If there is one clear message emanating from the coronavirus crisis in evolution, it is the utter failure of healthcare systems in the so called developed world, besides the fait accompli it provided, to developing countries.
The capitalist for-profit system epitomised by USA, as well as the inadequacies of the much vaunted advanced European health delivery systems in Spain, Italy, France and Germany were exposed.
Despite the claims, these countries have a disintegrated, universal health coverage that could not cope with the disease burden at hand.
In Pakistan, we have 20% of what our required WHO recommended hospital bed strength is. Our doctors are less than 50% of the recommended number for the population. Our nurses are in a ratio of 1:2 instead of 2:1 compared with physicians which means they are about 12.5% of what the recommended ratio is.
Our primary, secondary and tertiary healthcare in the public sector is grossly underfunded, overstretched and overburdened. The private sector is fraught with uneven resources, ranging from the sublime to the ridiculous. The armed forces have a service oriented focus and provide above average, if not brilliant ‘quarternary’ care.
Quality parameters are ill-defined for the most part.
Some have achieved joint commission accreditation which is often a “cat and mouse” game, with seasonal brilliance, based on my personal national and international experience.
Research is largely considered a luxury and disintegrated from service and quality management. Hence, the chaotic nature of our response to a purely scientific challenge .
The health governance is decentralized to the provinces, yet dependent on the central financial divisible pool. It is therefore no surprise, that Pakistan was caught napping with the quarantine fiasco in some places and disintegrated response between the provinces and center.
The plan to focus on “thousands of ventilators” but insufficient availability of COVID-19 testing kits, as well as gross inadequacies in personal protective equipment, suggests we are bracing for a tertiary care failed ‘capitalistic’ response, instead of implementing the basics of infection prevention and control through a strategic lockdown.
Pakistan has a three to four channel healthcare delivery system which fails to bring together the best experience and expertise. It also fails to provide equity in healthcare and has miserably failed in removing healthcare disparities.
Perhaps, now is the time to think nationally about an integrated healthcare workforce delivering universal equitable health care. If the less privileged are cut off from basic preventive care, those living in the proverbial ivory towers are also not spared of its effects. COVID-19 has very clearly demonstrated that.
Coronaviruses will keep coming back in mutant forms. However the time to learn lessons is now.
A university driven healthcare delivery system bringing in its fold public, private and the armed forces models, is a need of the hour. South Korea has shown the way forward with its universal, equitable healthcare delivery system which has contained the COVID-19 challenge in a matter of weeks.
Pakistani healthcare planners, instead of the usual reactive strategies, need to proactively step up now. It needn’t be recurrent coronavirus attacks that wake us up from our long drawn slumber.
A welfare state is all about its people and equitable healthcare is a universal right, that each citizen of Pakistan deserves.