Health in Pakistan

It consists of basic health units, dispensaries, rural health centers, sub health centers that include lady health workers and midwives.

It mainly includes district hospitals or some private hospitals. In district hospitals run by the government, the treatment comes without any cost.

It include both private and government hospitals, well equipped to perform minor and major surgeries. There are usually two or more in every city. Most of the Class “A” military hospitals come in this category. Healthcare and stay comes free of charge in government hospitals. There is also a 24 hours emergency care that usually caters to more than 350 patients every day.[9] They also include Tehsil headquarter hospitals.

The government of Pakistan has also started “Sehat Sahulat Program”, whose vision is to work towards social welfare reforms, guaranteeing that the lower class within the country gets access to basic medical care without financial risks.[10] Apart from that there are also maternal and child health centres run by lady health workers that aim towards family planning and reproductive health.[11]

• Cholera: As of 2006, there were a total of 4,610 cases of suspected cholera. However, the floods of 2010 suggested that cholera transmission may be more prevalent than previously understood. Furthermore, research from the Aga Khan University suggests that cholera may account for a quarter of all childhood diarrhea in some parts of rural Sindh.
• Dengue fever: An outbreak of dengue fever occurred in October 2006 in Pakistan. Several deaths occurred due to misdiagnosis, late treatment and lack of awareness in the local population. But overall, steps were taken to kill vectors for the fever and the disease was controlled later, with minimal casualties.
• Measles: As of 2008, there were a total of 441 reported cases of measles in Pakistan.
• Meningococcal meningitis: As of 2006, there were a total of 724 suspected cases of Meningococcal meningitis.

Pakistan is one of the few countries in which poliomyelitis has not been eradicated. As of 2008, there were a total of 89 reported cases of polio in Pakistan.[22] Polio cases may be on an increase. The total count of polio cases in the country reached nine in 2018.[23] World Health Organisation (WHO) Director General Dr Tedros Adhanom Ghebreyesus said “Pakistan also needs to stop transmission of the virus from Afghanistan. Our New Year’s wish is ‘zero’ polio by end of 2019. The children of Pakistan and the children of the world deserve nothing less. Failure to eradicate polio would result in global resurgence of the disease, with as many as 200,000 new cases every year, all over the world.”

Pakistan is one of the countries in the Eastern Mediterranean Region in which HIV infections are increasing at an alarming level since 1987.[24] The former National AIDS Control Programme (it was developed with the Health Ministry) and the UNAIDS states that there are an estimated 97,000 HIV positive individuals in Pakistan. However, these figures are based on dated opinions and inaccurate assumptions; and are inconsistent with available national surveillance data which suggest that the overall number may closer to 40,000.[25][26] From 25 April through 28 June 2019, a total of 30,192 people were screened for HIV, of which 876 were found to be positive. There are several risk factors for that which include unsafe intravenous injections during medical procedures; unsafe child delivery practices; unsafe practices at blood banks; poorly implemented infection control programs; and improper collection, storage, segregation and disposal of hospital waste.[27]

Pakistan has the highest rate of Breast Cancer among all Asian countries as approximately 90000 new cases are diagnosed every year out of which 40000 die.[28] Young women usually present at advanced stage of breast cancer, which has negative effect on prognosis.[29] Oral cavity and gastrointestinal cancers continue to be extremely common in both genders. Lung and prostate cancer are comparatively less common. Ovarian cancer also has high prevalence.[30]

Eczema is the most common skin disease in Pakistan, followed by dermatological infections including bacterial, viral, fungal, sexually transmitted infections, drug reactions, urticarial and psoriasis.[31]

"The government of Pakistan wants to stabilize the population (achieve zero growth rate) by 2020. And maximizing the usage of family planning methods is one of the pillars of the population program".[32] The latest Pakistan Demographic and Health Survey (PDHS) conducted by Macro International with partnership of National Institute of Population Studies (NIPS) registered family planning usage in Pakistan to be 30 percent. While this shows an overall increase from 12 percent in 1990-91 (PDHS 1990-91), 8% of these are users of traditional methods.[33]

Approximately 7 million women use any form of family planning and the number of urban family planning users have remained nearly static between 1990 and 2007. Since many contraception users are sterilized (38%), the actual number of women accessing any family planning services in a given year are closer to 3 million with over half buying either condoms or pills from stores directly. Government programs by either the Health or Population ministries together combine to reach less than 1 million users annually.[33] Demographic transition of Pakistan has been delayed by slow onset of fertility decline, with a total fertility rate of 3.8 children per woman - 31 per cent higher than the desired rate.[34]

Some of the main factors that account for this lack of progress with Family Planning include inadequate programs that do not meet the needs of women who desire family planning. Also, there is a lack of health workers who can educate about potential side effects, ineffective campaign to convince women and their families about the value of smaller families. Along with that, the overall social norms of society where women seldom control decisions about their own fertility also play a major role. The single most important factor that has confounded efforts to promote family planning in Pakistan is the lack of consistent supply of commodities and services.[35]

The unmet need for contraception has remained high at around 25% of all married women of reproductive age (higher than the proportion that are using a modern contraceptive and twice as high as the number of women being served with family planning services in any given year[36]) and historically any attempt to supply commodities has been met with extremely rapid rise (over 10% per annum) in contraception users compared with the 0.5% increase in national CPR over the past 50 years.

Currently the government contributes about a third of all FP services and the private sector including NGOs the rest. Within the private sector, franchised clinics offer higher quality health care than unfranchised clinics but there is no discernible difference between costs per client and proportion of poorest clients across franchised and unfranchised private clinics.[37] Government programs are run by both the Ministries of Population Welfare and Health. The most common method used is condoms 33.6%,female sterilization which accounts for 33.2%, injectables 10.7%, IUD 8.8%, Pill 6.1%, lactation ammenorhea method 5.7%, others 1.9%.[38]

The health system in Pakistan is influenced by several factors; communicable, non-communicable diseases, malnutrition in children and women and maternal and child morbidities. Pakistan ranks on no 22 in under 5 mortality rate accounting for 81 U5M (2015) per 1000 live births, whereas infant and neonatal mortalities per 1000 live births were 66 and 46. Maternal mortality ratio is also high at 178 per 100000 live births (2015) and only 52% births were attended by skilled worker.[39]

There is a huge imbalance in these figures. In Balochistan, for instance, the maternal mortality is 785 deaths per 100,000 live births which is nearly triple the national rate. In rural Pakistan, maternal mortality is nearly twice than that in cities. The sad reality is that 80 per cent of maternal deaths are preventable.[40]

Nutritionally deprived children not only face difficulties in learning, but also are at prime risk of getting infections, face difficulty in combating and recovering from diseases. Whereas, extreme malnutrition can have devastating effect on children such as stunting (45%), wasting (10.5%) and weight gain (4.8%).[39] These deficiencies mainly include iron and iodine deficiencies.[41]

Obesity is a health issue that has attracted concern only in the past few years. Urbanisation and an unhealthy, energy-dense diet (the high presence of oil and fats in Pakistani cooking), as well as changing lifestyles, are among the root causes contributing to obesity in the country. According to a list of the world's "fattest countries" published on Forbes, Pakistan is ranked 165 (out of 194 countries) in terms of its overweight population, with 22.2% of individuals over the age of 15 crossing the threshold of obesity.[42] This ratio roughly corresponds with other studies, which state one-in-four Pakistani adults as being overweight.[43][44]

Research indicates that people living in large cities in Pakistan are more exposed to the risks of obesity as compared to those in the rural countryside. Women also naturally have higher rates of obesity as compared to men. Pakistan also has the highest percentage of people with diabetes in South Asia.[45]

According to one study, "fat" is more dangerous for South Asians than for Caucasians because the fat tends to cling to organs like the liver instead of the skin.[46]