The Challenge Of The Healthcare Budget

The public sector healthcare spending needs to increase with the growing population.

Patchy, under-resourced and unequally distributed preventive and curative healthcare services are one of the contributing factors in perpetuation of intergenerational poverty. The trend, if not disrupted with policy interventions, is likely to keep the economy in a low-level equilibrium trap.

Pakistan has been unable to adequately respond to the communicable disease burden. Now a new burden of non-communicable diseases is hitting its people.

Empirical evidence about diseases leading to poverty is overwhelmingly convincing. A research study, Out-of-Pocket Expenditures Associated with Double Disease Burden in Pakistan: a Quintile Regression Analysis, was recently conducted by the Institute of Business Administration, Karachi.

Dr Lubna Naz, a professor of economics and director of the Centre for Business and Economic Research at the IBA, was the lead author of the research. She mentioned that the double disease burden is enormous. “Approximately 40 percent of the disease burden comprises communicable infections, encompassing tuberculosis, acute respiratory infections, diarrhea, malaria, hepatitis, and HIV/AIDS.”

Over the recent decades, there has been a gradual transition from communicable to non-communicable diseases, such as cardiovascular diseases, diabetes, mental health disorders, cancers and chronic airway diseases. “According to a recent global health report, 60 percent of the deaths in Pakistan are attributable to NCDs,” she added.

Research findings suggest that there is a concentration of the burden of diseases among households in lower socioeconomic strata. If you are poor, you are likely to remain unhealthy and poor intergenerationally. Households from lower income quintiles generally cannot afford costly medical treatment. To meet their health needs, they are forced to borrow or sell out assets.

The financial strain not only adversely affects the quality of life of the ailing persons but also makes their caretakers face the brunt of the reallocation of time and spending. Adversities coming through disease and disabilities push many families under a debt burden and cause impoverishment.

There seems to be a consensus about the dangers of the double disease burden and the rapid increase in non-communicable diseases. “Overweight, obesity and diet related NCDs are on the rise in Pakistan. The National Nutrition Survey 2018 confirmed the prevalence of overweight among children under five has almost doubled from 2011 to 2018. Similarly, obesity and overweight increased in women of reproductive age from 28 percent to 38 percent from 2011 to 2018,” said Muhammad Anwar, the Centre for Governance and Public Accountability executive director.

Research findings suggest that there is a concentration of the burden of disease among households in lower socioeconomic strata. If you are poor, you are likelier to be unhealthy and poor.

Dr Romaina Iqbal, the Pakistan Nutrition and Dietic Society, Karachi, president who is also affiliated with the Aga Khan University, said that according to the NCDs STEPS Survey 2014-2015, more than four out of ten adults (41.3 percent) were obese or overweight; 37 percent had hypertension. The cardiovascular diseases stand among the top killers of Pakistanis with a 29 percent contribution to the NCDs related deaths in the country.

One of the most dangerous diseases is diabetes. It has hit Pakistan hard. Diabetes alone is a heavy burden of disease, disability and deaths causing a devastating financial burden, overwhelming and choking health services and undermining the country’s economic and social well-being. Fayza Khan, the PNDS general secretary and a consultant nutritionist/ dietitian in Karachi, said the prevalence rates of conditions like diabetes and the increasing incidence of associated complications such as chronic kidney diseases needing dialysis, pre-mature heart diseases and stroke were alarming.

In the absence of immediate policy action with preventive approaches, the number of people living with diabetes is projected to reach 62 million by 2045. The International Diabetes Federation estimated Pakistan’s diabetes expenditure at $2.64 billion in 2021. It said Pakistan was among the top five countries in the region with high prevalence rates.

Food authorities have a role in prevention of the double disease burden that is often overlooked. Dr Tahira Siddique, the Islamabad Food Authority deputy director, said, “Being part of the food safety system in Pakistan, food authorities have an important role to play in the control of communicable and non-communicable diseases. These authorities play their role by enforcing food safety standards at the manufacturing and sale point levels.”

There is a need to create federal level coordination mechanisms between various players, such as the Health Departments and the PSQCA.

There is a gender dimension to disease burden, too. Many studies have established that households with female heads were found bearing higher out-of-pocket health expenditures than male-headed households. It may be due to cultural restrictions on women’s mobility. While designing policies this aspect must be taken into account and addressed.

Many experts have said that to address the problem of the double disease burden, the public sector healthcare spending needs to increase with the growing population. They say the budgets should lift the expenditure to 5 percent of the GDP and focus on preventive health. They also say that the private sector service health provisions must be examined from the perspective of distribution inequality, affordability and accessibility.