Strengthening the rural health care

Pakistan is the fifth most populous country with a population of about 241.49 million1 and its population is going to increase by 50% till 20502. The life expectancy in Pakistan has also increased from 61.4 years to 66 years according to World health organization3. This overall rise in the population will increase the burden of diseases on health care system. Primary health care initially was only comprised of public sector but inclusion of private sector has led to the improvement in the health care access and quality index. We are still very far from reaching United Nation Sustainable Development Goals (UNSDGs) and overall, the country’s progress on SDGs is modest4. The primary health care including public and private sector is facing many challenges; with only 2.95% of annual budget spent on the health the limited infrastructure, brain drain and inequitable distribution of resources are making it impossible to reach any of the health goals5. Every year almost 32,879 medical students graduate in Pakistan from 124 medical colleges6 but according to National Census 20171 only one doctor is available to serve 957 individuals. This is because 40% of fresh graduates migrate to other countries for better opportunities putting undue pressure on the primary health care system leading to inadequate provision of health facilities to the masses5. This situation gets worse by almost by two folds in the rural areas of Pakistan, which comprise of 70% of its population. Apart from poverty3, insufficient health facilities, lack of immunization, poor nutrition and scarce health education are the major contributing factors attributing to the worsening health care in the rural areas. According to National Nutrition survey7 40.2 % of the children are stunted and 70% child hood deaths are due to vaccine preventable infections but only 58% of at risk children get vaccinated. In addition to it Pakistan carries 61 % of the burden of Tuberculosis in the region and 15.9% of the population is having Stage II hypertension left untreated. There is high incidence of maternal death i.e., 186 deaths per 100,000 live births8 which is a 32% increase from 2017 (140/100,000)8 and infant death i.e., 51 deaths /1000 live births due to unsafe home deliveries, poor neonatal care and improper breast feeding. The Community Health Index (CHI) which measures the disparities between different regions based on health and well-being, scored Pakistan with an inequality ratio of 16.59 CHI. This means that the upper-tier districts are 16.59 times healthier than the lower-tier districts5. The solution to these problems lies in adopting a holistic approach to health, including primary health care principles and targeted interventions. One of the targeted interventions is to incorporate private sector on board, involving them in the up gradation of the district they belong to. There is mushroom growth of private medical colleges in Pakistan generating loads of graduates every year. What to talk of all Pakistan, only in Rawalpindi city starting from Rawat to Wah Cantt, there are 14 medical colleges. There are 166 districts in Pakistan1, and approximately similar number of medical colleges. If every medical college is attached to one of the district hospitals and medical colleges are bound to send their Under graduates, House officers and Post graduate students along with Senior registrars on three monthly rotational basis to these health care facilities, it can bring a significant improvement in the health of the community. More over specialized medical consultations and health education programs can easily be run by using virtual means of communication. The infrastructure at these secondary health care facilities can be further strengthened. Most of the private medical colleges are affiliated with one or two small hospitals with limited influx of the patients as compared to the government hospitals. This strategy not only will be beneficial for the community but it will also increase the skill and horizon of the young doctors. They will become more competent and skillful and understand the dynamics and suffering of the people. This initiative will definitely bring a drastic improvement in the health standards, at least first at the district level and later on at tehsil level. Simultaneously the young doctors will also be exposed to a wide variety of diseases prevailing in the community.