics were among the lowest. According to the World Bank Report 1990, the per capita income of Bangladesh was estimated to be about 188 US dollars while it was spending 8 per cent of its gross national product (GNP) on health sector. India with a 340 dollar per capita income was spending 1.8 per cent of its GNP on health Sri Lanka with 430 dollars per capita income was spending 1.9 per cent of GNP on health, Pakistan which had relatively the high per capita income of 370 dollars was spending only 0.9 per cent on the health sector.

Even some African countries with lower per capita income were spending relatively more percentage of their GNP on health than Pakistan. For example Somalia had a per capita income of 290 US dollars, but it was spending 2.7 per cent of its GNP on health. Similarly, Malawi with a 210 dollars per capita income was spending 1.4 per cent on health.

Table : Vital Rates (1990)
Crude Birth Rate (per 000) 40.5
Crude Death Rate (per 000) 10.8
Growth Rate (%) 3.2

Life Expectancy at Birth:

Both Sexes (Years) 61.0

Infant Mortality Rate (per 000 births (both sexes) 107.7

Maternal Mortality Rate (per 000 live births) 2.4

Source: Pakistan Economic Survey.

Table : Number persons per Hospital Bed (Persons per one bed)
 No. of
 Persons Persons
 per Hospi- per
Country tal Bed Doctor
USSR 72 259
Germany 91 357
Japan 77 668
Kuwait 340 669
Denmark 159 390
Italy 127 233
Iran 704 2992
UK 138 611
France 80 399
Brazil 282 684
Malaysia 489 2853
Sri Lanka 357 6989
UAE 267 659
China 432 668
Iraq 552 3324
Turkey 476 1360
Egypt 505 616
Saudi Arabia 406 973
India 1130 2471
Syria 870 1347
Indonesia 1495 8000
Pakistan 1783 2176
Nepal 4572 20356
Bangladesh 3187 6219

Source: The World Almanac and Book of Facts, 1991 Published in USA (1991)

Table : Health Personnel and Health Institutions 1990
 tion per
Category Number Facility

 Doctors 59,777 1,923
 Dental Surgeons 2,077 55,368
 Nurses 19,581 5,873
 Health Visitors 3,106 37,025

Health Institutions:
 Hospitals 733 211,460
 Hospital Beds 71,897 1,600
 Dispensaries 3,714 30,964

Maternity Child
 Health Centres 1,027 111,976
 Rural Health Centres 455 252,747
 T. B. Centres 230 500,000

Source: Computed from Health Statistics
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Pakistan
Publication:Economic Review
Date:Sep 1, 1991
Previous Article:Cabinet expansion - weakness or strength.
Next Article:Pharmaceutical industry: the impending collapse.

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