Personalised Primary Healthcare in Pakistan: Far away from reality
By Asad Ali Siyal
HEALTH HAS always been a major issue for any country. Anywhere in the world, health plays a primary role in determining the human capital. Healthcare reforms have gained serious attention in advanced countries from diagnosis to treatment practices. But still healthcare systems implemented today are not really “systems” at all in most of the developing countries like Pakistan. They have been fragmented from the primary situations to personalized era of medicine which has resulted in poorly coordinated patient care.
Primary healthcare, often abbreviated as “PHC” has been defined as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and that a coast that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.
The better personalized primary healthcare system helps to execute the ethical problems with the science of health and its delivery. It effects health promotion and care-delivery of patients by using more personalized information and clinical knowledge to help and promote their health from predicting, preventing and management of disease solutions. Unfortunately, in Pakistan personalized healthcare is too far from the reality. It generally has been practiced with limited availability of patient information, technical resources and clinical knowledge.
With the inception of improved science, and ongoing research in advanced countries Personalized primary healthcare has succeed to reduce overall costs of health promotion and care delivery and has enabled great potential to improve quality of life. Thus developed countries are investing more to improve their primary healthcare system.
Healthcare delivery is not an isolated system. It is primarily related with poverty, education, justice, security and emotional, mental and spiritual well being of a person and community at large which leads towards economic progress of a country.
The primary healthcare system in Pakistan has suffered a lot, due to structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. These all issues have been caused by the governmental policies as healthcare sector of Pakistan moves on the threshold of state policies.
The primary health factors and health funding infrastructure of Pakistan are generally poor throughout the country and in rural areas particularly. Over last 10 years data retrieves that Government of Pakistan has spent just 0.6 to 1.19 per cent of its GDP and 5.1 to 11.6 per cent of its development expenditure for healthcare sector and reforms.
Around 19-30 percent of population is malnourished including children that have caused number of diseases such as gastroenteritis, respiratory infections, congenital abnormalities, tuberculosis, malaria, typhoid fever and hepatitis that leads towards the causes of death.
In any complete true health system, good health services are those which deliver effective, safe, good-quality, personal and non-personal care to those that need it, when needed, with minimal waste, and more equitable coverage and quality.
From last few decades, ICT have proliferated vast impacts on healthcare systems globally. They have enabled healthcare by improving the science of health promotion and care delivery. Thus ICT has generated opportunities and new demands for a range of different approaches to health care and has played a key role in making it more personalized. Consequently, healthcare has always remained at the cutting edge of modern technologies. In most developing countries new developments in biomedical field such as telemedicine, e-health systems, bio-computational modeling, bioinformatics and biomedical imaging intelligence are being carried out for diagnosis, treatment, data acquisition and medical-profiling and ensuring better health facilities as they are leading towards a new era of personalized healthcare.
So far the accelerated technological revolution is developing the great potential for improving health and transforming health literacy for modernizing global society. But Pakistan like many other developing countries is still lacking in such sophisticated technical advancements and facing tribulations in health care deliver. Hence, primary healthcare in Pakistan is currently meeting with several reforms at the federal, provincial and district level particularly in delivery of health service to the inhabitants. Although there is a huge ratio of government/ taluka/ district hospitals throughout the country but still they are failed to provide better healthcare facilities due to inadequate technical expertise, the other major problems with most of them are the lack of resources, incomplete services and scarcity of technically skilled and quality biomedical/clinical engineers.
There is a perception among whole the country hospitals that if any piece of equipment or any machine gets any fault, in-spite-of making its proper maintenance new machines are acquired. Although Public health sector is spending millions on machines used for different purposes, but it would have been more better enough if despite of wasting millions on equipments (that are even not used properly later) quality biomedical engineers must be procured for their repair and maintenance, as machines required good maintenance for proper working which can only be provided by the services of Biomedical Engineers. The biomedical engineers are involved at many levels of healthcare management as they make the safe, appropriate and economical use of technology in the health care system.
In developed countries, for every 50-beded hospital minimum 2-3 biomedical engineers are must acquired as gazetted officers/employees. While here is the tragedy that recently I visited a hospital which contained 300 plus beds but there was no any single biomedical/clinical engineer hired for the repair maintenance of equipments being used over there. Only there were 2 technicians that were maintaining the equipments of all the sections from diagnosis to treatment in that entire hospital while most of the machinery was non-functional due to technical faults.
Thats what the main reason that many of our institutes have the most expensive machines but not in a working condition.
On the other hand there is no any particular policy announced by the state for these government hospitals for the availability of Biomedical Engineers. As a result utilization and satisfaction levels of primary healthcare in Pakistan have remained unchanged during the last three decades. Therefore, the healthcare scenario of the country is still below than the standard line.
To succeed in transforming healthcare, biomedical technology should be, at the heart of personalized healthcare system. Pakistan will need to move to more personalized healthcare in order to make its primary healthcare facilities stronger by improving technical enhancements. Successful results require access to more complete patient information to incorporate advanced clinical knowledge into clinical decision making. Better health improves the flexibility and the efficiency of inhabitants that contributes to the economic growth and leads to human welfare. Therefore, there is a dire need to strengthen primary healthcare system to make health information technology (HIT) environment wider throughout the country technically as well as clinically.
Therefore, an authenticate healthcare-infrastructure is needed in this regard to overcome the care delivery problems; and to bridge the gap between hospitals and their technical-drivers, so called the Biomedical Engineers. The successful execution of these technical-drivers would fuel economic growth and substantial improvement in the quality of life. Thus, effective primary health care will only be improved by hiring fine numbers of clinical engineers for available and new equipments, introducing modern technologies and information.
Now the improving access to quality health services depends on the way government organizes the services and manages the other incentives influencing healthcare. Government must take steps and define its role explicitly in designing, implementing, monitoring and hiring of healthcare facilities as well as technically-skilled professionals. As there is an utmost need for quality improvement and management of health care delivery and transforming primary healthcare of Pakistan in comparison with the modern world that is changing towards more personalized era of healthcare.
The writer is Chairman, Biomedical Association of Students for Excellence (BASE), at MUET, Jamshoro, Sindh, Pakistan.