023 was quite a happening year for the health sector in Pakistan in general and in the Punjab in particular.

To begin with, there was political uncertainty as four chief ministers took over the office in the last one-and-half-year. Some stability was finally restored as the caretaker government continued in office beyond its standard 90-day mandate.

Experimentation with the Health Department has continued under the current set-up with two ministers – Prof Javed Akram for Specialised Healthcare and Medical Education and Dr Jamal Nasir for Primary and Secondary Healthcare. Ali Jan Khan is the single secretary for the two departments. Previously, the PML-N government had run the health sector with two ministers and two secretaries. The PTI government had replaced them Prof Yasmin Rashid, the sole health minister, with two secretaries for the bifurcated departments.

The caretaker government started an ambitious project of revamping 100 hospitals across the Punjab. Mainly, the emergency departments and indoor wards were renovated. While most hospitals needed renovation, the selection of areas to be renovated in many hospitals was not right. Some of the funds were thus wasted. However, the project was widely hailed within the medical community as funds for the purpose had been extremely scarce for the last couple of tenures so that hospital administrations had in some cases sought donations from NGOs for necessary renovations.

However, the revamping project seemed to have been initiated without considering the alternative arrangements so as not to affect the services. The hospitals made makeshift arrangements by conducting emergency operations in operation theatres of various departments. This resulted in delaying other scheduled surgeries for months.

A building in the Services Hospital that had housed Paeds Surgery, Ophthalmology and ENT Wards collapsed. Fortunately, there were no casualties.

Chief Minister Naqvi made several visits to teaching hospitals as well as several other hospitals across the Punjab. The government started primary PCI (percutaneous coronary intervention), also known as angioplasty or coronary angioplasty, for the treatment of narrowed coronary arteries of the heart and angina patients.

The government also set up primary stroke centres at 15 hospitals in the province to provide tissue plasminogen activator injections to stroke patients free of cost.

The Young Doctors Association observed several strikes and boycotted services in Out-Patient Departments in public hospitals all over the province. Prof Javed Akram, the minister, engaged the YDA in a dialogue and resolved the matters amicably so that a deadlock was avoided.

The health secretary started a biometric initiative to identify unattended patients and unclaimed dead bodies in the Punjab to resolve the chronic issue with the support of the Police Department.

The authorities unearthed a scam, indicating misuse of the Sehat Sahulat Programme. It was alleged that funds had been misappropriated through various malpractices at empanelled private hospitals. Amid the deluge of complaints of unnecessarily diverting patients to private hospitals and labs, health authorities found anomalies such as excessive caesarian section cases, the implant of up to three stents during cardiac procedures and use of substandard stents, unregistered ophthalmological lenses and low-quality medicines. It was alleged that untrained and junior doctors had been engaged in some cases to perform complex procedures including bypass surgeries.

Some of the private hospitals were found to have recommended unnecessary tests and made counterfeit invoices.

The World Health Organisation recommends the allocation of 6 percent of the gross domestic product to the health sector. The medical fraternity is deeply concerned over minimal spending – 1-2 percent - on healthcare in Pakistan. Out of this meager allocation, most of the funds are diverted towards curative healthcare rather than preventive measures.

Consequently, Punjab Health Initiatives Management Company, the institution responsible to implement the SSP, suspended gynae/delivery cases and cataract surgeries at private hospitals. The PHIMC also imposed a co-payment of 40 percent by the patients, besides directing all empanelled hospitals to acquire regular licences from the Punjab Healthcare Commission till December 31, 2023.

In a major scandal, contamination in Avastin injection caused loss of eyesight in 60 patients, pointing to a weak drug control mechanism. The drug, primarily used for cancer treatment, is also recommended for ophthalmic use in small quantities. A high-level investigation found that the unauthorised refilling and unsafe transportation had caused the contamination. The culprits were identified and apprehended.

At least two instances of illegal kidney transplant were reported. In one case, the surgeries were allegedly performed at a home rather than some hospital. In the other, a kidney transplant racket was being run by some doctors from Dubai at a rented farmhouse.

The availability of medicines remained a cause of concern in hospitals. An anaesthesia medicine used prior to surgery was not available at government hospitals. The patients were asked to purchase it from the market.

The government pumped Rs 100 billion into the Universal Health Initiative, also known as the Health Card. The Finance Department was reluctant to provide more funds and asked hospitals to generate their own funds through Health Card after the government had already paid the premium. However, the hospitals failed to manage this.

Medicines became costlier by up to 400 percent amidst persistent shortages, mainly because the Pakistan Pharmaceutical Manufacturers Association went on a strike over their claim of higher cost of inputs and shortage of raw material as letters of credit for imports were closed.

The Punjab Healthcare Commission failed to bring substantial reforms and limited itself to imposing fines on quacks and hospitals. The PHC also failed to implement the Minimum Service Delivery Standards as many hospitals did not meet these standards.

The environmental samples for polio were found positive in Lahore and Rawalpindi. However, no new case of polio was reported this year.

Malaria and dengue virus epidemics resulted in nearly 100,000 and 16,000 reported cases, respectively. Isolated cases of Covid-19 were also reported.

A patient was diagnosed with locally-acquired Naegleria at Services Hospital in Lahore. The patient expired. Another patient, a resident of Rawalpindi, was diagnosed with monkey pox in Islamabad. The health authorities also generated a Congo virus alert after some doctors in Balochistan were diagnosed with the virus.

The historical status of the Pakistan Medical and Dental Council, Pakistan’s premier licensing body, was revived this year after intense lobbying by the Pakistan Medical Association.

The World Health Organisation recommends the allocation of 6 percent of the gross domestic product to the health sector. The medical fraternity is deeply concerned over low spending – 1-2 percent - on healthcare in Pakistan. Out of this meager allocation, most of the funds are diverted towards curative healthcare rather than preventive measures.

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