On one side there are shiny new hospitals and free medicines, and on the other tainted drugs and doctors’ strikes.
In its five-year term, the PML-N led Punjab government expanded health infrastructure, raised salaries and introduced new programmes, taking spending on health from Rs13 billion to Rs38 billion. But it also presided over the Isotab and Tyno cough syrup tragedies, as well as major outbreaks of dengue and measles.
The Express Tribune spoke to officials and doctors to assess the successes and failures of the government in the field of health care, and what lessons could be learned by the next government.
New hospitals and greater pay
“This government did more for the health sector in five years than all governments combined in the last 65 years,” said Khawaja Salaman Rafique, the former chief minister’s adviser on health matters.
Health Department records show that the government set up a 410-bed hospital in Bahawalpur, a new cardiology hospital and the Institute of Urology and Transplantation in Rawalpindi, a 60-bed hospital on Bedian Road in Lahore, and a 300-bed hospital in Shahdara.
It also bought six mobile health units each equipped with X-ray and laboratory facilities, two doctors, medicines and a small operation theatre – to Rajanpur, Muzaffargarh, Dera Ghazi Khan, Bahawalnagar, Bahawalpur and Rahim Yar Khan. They attended to an average of 1,200 patients per day, Health Department officials said. Five new medical colleges were opened, in Sahiwal, Gujranwala, Sialkot, Dera Ghazi Khan and Lahore. Moreover, 450 additional MBBS seats were created in existing colleges.
The government also launched schemes to expand access to healthcare. These included the Schools Health Programme, under which school health and nutrition supervisors in 32 36 districts paid a total of 3.1 million visits to primary and middle schools and screened 6.3 million students for medical problems.
The government launched, or took over from the federal government, several other health initiatives, including the Lady Health Worker Programme and the Expanded Programme on Immunisation, as well as programmes for the control of hepatitis, dengue, TB and malaria, and for maternal, neonatal and child health.
On the legislative side, the provincial government passed the Punjab Healthcare Commission Act in 2010, to set up a regulator for both public and private hospitals.
Health Department officials said that the government also provided free medicines, as well as free dialysis, for which some Rs500 million was allocated annually; upgraded tertiary care hospitals by equipping them with MRI, angiography and CT scan machines; and installed air conditioners and provided free parking in all public hospitals.
It also regularised the services of 6,000 contract doctors, increased the paid posts of postgraduate trainees by 33 per cent, and gave a Rs5.20 billion package to raise the salaries of doctors, nurses and paramedics.
Tainted drugs and militant doctors
The government was also faced with two major cases of adulterated drugs that cost hundreds of lives. A contaminated batch of the drug Isotab, handed out for free at the Punjab Institute of Cardiology, resulted in the deaths of over 200 people from December 2011 to February 2012, according to an inquiry conducted by a Lahore High Court judge. And some 50 people were killed after consuming the Tyno cough syrup. The scandals highlighted the absence of adequate lab facilities to check drug quality, and the Punjab government was criticised for its response to both.
Experts also decried the government’s vaccination programme as inadequate, particularly in view of the ongoing measles epidemic in the province. “After the 18th Amendment, it became the provincial government’s responsibility to buy vaccine and conduct vaccination campaigns. How appropriately the previous government ran this campaign is evident from the fact that over a hundred children have died of a preventable disease,” said an office bearer of the Pakistan Medical Association (PMA).
He also pointed out problems in the Hepatitis Control Programme. “The Punjab government supplied Hepatitis C medicines and injections to nine teaching hospitals and 36 district headquarters hospitals, but the PCR test for hepatitis diagnosis is available only at two public sector hospitals. This is putting the horse before the cart,” he said.
He said that the government had responded slowly to the dengue outbreak of 2011, which claimed 256 lives, though there has been no major outbreak of the disease subsequently.
Government-employed doctors were also extremely unhappy over the past five years about their treatment by the Punjab government, as evident from a series of strikes by the Young Doctors Association.
“The government gave a new service structure to the doctors, but in such a way that no one thanked them for it. And they registered baseless murder cases against doctors, which is a terrible way of doing things,” said Dr Salman Kazmi of the YDA.
He also said that the government’s claims about increased health expenditure were misleading. “If you judge it as spending as a proportion of GDP, it was almost the same as previous governments. And most of the money was spent on development projects rather than patient welfare,” he said.
The PMA official was also critical of the chief minister for not appointing a full-time health minister.
“The next government should have a dedicated health minister and a doctor should be appointed as health secretary. Its focus should be on long-term solutions, drawn up by experts,” he said.
Published in The Express Tribune, May 8th, 2013.