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