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Pakistan
Health Care Policies and Developments
National public health is a recent innovation in Pakistan. In
prepartition India, the British provided health care for government
employees but rarely attended to the health needs of the population
at large, except for establishing a few major hospitals, such
as Mayo Hospital in Lahore, which has King Edward Medical College
nearby. Improvements in health care have been hampered by scarce
resources and are difficult to coordinate nationally because health
care remains a provincial responsibility rather than a central
government one. Until the early 1970s, local governing bodies
were in charge of health services.
National health planning began with the Second Five-Year Plan
(1960-65) and continued through the Eighth Five-Year Plan (1993-
98). Provision of health care for the rural populace has long
been a stated priority, but efforts to provide such care continue
to be hampered by administrative problems and difficulties in
staffing rural clinics. In the early 1970s, a decentralized system
was developed in which basic health units provided primary care
for a surrounding population of 6,000 to 10,000 people, rural
health centers offered support and more comprehensive services
to local units, and both the basic units and the health centers
could refer patients to larger urban hospitals.
In the early 1990s, the orientation of the country's medical
system, including medical education, favored the elite. There
has been a marked boom in private clinics and hospitals since
the late 1980s and a corresponding, unfortunate deterioration
in services provided by nationalized hospitals. In 1992 there
was only one physician for every 2,127 persons, one nurse for
every 6,626 persons, and only one hospital for every 131,274 persons.
There was only one dentist for every 67,757 persons.
Medical schools have come under a great deal of criticism from
women's groups for discriminating against females. In some cities,
females seeking admission to medical school have even held demonstrations
against separate gender quotas. Males can often gain admission
to medical schools with lower test scores than females because
the absolute number for males in the separate quotas is much greater
than that for females. The quota exists despite the pressing need
for more physicians available to treat women.
The government has embarked on a major health initiative with
substantial donor assistance. The initial phase of an estimated
US$140 million family health project, which would eventually aid
all four provinces, was approved in July 1991 by the government
of Pakistan and the World Bank, the latter's first such project
in Pakistan. The program is aimed at improving maternal health
care and controlling epidemic diseases in Sindh and the NorthWest
Frontier Province. It will provide help for staff development,
particularly in training female paramedics, and will also strengthen
the management and organization of provincial health departments.
The estimated completion date is 1999. The second stage of the
project will include Punjab and Balochistan.
In addition to public- and private-sector biomedicine, there
are indigenous forms of treatment. Unani Tibb (Arabic
for Greek medicine), also called Islami-Tibb, is Galenic
medicine resystematized and augmented by Muslim scholars. Herbal
treatments are used to balance bodily humors. Practitioners, hakims,
are trained in medical colleges or learn the skill from family
members who pass it down the generations. Some manufactured remedies
are also available in certain pharmacies. Homeopathy, thought
by some to be "poor man's Western medicine," is also taught and
practiced in Pakistan. Several forms of religious healing are
common too. Prophetic healing is based largely on the hadith
of the Prophet pertaining to hygiene and moral and physical health,
and simple treatments are used, such as honey, a few herbs, and
prayer. Some religious conservatives argue that reliance on anything
but prayer suggests lack of faith, while others point out that
the Prophet remarked that Allah had created medicines in order
that humans should avail themselves of their benefits. Popular
forms of religious healing, at least protection from malign influences,
are common in most of the country. The use of tawiz,
amulets containing Quranic verses, or the intervention of a pir,
living or dead, is generally relied upon to direct the healing
force of Allah's blessing to anyone confronted with uncertainty
or distress.
Data as of April 1994
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