Yet another Health Policy
Dr Ghayur Ayub
Sherry Rehman, who holds the health portfolio as additional charge,
announced a new health policy the other day. The question in my mind is;
why is she in such a hurry to table a new health policy? The little I
know about her with our contacts at CoD and ARD meetings in London, she
doesn’t seem to be a lady who is usually in a ‘rush’. Before elaborating
on this point let me write a few words about the health policies of
Pakistan. The first health policy was formulated in the mid 80s and was
introduced in 1990. It did not adequately cover all areas of Primary
Health Care according to Health For All (HFA) strategy of WHO. In
December 1997, the Cabinet of Prime Minister, Mr Nawaz Sharif, approved
the first comprehensive National Health Policy based on the new
definition of health as described by WHO at Alma Ata in 1978. The aim
was to provide universal coverage of quality healthcare through an
integrated Primary Health Care approach to promote preventive healthcare
without ignoring its curative aspect and making good governance as
primary target with special emphasis on strengthening the district
health system through decentralization policy of the government using
the available facilities.
Based on that principle, the policy was designed on; rationalizing human
resource development; giving greater responsibility to private sector in
health delivery services; empowering community to take active role in
the decentralized health system; making health planning scientifically
based on research; making the health sector responsive to the current
and future challenges; giving priority to the vulnerable and
disadvantaged groups through social uplift programs; addressing the
health problems in the community by providing, promotive, preventive,
curative and rehabilitative services to which the entire population has
effective access; improving the utilization of health facilities by
bridging the gap between the community and the health services;
expanding the delivery of reproductive health services including family
planning both in urban and rural areas; to gradually integrating
existing health care delivery programs like EPI, Malaria control, TB,
nutrition and MCH within the Primary Health Care (PHC); improving the
nutrition status especially of mothers and children and reduce the
prevalence of the malnutrition and to promote intersectoral action and
coordination at all levels; and providing an overview of the health
sector in the country that gives guideline for action in all priority
health areas with vision up to the year 2010.
The main strategies were structured on; strengthening the district
health system and provide necessary support mechanism in terms of
training, and logistics to effectively supervise the performance of
health workers at all levels.; ensuring satisfactory staff levels at
Rural Health Centers (RHCs) and Basic Health Units (BHUs) and promote
the deployment of the female workers as human resource; improving the
function of referral system to ensure equitable accessibility to
emergency, secondary and tertiary heath care services; ensuring
effective community involvement and bringing about coordination and
collaboration between health and the other government sectors and the
NGOs; introducing alternative approaches to financing health care
through involvement of the private sector and the national health care
schemes having mechanism of strict supervision, monitoring and
accountability; integrating all vertical programs into Primary Health
Care (PHC) at the operational levels; promoting innovative control
strategies for the prevailing communicable diseases such as
tuberculosis, malaria, HIV, viral hepatitis, acute respiratory infection
(ARI) and diarrhoeal diseases; undertaking the control of major
prevalent non-communicable diseases such as cardiovascular diseases,
blindness, diabetes, cancer; taking care of senior citizens; and
promoting burns and injury prevention and rehabilitation services as
part of the policy. Thus a national health policy was built on a
structural skeleton having; principle interventions of strict equity to
ensure universal provision of PHC services; decentralization to reach
the gross root level and giving the community an active participatory
role; establish district planning and implementation cells to arrange
short refresher courses for DHOs/ADHOs, health managers and
administrators on planning and implementation. In 1999, when the country
was targeted by the terrorists with bomb blasts, a few new activities
were proposed for inclusion in the policy.
They were; mosque and health project; making communication maps
especially in tribal belt (this activity was initiated and such a map
was made of the border areas of Baluchistan during Immunization Days in
1999); using health activities as tools to counter terrorism; and making
nationwide database for multi faceted productive purposes. After the
military takeover in 1999, most of the ongoing activities had retarded.
Then, in 2001, the government announced a new Health Policy with 10
salient features, labeled as: ‘concretising the Vision: Ten Specific
Areas of Reforms’. It covered; communicable diseases, such as EPI
cluster of childhood diseases; TB; Malaria; Hepatitis B; and HIV-AIDS;
addressed inadequacies in primary,/secondary healthcare services;
removal of professional and managerial deficiencies in district health
system; promoting greater gender equity; bridging the basic nutrition
gaps in the target-population; correcting urban bias in the health
sector implementation modalities; introducing required regulation in the
private medical sector with a view to ensuring proper standards of
equipment and services in hospitals, clinics and laboratories as well as
private medical colleges and Tibb/Homeopathic teaching institutions;
create mass awareness in public health matters; improving the drug
sector with a view to ensuring the availability, affordability and
quality of drugs in the country; and finally capacity building for
health policy monitoring in the Ministry of Health. This was called the
Health Policy of 2001. Again in 2005, the government came up with
another NHP with a preamble, ‘The Health Sector Reform agenda is being
carried forward in keeping with the strategic direction of the National
Health Policy 2001’. It included 9 core programs of; National Program
for Family Planning and Primary Health Care; EPI; National AIDS Control
Program; Malaria Control Program; National TB Control Program; Nutrition
Program; Women Health Project; Prime Minister’s Program for Prevention
and Control of Hepatitis in Pakistan; and finally, National Program for
Prevention and Control of Blindness in Pakistan.
It turns out that the two ‘Health Policies’ were no more than extension
of programs taken from the Health Policy introduced by the government of
Nawaz Sharif. Why these programs were announced as ‘policies’ is beyond
me. I did my own investigations and found it was a bureaucratic gimmick
to attract the attention of the health ministers and to make it seem as
if they were doing something new. For example, when an ex-health
minister Nasir Khan found himself loosing credibility, he started
working on improving his image; so how better to do that than announcing
a new health policy! The then shrewd health secretary formed a special
health policy unit employing retired bureaucrats especially from the
planning division for this purpose. The unit, as far as I know, is still
operative today. Their job is to keep bringing up programs from the
Health Policy of 1997 terming it as ‘new health policy’ giving a moral
boost to the incumbent health minister. Once I asked a key member of
this gimmick show why they didn’t call them the programs of Health
Policy of 1997? To which he replied, ‘linking anything with Nawaz Sharif
will put us in hell’. What he said then about the politicians running
the Health Ministry is unrepeatable. This brings me back to the initial
question of why is Sherry Rehman in such a hurry to table new health
policies. I wonder if smart Sherry is getting trapped like her two
predecessors by the mostly retired officials of the health policy unit
who want to still prove their ‘usefulness’? |
