Health Care صحت عامہ اصلاحات اور احتساب کی ضرورت

Health Care   صحت عامہ  جایٔزہ  Pakistan
Year(2016 )brought three very positive but overwhelming news stories regarding the Health and Social Welfare sectors in Pakistan; all three programmes, if followed and implemented well, can take us into the right direction especially at the welfare state level.
When  development and welfare is considered in Pakistan, Punjab is way ahead in its efforts compared to other provinces and regions. There have been a number of major health emergency situations in recent years which the Punjab administration has fought and responded to successfully.

New Programmes for Health and Social Welfare :
  • Disabled Stipend (Khidmat Card)
  • National Insurance
  • Rehab Centers in Punjab Districts
Fortunately, all the above-mentioned announcements are about health care and the welfare of the deprived Pakistani citizens, which the civil society welcomes and believes in the good intentions behind such social uplift initiatives; however, there are still a few lingering, crucial questions, concerns and suggestions regarding new and old programmes. 
These concerns are linked with previous campaigns for social uplift and new efforts can not bear fruit without taking inventory of past work. Pakistan is  witnessing  an exploding population sinking  in poverty  and there seems to be an obvious void between health care and social welfare programmes.  All major campaigns for welfare and health care which the nation has experienced earlier have begun with good intentions and big budgets, however,  somewhere in-between, the programmes go off-track and become wholly ineffective.
There should be a holistic approach for all welfare and local health programmes; one programme can not be effective in isolation.

Suggestions, Concerns and Questions
  1. :It is important to  review the stipend amount for “Khidmat Card “ and should only be finalised with relevant feedback, while keeping real costs of basic survival in mind.
  2. Approval of Khidmat Card applicants’ cases should be decided considering the severity of each individual applicant’s disability.
  3. The definition and classification of Disability should be set with our local conditions in mind and public feedback should play a significant part in the process.
  4.  Disability-related services should be approved for the seriously and chronically- disabled on an urgent basis.
  5. Procurement process for citizens to access disability care, such as devices, crutches and therapies, should be clearly explained and this information should be easily accessible to the public-at-large (in bilingual/multilingual formats).

This information will be easier to understand  if authorities  and concerned departments  try to answer these few Questions for the intended beneficiaries !  

  • Suggestion(disability should be determined at  the time of first registration at NADRA  like for a B form, or CNIC ) ?
  • What is the role of NADRA ? 
  • Is there an overlapping of services being offered, like the “Khidmat card” , , BISP, National Insurance” and “Rehab centre” services? 
  • Do applicants require one central form or approval number ?
  • Do they need to submit multiple applications to get disability services and funds? 

    Suggestions for PWD:

The way the disabled currently access services or even prove their disabilities to the Social Security department is exhausting, and self-defeating. There has to be a better, more accountable process that reaches directly to the disabled population in-need, from the top-down.

  1.  Basic Health Unit (BHU), Lady Health Visitors (LHV) and Lady Health Workers (LHW) programmes can be used for an early intervention system setup to minimize disabilities damage if they occur   at the time of birth (such as Cerebral Palsy, Down’s Syndrome, etc).
  2.  District hospitals should be equipped and staffed better to provide services for their local populations.

  3. Suggestion: Government should make it mandatory for employers to get group insurance for all of their employees.
  4. Suggestion: Capacity Building: There is an an urgent need for a framework for capacity building in relevant fields, from education to creating jobs in  fields concerned with the disability sector. This can be accomplished by giving free scholarships to welfare professions like Physiotherapist, occupational, and vocational therapist and at the school-level, providing caregivers, and nurses’ training with guaranteed jobs to fill the space and need.
  5.  At the next level,  “Ray Shumari” NADRA cards should have disability data updated to verify family members with special (disabled) needs and with chronic health care needs.

Concern: Business loans for Hospitals is not a good idea; this can trouble an industry that already is suffering from lack of transparency and poor services rendered to the general public.
BISP or Khidmat Card:
If we plan to base the Khidmat Card on the Benazir Income Support Programme (BISP) assessment  basis (which is linked to the older Zakat &Usher programme), then we need to face the reality that goals set for BISP have yet to be met. There are massive instances of mishandling and fraud around this programme; the actual deserving citizens are still in despair.All these free services are not reaching the disenfranchised. It is unrealistic to expect better results with the same framework, same staff and departments in place.   
Disability Situation In Pakistan:
Rehabilitation and health care work is no longer a simple task; Pakistan faces numerous challenges from an on-going war,  to years of terrorism, disabling natural calamities and an increasing number of road accidents. We have an ever-increasing number of people with disability who can not perform their daily-living activities (DLA)  alone and are dependent on their family or friends for these basic needs.

Disability is Expensive! 

If the state can not  take up the tab, that instance of  individual disability can negatively affect the whole family, because a disabled child has more needs (financial, medical, and otherwise) compared to his healthier siblings.
If a child is disabled by birth, like in the case of Cerebral Palsy  or  developmentally delayed growth, his family needs to spend extra time and money to maintain his basic living, in the form of medicines, diapers to wheel chairs, medical and therapeutic services on a frequent basis. However,  all these needs require funds, a minimum basic amount to maintain a dignified living.  Most rural and urban  areas , representing  70% of the nation’s population, do not possess the knowledge or resources to cope with the challenges of sustainable disabled care.