By Dr Ghayur Ayub
In December 1997, the Cabinet of the then Prime Minister, Mr Nawaz Sharif, approved a comprehensive National Health Policy based on definition of health as prescribed by WHO at Alma Ata in 1978. Prior to that, a health policy was prepared in mid 1980s and was introduced in 1990. That policy did not cover all areas of Primary Health Care according to Health For All (HFA) strategy of WHO. So the aim of the new policy was to provide universal coverage of quality healthcare through an integrated Primary Health Care approach to promote preventive, curative and rehabilitative healthcare with special emphasis on strengthening the district health system through decentralization and good governance.
Being a lengthy document its details are beyond the scope of this piece but the strategies at the gross root level which had guiding input from Mr Shahbaz Sharif were structured on; Primary Health Care & Family Planning with its associated activities; Strengthening the district health system and providing necessary support mechanism in terms of training and logistics to effectively supervise the performance of health workers; Creating District Health Authority (DHA) to decentralize hospital management and improve the health sector at district and sub-district levels; Ensuring satisfactory staff levels at Rural Health Centres (RHCs) and Basic Health Units (BHUs) and promoting deployment of female workers as human resource; Giving priority to the vulnerable and disadvantaged groups through social uplift programs; Assuring effective community involvement and facilitating coordination and collaboration between health and other government sectors and the NGOs; Introducing alternative approaches to financing the health-care by involving private sector and national health-care schemes under strict supervision, monitoring and accountability; Improving the function of referral system to ensure equitable accessibility to emergency, secondary and tertiary heath-care services; Integrating all vertical programs into Primary Health Care (PHC) at operational levels; Promoting innovative control strategies for the prevailing communicable diseases such as tuberculosis, malaria, HIV, viral hepatitis, acute respiratory infections and diarrhoeal diseases; Undertaking the control of major prevalent non-communicable diseases such as cardiovascular diseases, blindness, diabetes, cancer; Improving the nutrition status especially of mothers and children and reduce the prevalence of the malnutrition; Addressing the health problems of senior citizens in the community and providing them help at the door steps.
To make it operational at gross root level, the policy was built on a structure; to establish district planning and implementation cells to arrange short refresher courses for DHOs/ADHOs, health managers and administrators on planning and implementation; need-based planning on realistic and participatory approach keeping in view the situation, cost analysis, reliable data, disease patterns and the environment; provision to link the planning cells effectively with Health Management Information System (HMIS) based on “create facilities and reduce liabilities” lines and connect the recurring budget with the development budget; and to form appropriate standing committees as and when required to coordinate with external assistance.
In addition to dealing with health problems at the gross-root level, the policy covered matters related to other spheres such as; National Drug Policy including pharmaceutical sector and vaccine production; Poverty alleviation program based on Basic Minimum Needs (BMN) program of WHO, which was renamed as Basic Development Needs (BDN) program; Dialysis program; Human resource development for health; Epidemic/Disaster Preparedness (DEWS) as part of Health Management Information System (HMIS) and Early Warning System (EWS); National Health Care Schemes including National Health Card System for families in rural and under-served urban areas, and Health Card Scheme to help pregnant women, children under the age of 12 years and the old over the age of 60 years; Public Sector Finance System including National Health Insurance Scheme which had provision to cover the poor from Zakat and Bait-ul-Mall funds, selection of which was based on scientifically prepared 10 points scoring Cards; Setting priorities including, Mosque and Health Program, making Database through immunisation activities for Disease demography, Population Census purposes and updating Communication Maps especially in tribal belt; Improving Pakistan Medical and Dental Council (PM&DC); Introducing Community Oriented Medical Education (COME); Facilitating curative care and upgrading hospitals; Introducing comprehensive referral system; Improving environmental health; Opening venues for traditional medicine; Drug abuse control; New and emerging health challenges; Health legislation; Involving private sector in health; Priority health programs; Human resource development for health; Mental health; Oral and dental health; School health programs; Nursing education; International health activities including provision for PLAB exams in Pakistan for deserving doctors to avail higher education and training in UK; Health policy guidelines according to ‘Vision 2010’ prepared by Ahsan Iqbal who headed Planning and Development Division.
According to the needs of the people and policy guidelines visualized in ‘Vision 2010’, programs of the health policy were prioritized in three groups; short-time, mid-term, and long-term. Short-term programs were to be implemented during the tenure of the PML-N government ending in 2003. Mid-term programs were to be put on track according to ‘Vision 2010’. Long-term programs were placed on the list beyond 2010 but could be picked up earlier if needs arrived. The programs were smoothly facilitated according to the classification when Gen Musharaf packed up the government on October 12, 1999.
Over a decade has passed since the policy was derailed. Most of the health related matters have been shifted to the provinces after 18th amendment. Public needs and societal psyche have changed since 9/11. There were programs in the policy which were needed then and which are needed today. Also there were programs which were not applicable then but which are applicable today. For example, some programs were tailored as mid-term according to ‘Vision 2010’ which can be placed as short-term in present circumstances. Similarly, there were programs which were placed in the class of long-term have become essential in light of post 9/11 conditions. In other words, the recipe has changed but the ingredients remain the same. So, when Mr Nawaz Sharif, well before the elections, asked Mr. Sartaj Aziz to head a PML-N committee and prepare its election manifesto based on various policies for future PML-N government, health matters were also discussed in those committee meetings. (to be continued)