Economic survey 2020-21: health spending increases by 14.3 pc to 482.3 billion rupees – business & finance
ISLAMABAD: Health-related spending increased by 14.3%, from Rs 421.8 billion in 2018-19 to Rs 482.3 billion in 2019-2020, according to the Pakistan Economic Survey 2020-21.
Public sector spending on health was estimated at 1.2% of GDP in 2019-20, up from 1.1% in 2018-19. He added that healthcare spending has increased gradually since 2011-12.
According to the survey, Pakistan has shown improvement in health indicators over the past three years. Life expectancy fell from 66.9 years in 2017 to 67.3 years in 2019, but still lags behind in the region. The infant mortality rate, maternal mortality and population growth rate have declined over the past three years.
Afghanistan is the only country in South Asia that lags behind Pakistan due to life expectancy of 64.8 years, while the rest of the countries in the region are ahead of Pakistan because life expectancy in China is 76.9 years, Bhutan 71.8 years, Nepal 70.8 years, Sri Lanka 77 years, Bangladesh 72.6 years and India 69.7 years.
Pakistan lags behind all countries in the region because of the infant mortality rate as in Pakistan it is 55.7 to 1,000 lives, while in India it is 28.23, in Bangladesh 25.6, in Sri Lanka 6.1 and Afghanistan 46.5.
Pakistan’s maternal mortality rate is 140 per 100,000, while in Afghanistan it is 638, India 145, Bangladesh 173 and Sri Lanka 36.
The under-5 mortality rate is highest in Pakistan at 67.2 per 1,000, while it is 34.3 in India, 60.3 in Afghanistan, 30.8 in Bangladesh and 7.1 in Sri Lanka.
With a population growth of over 1.9%, Pakistan is behind only Afghanistan which has a population growth of 2.3% in the region, while the population growth in India is 1%, in Bangladesh by 1% and in Sri Lanka by 0.6%.
By 2020, the national health infrastructure includes 1,282 hospitals, 5,472 basic health units (BHU), 670 rural health centers (CHR), 5,743 dispensaries, 752 maternal and child health centers and 412 TB centers , while the total availability of beds in these health facilities was estimated at 133,707.
There are 245,987 registered physicians, 27,360 registered dentists and 116,659 registered nurses in these facilities in total.
The survey indicated that although after the passage of the 18th Constitutional Amendment, the provision of health services falls under the mandate of provincial governments; However, the federal government has supported various health-related projects through the Public Sector Development Program (PSDP), for the achievement of the Sustainable Development Goals (SDGs) and the general state of health of the country.
In FY2021, PSDP allocations of Rs 20,193.9 million were allocated to 71 health sector projects. In addition, the government has set up a special program with an expenditure of Rs70 billion to mitigate the impact of the Covid-19 pandemic. The program focuses on modernizing healthcare facilities, the sewage system, solid waste management, drinking water and education.
Under the federal PSDP, the government is funding the following projects: (i) The Sehat Sahulat program is implemented in phases and its first phase (2016-2018) was implemented in 38 districts, covering 3.2 million of families.
In the second phase (2019-2020), the program is implemented in 91 districts, providing services to 8.5 million families and the number of beneficiaries of the program is increasing every year.
(ii) The “Ehsaas” program, the family planning and primary health care (FP & SPC) program coupled with the Ehsaas program, strives to control population growth.
Pakistan has a total fertility rate (TFR) of 3.7% and a contraceptive prevalence rate (CPR) of 34.0% (PSLM, 2018-19). Pakistan has shown continued efforts to promote family planning. Each province has developed its own family planning plan. Family planning working groups comprising public and private sector stakeholders have been formed.
The government is committed to ensuring a range of methods easily accessible in the country and has trained mid-level service providers in the public and private sectors to provide intrauterine devices (IUDs) and implants.
In addition, to promote the acceptability of family planning, the government is working with family elders and religious leaders as part of its social mobilization efforts.
The governments of Punjab, Sindh and Khyber-Pakhtunkhwa have established health centers specifically for adolescents.
To continue to promote strong government commitment, the government is working to strengthen collaboration between regions, to reach 6.7 million additional contraceptive users and increase CPR to 50 percent.
(iii) Expanded Program on Immunization: Pakistan became the first country in the world to include the typhoid conjugate vaccine (TCV) in its Expanded Compulsory Immunization Program (EPI).
EPI now immunizes children against eight vaccine-preventable diseases, namely childhood tuberculosis, polio, diphtheria, pertussis, neonatal tetanus, measles, hepatitis B and typhoid.
The government is committed to overcoming obstacles to improving the immunization coverage program through better management, effective monitoring and evaluation (M&E), improved performance management in service delivery, logistical control, human resources management (HRM) and financing.
Encouragingly, the proxy for fully immunized children, measles-1 coverage, is currently 88 percent in the country.
For the EPI, the government has allocated an amount of Rs 2.2 billion in the PSDP.
(iv) Polio Eradication Initiative (PEI) program: nearly 38 million children were vaccinated in March 2021 as part of the National Immunization Day (NID) campaign through the country.
Pakistan is one of only two countries in the world where transmission of wild poliovirus continues, along with Afghanistan.
The number of polio cases increased from 306 in 2014 to 54 in 2015, 20 in 2016, eight in 2017 and 12 in 2018.
However, in 2019, the program witnessed a significant spread of the virus and reported 147 polio cases across the country.
In 2020, 84 cases were reported (Punjab 14, Sindh 22, Khyber-Pakhtunkhwa 22 and Balochistan 26).
(v) National Health Emergency Preparedness and Response Network (NHEP & RN) created in 2011 with the aim of: (i) coordinating and liaising with other national stakeholders to maximize efficiency, (ii) formulating and disseminate health-related updates and information, (iii) coordinate delivery as needed, (iv) coordinate with provinces / districts for the collection of information on essential drugs, (v) coordinate with ‘WHO / provinces / districts for collecting disease data on a daily basis.
In 2020, the NHEP & RN in collaboration with JHPIEGO (Johns Hopkins Program for International Education in Gynecology and Obstetrics) conducted training sessions for quarantine facility staff on infection prevention and standard precautionary measures regarding Covid-19.
(vi) The Safe Blood Transfusion Services (SBTS) program was established by the Ministry of Health, with the collaboration of the German government, to restructure the blood transfusion system and promote a modern national blood transfusion system.
The strategy was to gradually replace the existing dangerous fragmented system with the centralized model recommended at the international level.
In this regard, the government has allocated 235 million rupees in the 2020-21 PSDP to the ongoing SBTS project, titled “Establishing Safe Blood Transfusion Services in ICT”.
(vii) Malaria Control Program: According to the Malaria Control Directorate, Pakistan remains one of the countries in the Eastern Mediterranean Region (EMR) that shares the heaviest burden, with around one million cases of malaria per year.
Efforts have been made to reduce the burden of malaria, particularly in 60 high-risk districts of the country (mainly Balochistan and Khyber-Pakhtunkhwa), by providing free diagnostic and treatment services in more than 5,000 health centers. health, distribution of long-lasting insecticides treated Mosquito nets (LLITN) among the population, capacity building of health personnel, spraying in epidemic situations and in areas prone to epidemics and awareness campaign on malaria in the community.
About seven million suspects are tested for malaria each year. While around 350,000 confirmed cases of malaria are being treated according to national treatment guidelines. Over six million LLINs have been distributed in Balochistan, Khyber-Pakhtunkhwa (including the amalgamated tribal areas) and Sindh province to prevent the population from malaria.
(viii) Tuberculosis (TB) Control Program: According to the WHO, Pakistan ranks fifth among the countries most affected by tuberculosis in the world, with around 510,000 new cases of tuberculosis emerging each year.
The incidence and mortality per 100,000 population per year of tuberculosis in Pakistan are 263 and 19 respectively. Under the leadership of WHO, Pakistan has developed a National Tuberculosis Control Program (NTP) to prevent tuberculosis in the population.
The program includes universal access to quality TB care in the country, expanding partnerships and multisectoral approaches involving all stakeholders.
NTP strives to eliminate tuberculosis in Pakistan by reducing the prevalence of tuberculosis in the general population by 50 percent by 2025 compared to 2012, through universal access to quality tuberculosis care and achieving zero tuberculosis deaths.
Copyright Business Recorder, 2021