There is an African idiom that if a man does not eat at home, he may never give his wife enough money to cook a good pot of soup. This might just be true when applied to politicians on the continent seeking medical help anywhere but home.
Pakistan’s public health systems are in a depressing condition. Preventable diseases still kill a large number of women and children, especially dengue and other vector borne diseases due to poor mismanagement of the local governments, poor sterilization of equipment, doctor’s negligence and the doctor-pharmacist nexus that plays an integral part in the role of doctors, whether they know it or not, are being incentivized by luxurious S400 Mercedes (Residents of Islamabad must have seen two parked at IDC and at the homeo-pathic Uppal) to prescribe certain medications by pharmaceutical companies. When we say “bribe”, we don’t want you to envision some illegal, money transaction taking place. But there is incentive, and that incentive can be dangerous to you. Especially when these medications turn out to be deadly. And this has happened.
The unethical relationship between doctors and drug companies harms both patients and doctors: it harms patients because it brings a corrupting component to their medical care and it harms doctors because it alters the quality and character of their care. In addition, it hinders the proper functioning of the health care system in the country and increases drug costs. According to some estimates, up to 30 per cent of the cost of drugs is kicked back to doctors to increase sales.
There are several ways in which doctors are bribed by drug companies. They range from cash payments, hospitality and all-expenses-paid trips, to gifts for their families etc. Drug companies also bribe hospitals to stock their drugs so that doctors can prescribe them. It’s not only drug companies that bribe doctors, though. Often, patients bribe doctors to get procedures done, or done earlier.
Doctors swear an oath to uphold their integrity – the “Hippocratic Oath”. In doing so, we should expect that when we can come to them with a medical issue, they will prescribe (if need be) medication that’s proven safe if used correctly. But not all medications are truly safe, even if used correctly.
These unsafe medications are still being prescribed. Why? The answer may lie in the relations between these huge pharmaceutical companies, who gain to profit off these medications, and physicians with the ability to prescribe them
Pharmacists do not perform these functions in all countries but Pakistan is an exception. A prerequisite to their widespread adoption is the involvement of pharmacists with the appropriate expertise in the determination and implementation of national health policy, which provides the context for policies related to drugs and pharmacy. In view of the special knowledge and expertise of pharmacists, they are given the responsibility at a senior level for the determination and implementation of policy on drugs and pharmacy manpower and for the drafting and administration of legislation, which they tend to exploit. Pharmacists in such senior positions should preferably have postgraduate training and a qualification in public health.and a regulatory setup that monitors the effectiveness and usage of drugs prescribed to patients by doctors
But in a country like Pakistan, potent medicines and related products may be supplied or dispensed by non-pharmacists and without the supervision or control of pharmacists. For the safety of the public, such transactions should be performed or supervised by pharmacist regulatory body, to ensure the supply of correct medicines of acceptable quality are being dispensed to patients in local hospitals
It’s therefore not surprising that people from Pakistan, not even people, only the elite and politicians travel abroad – mainly to Europe, North America and UK – for their medical needs. Superseding the Sept 19, 2016, a letter, from the Punjab finance department issued fresh austerity and economy measures for 2017-18 to observe financial discipline in the province by judiciously reducing expenditure but aligning with the organisational goals to make them target-based and cost-efficient. The measures also also constituted a seven-member Austerity Committee headed by finance minister Dr Ayesha Ghous-Pasha to examine and recommend procurement of vehicles and cases for foreign visits as well as examine of medical facilities of local MPAs and decide in line with the austerity drive to curtail current and development expenditure of the provincial government. Source: https://www.dawn.com/news/1357988
Aimed at effective and economic use of public money, the Punjab government has banned foreign air travel of ministers, MPAs and government officials through government funding. Similarly, no official or elected representative will be allowed treatment abroad at government’s expense during the current fiscal deficit lest its a Queen from the Monarch
It can be argued that private cadre opting to seek medical help in other countries don’t owe the public any explanation, because it’s their own affair from their own money. But medical tourism among Pakistan political elite is a completely different kettle of fish and a big cause for concern, because they are responsible for the development of proper health care for the citizens of their countries.
It’s well documented that politicians from across the continent go abroad for medicl treatment. The reasons for exercising this choice are obvious: they lack confidence in the health systems they oversee, and they can afford he trips given that the expenses are paid for by taxpayers.
The result is that they have little motivation to change the status quo. Medical tourism by PAKISTANI leaders and politicians could therefore be one of the salient but overlooked causes of Pakistan’s poor health systems and infrastructure.
“Every country, except Pakistan, is concerned with medical tourism,” say doctors, who bemoan the fact that our government is sleeping over a golden opportunity.
Pakistan Medical Association Sindh President Dr Samrina Hashmi says there is huge potential for Pakistan in becoming a hub for medical tourism, like so many other countries in its neighbourhood.
“Already, a number of patients from places such as the Middle East, UK and US seek a range of treatments in Pakistan; these include cardiac surgery, infertility treatments and cosmetic surgery,” she says.
Costs for treatment in Pakistan are more than 50% of what doctors and hospitals charge abroad, she explains. At the moment, most foreign patients who come here for treatment are of Pakistani origin
Costs and risks
Countries pay a heavy cost for this behaviour. It’s estimated that in Pakistan, the funds spent to treat top government officials abroad every year could build 10 hospitals
Not only do the leaders travel with elaborate entourages, but they also travel in expensive chartered or presidential jets. For example, the cost of parking presidential plane during his three month spell in London is estimated (approx) at £360,000. That’s equivalent to about 0.19% of Pakistan’s total 54 billion of total health budget, given the fact even Nigeria has a 304 billion budget allocation for health for the year 2017-18 And there would have been many other heavier costs incurred during these stays.
The failure of leaders to improve health care and stem brain drain also carries a heavy price. On top of this, Pakistani hospitals that were previously world class have been reduced to symbolic edifices due to political negligence.
Essentially, when people charged with responsibility feel they have no need for public health systems because they can afford private health care at home or abroad, ordinary citizens bear the brunt.
The way forward
The effective health systems in western and Asian countries that are being patronised by Pakistani leaders only exist because they were developed, and are consistently maintained, through political commitment and visionary leadership, qualities that are clearly lacking in Pakistan
To bring change, our citizens must start condemning political medical tourism. They must also push for regulations to curb the shameful practice. Taxpayer funded medical trips should be banned and criteria set detailing what sicknesses that can be covered by the public purse. Though a law to this effect does not even exist in Pakistan.
The management of drug procurement and supply, and drug control, registration and enforcement, do not meet satisfactory standards. To achieve acceptable standards, pharmacists with suitable postgraduate training should be appointed to senior positions, and standards should be assured by comprehensive pharmaceutical legislation and its effective enforcement.
Make pakistan a medical hub by regulating pharmacist industry with NHS
Essentially, if the leaders do not experience the poor state of health care, they might never strive for any positive changes to it.