Excellent healthcare is being provided in Pakistan, but at a high cost. An overwhelming majority of Pakistanis cannot afford the specialized healthcare that they seriously need. The challenge in Pakistan is to enable access to quality healthcare to those who cannot afford it.
The quality of healthcare largely depends upon the skill and experience of physicians and the ready availability of advanced equipment needed for diagnostics and procedures. In Pakistan, we are able to have all the tests done immediately, but at a high cost. The MRI scan alone is prohibitively expensive for the majority of Pakistanis.
The healthcare cost in general and medicines cost in particular, are escalating everywhere and most of the increased cost of medicines throughout the world are due to the use of new medicines and Pakistan is no exception. The consultant doctors play the role of trainers of future prescribers. In Pakistan private practitioners are often preferred to the government-funded health centers where free medical supplies are limited. Many doctors in Pakistan continue to prescribe the new and the more expensive medicine. Scarce financial resources are spent on unnecessary nutritional supplements mostly by prescribing vitamin preparations and nearly half of prescribed medicines are tonics and antacids.
Increasing costs of medicines and diagnostic tests have made affordable treatment difficult for most people in Pakistan with low and medium income levels. The country also suffers from shortage of doctors and healthcare facilities to cater to the needs of over 180 million populations. More and more people are being denied health care simply because they cannot afford it. Fewer and fewer people consult doctors. Fees have not gone up, but the cost of medicines is high, and even when they see a doctor they often cannot follow up on care, as medicines are beyond their budget.
The Network for Consumer Protection, an Islamabad-based NGO, which conducted a detailed survey in 2004 on the pricing of drugs and access to them, found “public health facilities had extremely low availability of essential medicines” while “medicines for common treatments were unaffordable and out of reach to the poor when purchased in the private sector.”
Booming drugs business
Spurious drugs businesses are booming. The illegal business of production, supply and sale of spurious drugs in Karachi and other parts of Pakistan are on the rise posing a serious threat to the lives of citizens while the authorities concerned are all ignorant to this alarming situation.
Some local factories and pharmaceutical companies are using fake stamps of reputed companies for manufacturing unauthentic medicines thus affecting the health of general public and patients struggling for lives in the city hospitals. These spurious are sold at a fantastic high price. Action should be taken against drug inspectors or health department officials if found involved in protecting this heinous business. No leniency should be shown to those involved in manufacturing spurious drugs.
There is a widespread conception that the pharmaceutical industry in the country is making extraordinary profits, possibly at the cost of consumers. On the other hand, companies say this is forcing them out of the business owing to the rising cost of production. There are 90 FDA certified plants in India while Italy has 40, China 22, Taiwan 10, Bangladesh four, and Jordan has three such plants but, unfortunately, Pakistan has not a single plant which is certified by FDA.
Unavailability of essential drugs
Due to pricing issues, availability of essential drugs in Pakistan is becoming a serious concern. The medicine export of neighboring India was $6 billion and it has 75 FDA approved plants for pharmaceutical production. But Pakistan could not attract FDA approved plants due to country’s rigid drug policies.
PPMA president said that high cost of doing business including costly land, utilities and high interest rates was seriously hampering the growth of pharma industry.
In Pakistan, doctors write a prescription that does not fulfill the requirements of international medical standards. The doctor prescribed excessive and expensive medications to patients, as doctors are often illegible, missing instructions on dosage, and list of large number of expensive branded drugs.
A recent study published in the Pakistan Journal of Medical Sciences reviewed 1,100 prescriptions in Peshawar. The study revealed that 59 percent of the prescriptions were barely legible, and many others offered incomplete directions about dosage and use. More importantly, certain expensive drugs were over-prescribed even when generic cheaper versions were available in the market.
Over three billions prescriptions are written in the United States every year. Unreadable handwriting, indistinct abbreviations and dosage instructions are the reasons behind mistakes that prove incurable for thousands of patients. But more notably, all prescriptions included only branded, and hence more expensive, drugs rather than the cheaper generic drugs.
Some medical stores in Pakistan can be counted in the fingers where doctor’s fault can be catch easily because there are qualified pharmacists who can detect the doctor’s fault. Pakistani doctors tend to prescribe 3 to 30 medicines per time, GP prescribed drugs were 90 percent more expensive branded drugs despite the poverty in Pakistan.
The other main distress was about the common dispensing of painkillers that were listed on almost 62 percent of the prescriptions. Even when prescriptions are legible, there is still no guarantee for the patient to get the right medicine in Pakistan where fake drugs are ubiquitous.
The Sindh High Court SHC) has admitted another petition against the Sindh government for purchasing costly hepatitis medicines from multinationals in violation of prevalent rules and regulation. The petitioner sought court’s intervention against award of hepatitis tender to multinational companies terming it illegal, exploitative and based on personal interests. The counsel for the petitioner, argued that the hepatitis tender had been awarded to foreign companies in violation of the law on exorbitant prices in collusion with the Sindh government
Millions of people in Pakistan do not have health coverage. This pushes the poor into debt and an inevitable medical-poverty trap. Two-thirds of households surveyed over the last three years, reported that they were affected by one or more health problems and went into debt to finance the cost. Many who cannot afford treatment, particularly women, forego medical treatment altogether
Pakistan needs strong and stable health insurance system that offers the same healthcare to the low-income households at affordable rates. It is recommended that the governments should increase their healthcare spending to at least 4 to 5 percent of the GDP. It is further recommended that the focus of healthcare should be extended from tertiary care to preventive and primary care. In addition, generic drugs should be promoted to reduce the cost of prescription drugs.