he healthcare needs of a growing population have overstretched and overwhelmed the public health system in Pakistan. It should be obvious to policymakers in all political parties, therefore, that the governments need to divert all the resources they can to preventive healthcare.

Most of the political parties are currently in the process of finalising their manifestos ahead of general elections scheduled to be held on February 8. Public health professionals are emphasising the need to sensitise the political leadership to make healthcare, a fundamental right under the constitution, a national priority.

“The state is fast losing its grip on healthcare, which is being overtaken by the private sector under an undeclared privatisation policy,” the Pakistan Medical Association has warned. Public spending on health has oscillated between 1 and 2 percent of gross domestic product which is too little considering the World Health Organisation recommends an allocation of 6 percent of the GDP.

While the medical community has been urging the political parties to retrieve healthcare from private sector with a view to implementing homogenous health policies across all provinces, a cursory glance at the election manifestos of mainstream political parties seems to suggest that there is no intention to reverse the ‘devolution’ of health sector to allow greater federal government control.

Pakistan Muslim League-Nawaz has yet to announce its election manifesto. Azma Bukhari, the information secretary for the Punjab organisation, refused to divulge any information until the formal announcement of the manifesto. However, reliable sources in the party say it will include provision of 24/7 high-quality healthcare services. The party plans to start evening services at Out-Patient Departments at the DHQ and THQ hospitals and introduce dental and mental healthcare services at these hospitals. It also intends to improve the preventive healthcare system and set up One Health Councils at district and regional levels.

The PML-N also intends to revamp the major public sector hospitals; upgrade healthcare in prisons and make it independent of the jail superintendent; make medical services available on call in rural areas. It will initiate a revision of curricula in medical education; introduce a PhD programme in nursing; and grant university status to the Pakistan Kidney and Liver Institute, Lahore.

Former federal minister and a central leader of Pakistan Tehreek-i-Insaf Shafqat Mahmood says the party attaches top priority to healthcare. He says the PTI intends to strengthen the Sehat Sahulat Programme (Health Card) under its Universal Health Initiative.

The newly-formed Istehkam-i-Pakistan Party, too, has announced its election manifesto. It envisages the establishment of fully equipped free dispensaries at the union council level. The party’s also promised to ensure accessibility of clean drinking water in all urban and rural areas, free of cost. It has announced that it shall establish public medical colleges and universities in all districts.

The manifesto unveiled by the Pakistan People’s Party says that it will take healthcare services to people’s doorstep and ensure provision of quality healthcare free of cost modelled after the Gambat Liver Transplant Centre, the National Institute of Cardiovascular Diseases, and Sindh Institute of Urology and Transplantation. The PPP also intends to provide clean drinking water everywhere using reverse osmosis plants where necessary.

It says the PPP shall expand the Benazir Income Support Programme to incorporate education, employment and health. “We wish to restore the features of the programme that faced hindrances during the PML-N and PTI tenures,” says Taj Haider, the party’s secretary general. He also says they wish to introduce a Mazdoor Card that will help labourers access financial as well as health benefits. “The party will launch a Bhook Mitao programme at the UC level to address the issue of malnutrition,” he says.

Meanwhile, the medical fraternity remains apprehensive. Leaders of most of the health professionals’ associations say they worry that the healthcare is slipping into the hands of the private sector following its devolution under the 18^thAmendment.

“The Health Card is surreptitious privatisation,” says Prof Dr Shahid Shaukat Malik, general secretary of the PMA’s Lahore chapter. He says finances are being diverted towards private sector through health card in an opaque way. He says the next government should draw a line between private and public health sectors.

He also emphasises the need to prioritise preventive care. “The more a government spends on preventive care, the less it has to spend on curative healthcare. Clean air and safe drinking water can reduce the disease burden by over 65 percent. Vaccines protect the population in an affordable way,” he adds.

He also calls for integration of horizontal and vertical programmes for improved coordination to achieve the objectives in the health sector. He stresses the need for strengthening Disease Early Warning Systems so as to preempt and generate timely alerts about epidemics and to prepare for efficient responses.

He is disappointed that the caretaker government in the Punjab has spent Rs 35 billion on revamping the existing hospitals. Most of the money, he says, would have been better spent on improving the human resource and provision of equipment.

He says the healthcare services have been halted as the ongoing revamping of hospitals has delayed elective surgeries “for months.” The ban on transfers and postings has also affected the delivery of healthcare services in some hospitals.

Following the bifurcated of Health Department– into Primary and Secondary Healthcare and Specialised Healthcare and Medical Education Departments — posts such as APMO, SMO, and PMO have been abolished at the DHQ and THQ hospitals and are no longer available for promotions.

PMA leaders say the pharmaceutical industry is holding the health system hostage. The pneumonia vaccine, for instance, is not available in the market due to hoarding by certain businesses. “The government seems to be losing its writ in the health sector in general and with regard to pharmaceutical industry in particular,” says Dr Salman Kazmi, general secretary of the Young Doctors’ Association, Pakistan.

There has been a mushroom growth of medical colleges in the private sector despite the faculty shortage. The Pakistan Medical and Dental Council has been regularly approving fee raises at private medical colleges. Dr Kazmi says a medical graduate gets a monthly salary of Rs 30,000 at a private hospital after paying over Rs 20 million for his education.

The medical community wants the next government to espouse the concept of One Health.

The writer is a reporter associated with The News International. An EWC and GIJN fellow, he contributes to various international media outlets. His X handle: @AmerMalik3