In 1980, medical science put an end to one of the deadliest infectious diseases in human history. The ugly Smallpox, perhaps the most horrific looking disease, was declared completely eradicated by the World Health Organization. That marked the beginning of the era of endless possibilities against the challenges to human wellbeing.
Since then, millions of deaths have been averted through use of vaccines, access to clean water and sanitation has relatively improved while the fight against major infectious diseases has reached a decisive stage. Today we have a global vision of “healthy lives and wellbeing for all.” Will our society ever be able to realize this vision? The fight is hard, but success is promising.
The provision of modern public health services in subcontinent dates back to the health survey of the Bhore Committee, carried out in 1943. The committee outlined the fundamentals of health services, the core principles on which we have our public health system. They believed that the loss of human lives and efficiency is avoidable through integrated preventive and curative services, development of primary healthcare, and education of social medicine.
Such health services however, could not be made fully functional in Balochistan until 1971. For majority of Balochistan there had been no public health services at all until then. After decades, the province is still struggling with provision of quality healthcare. However, given the relatively shorter operational history and bigger challenges, there has been some progress that gives us hope for the achievement of healthcare goals.
Contrary to national healthcare system, in Balochistan the share of private sector in curative services is minimal. Government remains the major provider of curative and preventive services not just in most of rural areas but also to majority of urban population. Therefore, the improvement in health conditions depends directly on the performance and efficiency of provincial health department. The responsibilities and role of the department has also increased after the 2011 devolution of federal subjects, including health to provinces.
Currently the provincial health department is operating a vast infrastructure of health facilities at primary, secondary and tertiary levels which operate through referral system. The system has undergone various reforms over the time, mainly in primary healthcare. Following the 2001 devolution, basic health management was placed under district government. In a later move the vast network of Basic Health Units was handed over to People’s Primary Healthcare Initiative, improving the access to basic health services through public-private partnership. The provincial government has also announced recently to up gradate over 130 BHUs and RHUs to plus level with additional staff and equipment.
The operational and fiscal scope of public health sector has increased much in last five years. The share of health sector in provincial budget has increased 20% from 15.2 billion rupees in 2013-14 to 18.3 billion rupees in current fiscal year. Besides the growing share in budget there has also been progress in private-public partnership, and cooperation of the department with international aid agencies.
Despite the morbidity that is prevalent in government offices, the health department has been able to show up with some major developments. Recently Balochistan has witnessed its first-ever renal surgery. The surgery was carried out at the newly upgraded Nephro-Urology institute in Quetta. The well-equipped institute is providing health services to patients with renal problems in their home province. Patients from all over Balochistan previously had to travel to Karachi and Lahore for surgery and dialysis services. The modernized health facility is functioning at an exceptional level of efficiency which is rare in Balochistan.
The government has also acted as per recommendations of judicial commission constituted after August 8 civil hospital carnage. Following the observations and directives of the commission the trauma and emergency center at the civil hospital has been declared autonomous body.
The prime health facility in the province has also been beefed up with much-needed CT and MRI scanners. Some strict checks and balances have also been put in place to improve the performance of staff. As per health department sources, in a recent move action has been taken against 118 doctors and other staff over absenteeism.
It was also for the first time that many parts of Balochistan got access to ambulance services in their area. As per government claims, each district now have ambulances at their disposal. The fleet also includes ten ambulances gifted by Emir of Qatar last year which were distributed in Washuk and Kharan districts.
Besides this, a number of ambulances have also been distributed in various districts by MNCH, the Mother, New Born and Child Health Programme. The service means much for the rural Balochistan which is mostly ignored by the major ambulance services such as Edhi and Chhipa.
The ambulances provided by MNCH are specialized for the care of expecting mothers and can help reducing maternal and child mortality rate. Balochistan has the highest ratio of maternal and child mortality rate as compared with other parts of the country. As per estimates nearly 800/100,000 mothers die giving birth, while around 160/1000 children die during birth in Balochistan. Similar statistics are also witnessed in other health indicators.
For instance, the ratio of infectious diseases in Balochistan is 53 percent of disease burden, which is around 40 percent on country level. The province is also facing acute food insecurity; out of country’s 20 highly food insecure districts 10 are in Balochistan. Over 60% of province’s population is exposed to moderate to high food insecurity.
The health targets set by the United Nation in its Sustainable Development Goals require a strengthened public health system. The current status of public health services in Balochistan is not exemplary, but it can help improving the situation. The recent developments need to trickle down to marginal areas, particularly the rural areas and urban slums.
According to 2017 census, Balochistan’s population is growing at a rate of 3.37% which is quite high compared with the national average of 2.4%. The urban share was recorded to be 27.5% whereas 72.5% of population lives in rural areas which are less likely to get access to quality healthcare.
To attain ‘healthy lives and wellbeing for all’ needs sustainable development in entire social and economic structure. According to UN reports, the likelihood of infant mortality is almost twice in poor families as those of wealthier families. Also the proportion of mothers that do not survive childbirth is 14 times higher in underdeveloped regions.
Along with economic conditions, education also plays a key role in improving health and wellbeing. Data show that children of educated mothers are more likely to survive as compared with children of illiterate mothers.
The global community has shown its commitment towards human development, particularly for health and wellbeing. Any society willing to fully utilize its potentials can find many helping hands to overcome the pressing healthcare challenges. It is high time that we pick on our shortcomings and capitalize our gains to attain a healthy society.
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