Health gains offset by rapidly growing population: new survey – Several MDGs could not be achieved due to food and nutrition security issues

KARACHI: The health expenditure over the last seven years i.e. since 2007-08 (Rs 60 billion) to 2013-14 (Rs 102 billion) witnessed a growth of 10 percent per annum, says new Pakistan Economic Survey 2013-14.

According to the survey, investment in health over years have seen improvement in health facilities and healthcare providers. By the year 2013, the number of public sector hospital has increased to 1096, more than 5527 basic health units (BHUs), 650 rural health centers (RHCs) and 5310 dispensaries.

These facilities together with 167759 doctors, 13716 dentists and 86183 nurses brings the current ratio of one doctor for 1099 persons, 13441 person per dentist and availability of one hospital bed for 1647 person and shows that number under each establishment is increasing. However, due to population growth, the number of per bed, per doctor and per nurse is also increasing.

Federal government is committed to achieve better health outcomes by taking care of issues through increased coordination of the provincial governments along with UN agencies and donor institutes.

It is very much encouraging that during the fiscal year 2014, the health expenditure increase by 28.78 percent over last year, which is an indicator that present government is making best efforts to provide better health facilities to general public. The promulgation of the 18th Constitutional Amendment and the 7th National Finance Commission Award (NFC), the federal government has transmitted greater bulk of payment to the provinces.

The provinces with newly empowered status have allocated more funds to healthcare, making it more responsive to the needs of population. Pakistan with regard to fulfil its MDGs commitments has made considerable progress on health related indicators over the last 20 years.

But the gains have been offset by the rapidly growing population. The child and maternal mortality rates have been declined but at comparatively lower rate than the other countries in the region.

The government has taken various steps through initiating several vertical programs such as the National Maternal and Child Health Program, the Cancer Treatment Program and the Aids Control Program. The National Program for Family Planning and Primary Health Care also known as the Lady Health Worker Program was launched by the Government of Pakistan with objective to reduce poor health conditions by providing essential primary health care services to communities and improving national health indicators. The program contributed to the overall health sector goals in improving maternal and child health, provision of family planning services and integration of other health promotion program.

Public expenditure on provision of health facilities has been progressive at all levels. However, some specific gaps continued to persist largely on account of demographic, epidemiological and socio-economic factors, leaving large segments of population with inadequate health care access.

Healthcare facilities at some parts of the country are found to be inadequate and also mostly ill equipped and the coverage also vary across the provinces. The shortage of trained health workers and the rising population pressure on public health institutions has allowed the private sector to bridge the demand and supply gaps. The private health sector in Pakistan is comprised maternity homes, dispensaries, diagnostic centers, physicians and practitioners. NGOs also form part of private sector and provide various health care services.

The private sector is now the leading source of maternal and child health services and its dominance in the health field demonstrates that market sector stretches from primary to tertiary care level is contributing significantly in provision health services in the country through its high specialized medical professional.

Mother and child health has been one of the priority areas of public health in Pakistan. This program has been launched by the e government in order to improve maternal and neonatal health services for all, particularly the poor and the disadvantaged at all levels of health care delivery system. It aims to provide improved access to high quality mother and child health and family planning services besides training 10,000 community midwives.

Social insurance is one of the instrument of health financing and meet health expenditure. Social insurance can provide finance for health care either for the whole population or a part of it, such as employed workers. Compulsory insurance payments may be imposed on employees as a percentage of their wages and on employers a similar or higher payroll tax.

Food is the fundamental right of the people and government is committed to provide it at all levels. In spite of adequate production and availability of essential food items of consumption, malnutrition continues to persist in the country.

Several MDGs have not been achieved due to food and nutrition security issues, which directly or indirectly depend on nutrition interventions in various sectors. The factors affecting malnutrition are food security, feeding practices, access to health care, water supply and sanitation, education and nutrition awareness. Therefore, reduction in malnutrition can improve productivity and solution of malnutrition lies in Scaling up Nutrition (SUN) Movement through integrated multi-sectoral approaches, being cross cutting issues.

The national food availability estimated through food balance sheets, has been satisfactory for major food items during the fiscal year 2013-14. The average calories estimated based on food availability has been 2450 per capita per day.

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