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Healthcare stands on three pillars: Healthcare related policies; Public and private health infrastructure; and availability of diagnostic and treatment tools, the last one also includes easy access to drugs. We shall review each of these in some detail to understand the entire healthcare landscape. The information is gathered from several sources, and references are given at the bottom.
Public and Private Health Infrastructure – Second Pillar
Healthcare is delivered through the infrastructure of dispensaries, primary care, secondary care, and tertiary care hospitals.
Primary care is run in both public and private sectors; all General Practitioners, Family Physicians, Basic Health Units (BHUs), and Rural Health Centers (RHCs) are the delivery points of primary care. Primary care is limited to outpatients, including simple first aid for non-serious injuries. Primary care in any country is the key element in healthcare chain. It is readily accessible, and affordable, and in most cases the patients are relieved and do not need further treatment. The largest bulk of health issues is handled by the primary healthcare system. The second most important function of primary care is that it acts as a filter and referral system for secondary and tertiary care. Without adequate primary care structure, the overall healthcare structure would collapse rather quickly. Being associated with pharmaceutical industry for almost fifty years, I have seen primary care in private sector grow enormously, arguably to keep pace with the burgeoning population. With the increase in size, complaints of misconduct have also increased. Patients are fleeced by giving cheap drugs at high prices, diseases are prolonged rather than being treated, and wrong treatments. The referral is not done at the right time, rather the patient is lingered till it would be possible, and then referred when his/her condition is severely deteriorated. Greed to earn more and quickly shows in many more ways. Having said that, the primary care system is still keeping healthcare afloat, by and large.
Secondary care is provided through Tehsil Head Quarters Hospitals (THQs), and small private hospitals with some facilities for patient admission. Deliveries are the biggest business in private sector secondary care hospitals. Most deliveries are normal and not much hassle is involved except a clean environment and proper medical/paramedical care. However, almost all private hospitals are notorious for unnecessarily doing C-section (surgical procedure) for deliveries as it brings more revenue to the hospitals. Pediatric care, gastroenteritis, high-grade fever, and other less serious conditions are also treated through secondary care outlets. Trauma cases have increased exponentially due to road accidents, violence, terrorism, abuse, riots, and industrial accidents. A large bulk of trauma is also catered at the secondary healthcare system. Complaints about this sector are higher and more serious, because patients are admitted for certain number of days and the relatives are never properly informed about what is being done. Loads of unnecessary and irrelevant, expensive diagnostic tests, consultant fees, nursing charges, and many other heads are charged from unsuspecting patients. Hospital stay is prolonged without justification to make more money. Since COVID19, private hospitals have discovered that ventilators are great money-making machines, their life saving aspect besides.
Tertiary care is delivered through teaching hospitals in public and private sector, and some large private hospitals. Tertiary care is about serious diseases such as heart disease, stroke, cancer, major surgeries, major trauma, transplants, complicated cases, difficult-to-treat cases are handled at the tertiary care facilities. The quality of care provided at major public hospitals is at once excellent and pathetic; it depends upon the consultants. Unfortunately, the standardization is not there in any form.
Public hospitals are under enormous pressure because their capacity has not been enhanced in relation to the increase in population. Government has tried to tackle this issue through upgrading the secondary care institutions at tehsil, district, and division level. Specialists have been appointed in these places, and divisional headquarters hospitals have been upgraded as teaching hospitals. However, our population explosion gobbles up every development fast. Tertiary care facilities in private sector are even more notorious for fleecing the patients. Owing to the seriousness of diseases, the patients are exploited to much greater extent. In my own personal experience, I had to take some very firm stands for my patients, which obviously they did not like, but somehow bowed to.
We shall discuss the issues related to delivery of healthcare later, let me share some statistics with you.
- Number of Medical Colleges 45
- Number of secondary and tertiary care hospitals 1282
- Punjab 400Sindh 473Khyber Pakhtunkhwa 277
- Balochistan 132
- In-patient Beds 132, 227 (0.63 per 1,000 people)
- Registered doctors 220,829 (one per 1,000 people)
- Registered Dentists 22,995 (one per 10,000 people)
- Registered Nurses 110,974 (0.48 per 1,000 people)
- Basic Health Units 5,527
- Rural Health Centers 686
- Health Dispensaries 5,671
- Number of Medical Colleges 69
- 50 Beds and above – Punjab Health Commission registered 166
- 1 – 50 Beds – PHC registered 3,208
- Clinics – PHC registered 54,951
- Licensed hospitals – Sindh Health Commission 574
- Licensed hospitals – KPK Healthcare Commission 102
- Licensed Hospitals – Balochistan Not Found
As you see, the information about private sector healthcare structure is quite patchy. It is the reality because private healthcare business is largely unregulated, even after some form of licensing.
Healthcare business regulation is a whole new chapter, and we shall talk about it in the next post.
To be Concluded……
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