As a developing country with 3% of its GDP allocated for total health expenditures1, Pakistan faces many hurdles to maintain a proper healthcare system with effective and efficient testing and treatment capabilities. These challenges were exacerbated by the pandemic. Although the government has invested to provide primary health centres within reasonable reach of most of their population, Pakistan still ranked 154 among 195 countries in terms of accessibility and quality of healthcare2. Realising that health cannot be a second priority, Pakistan is working to reform its public health institutions.
Prof Dr Bushra Jamil, Professor of Medicine and Infectious Diseases, Aga Khan University Hospital; President, Medical Microbiology & Infectious Diseases Society of Pakistan (MMIDSP), dives into the healthcare system in Pakistan, and the steps being taken to overcome access barriers to quality diagnostics there.
Looking at the current healthcare infrastructure in Pakistan, can you describe the hurdles it caused during the pandemic?
Our main problem has been the lack of a robust healthcare delivery system from the get-go. These problems were compounded by the pandemic. We realised laboratory investigations are absolutely essential – not just for Covid-19, but also for monitoring, ruling in/out other concomitant infections and diseases. It is essential to have easily available tests with rapid turnaround and availability of results so appropriate decisions are made.
There is an urgent need to strengthen the health system of the country. We need to invest to not only close gaps, but improve the effectiveness and efficiency of our healthcare system so we can deal with a larger patient load, increase our testing capabilities, and have the resources to treat accordingly.
What are the main public health challenges you see for Low and Middle Income Countries (LMICs) like Pakistan which have developing healthcare systems? How do you think we can tackle these challenges?
There are two main challenges. One is the investment required to create a robust healthcare system, and the second is training of undergraduates or graduates of different programs.
A properly trained workforce – not just doctors – but nurses and other allied healthcare professionals is essential. They need to know the principles of effective diagnostics and management of diseases. When a workforce is inadequately trained, they tend to bypass these essential steps, and patients end up getting treated empirically. This is harmful to the patient, because we’re not providing the accurate treatment they need based on accurate and timely diagnostics. This also has negative implications on the community and country as a whole.
What is the role of public-private partnerships, and international collaboration in increasing access to testing and treatments?
Before we can think about training, we first need access to effective and efficient diagnostics. This is where public-private partnerships can play a role – to bring diagnostics that are available, affordable, simple, and fast into public healthcare systems in an economical manner. We can then work together to train the workforce and build these diagnostics capabilities into our procedures for improved patient journeys.
How can the system be improved to cope better with future pandemics or outbreaks?
This is another reason why international collaboration is very much needed. We can learn from one another and work together to strengthen old systems, but also create new ones based on the lessons we’ve learnt in the pandemic. To raise the quality of research, services, patient care, and disease prevention and management we need international collaboration so we can tap on our expertise, and work with other committed and passionate healthcare professionals around the world to collectively elevate the quality of care we can provide to our patients.
What value do new diagnostics innovations like Point Of CareTesting (POCT) bring?
POCT is absolutely essential in medicine today. It allows you to make quick decisions on severely critical patients. They’re actually lifesaving because you can make the right decisions fast. Not only do they have importance in planning management, but they are also of prognostic significance because time is of the essence.
In your opinion, what do you think the value of diagnostics is, and what role does it play in the management of public health?
When finances are low, it makes sense to go for empiric treatment, but the situation right now is catastrophic in Pakistan. Antimicrobial resistance has increased tremendously and this will lead to a failure of empiric treatment because all the available drugs are no longer effective. This is one example of the essential role diagnostics play in the wider healthcare ecosystem because it’s only through a test that we’re able to provide patients with the treatment they actually need. Even in an outbreak situation, a test can serve as a pointer to a new pathogen or a seasonal variation or peak coming. Diagnostic tests are absolutely essential to healthcare, not just in the management of the individual patient, but for the community.
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1World Bank Data. Retrieved on: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=PK
2The Lancet Journal. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext#seccestile19