Primary oral health care: a missing link in public health in Pakistan

In Pakistan, the limited availability of oral health care and the high level of unmet oral health care needs are well documented. The recorded prevalence of dental caries is 50-70% and that of oral cancer is among the highest in the world. Although oral health care has been declared to be part of the primary health care system, oral health disparities between rich and poor, and emerging problems of access to and use of appropriate care have never been addressed, reflecting a lack of awareness among both patients and health system decision-makers. Oral cancer screening and atraumatic restorative treatment for tooth decay could be included in a basic package of oral care that does not require qualified dental surgeons. This article develops an argument, based on literature review and an analysis of the health system in Pakistan, for how a basic oral health programme could be an accessible, affordable and acceptable component of the primary health care system

Knowledge about hepatitis B vaccination among women of childbearing age: a cross-sectional study from a rural district of Punjab, Pakistan

Pakistan is considered as an intermediate zone of hepatitis B virus [HBV] infection, with an estimated population prevalence of 2-7%. This study assessed knowledge about HBV and vaccination among women of childbearing age in a rural setting of Punjab province, Pakistan. In 2012 a cross-sectional, community-based survey of 430 women was conducted using a semi-structured questionnaire. Less than half of the women [43%] surveyed had correct knowledge about HBV vaccination, and knowledge was especially poor among the low socioeconomic groups. Age, level of education and obstetric history of the respondents were significantly associated with knowledge about HBV and its vaccination. The main sources of information regarding HBV vaccination were lady health workers [53%] and traditional birth attendants [22%]. Health promotion and behaviour change campaigns highlighting the importance of hepatitis B vaccine need to be designed to meet the needs of rural areas where women have little exposure to the mass media

Political and economic unfairness in health system of Pakistan: a hope with the recent reforms

For the last few years, Pakistan's health system has faced numerous challenges pertaining to human resource and its deployment, resource allocation among the different tiers of the health care system, infrastructure development and unfair access to care. The enactment of the recent constitutional amendment has made the health system's situation even more uncertain than before. A detailed literature review was carried out to understand fairness an responsiveness in health systems. The findings of the review were then compiled particularly in the wake of recent constitutional amendment defining health sector reforms in Pakistan. Various levels, features and components of health system of Pakistan were looked into in view of understanding the extent of 'fairness', 'responsiveness' and 'adequacy'. Healthcare financing; geographic distribution of health care facilities; human resources in health; access to health services and essential medicines; the allocations to urban and rural segments; and finally understanding the health positioning in national agenda and priorities were examined for this purpose. In the post-devolution scenario, provinces must think systematically how to deal with the capacity issues to manage different components of health care system. Nonetheless, as a country, collective actions would be required to avoid any pitfalls, while approaching Millennium Development Goals by 2015

state of affairs at primary health care facilities in Pakistan: where is the State's stewardship?

Primary health care [PHC] services in Pakistan, particularly in rural areas, are in a dismal state. Inadequacies, unfairness and ignorance about the importance of the basic health care provided by these facilitates have led to a disorganized and poorly performing system. This paper reviews the situation in certain PHC facilities in Sindh province. Inadequate medicines and supplies, underutilized family planning services, lack of human resources, faulty equipment, and absence of a proper referral mechanism were some of the key findings. There is therefore an urgent need for radical improvement in the PHC system in order to maximize the appropriate use of PHC facilities. In order to do this, the paper argues that the stewardship role of the State must be strengthened

many faces of supplier induced demand in health care

Health economists look towards health care sector as a market whereby there is a distinct demand and supply phenomenon exists. Dearth of regulation of the doctors' practices lead to inappropriate and unjustifiable demand for health care among the patients. In developing and under-developed countries, this adverse practice may push a poor family into a vicious circle of poverty and illness, especially where out of pocket expenditure on health is too high. Unnecessary prescriptions, prolonged treatments and unjustified user fee grossly deprive the patient's family financially. In developed countries, the flourishing health care technology and sophisticated laboratory diagnostics could incur significant expenditure which is sometimes even not covered under the insurance. State is the custodian of health care in any country; therefore, vigilant regulation of the health care providers may curb the supplier induced demand through strict laws and policies

Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan

A cross-sectional study of patient satisfaction with care was conducted over a period of 1 year from March 2004 to March 2005 in a secondary-level hospital in a peri-urban area of Karachi, Pakistan. Using the SERVQUAL tool and exit interviews, data were collected quarterly from a total of 1533 patients. Results sharing and capacity-building workshops were arranged during the 4 phases of the survey to sensitize the staff of the hospital to work towards improving patient satisfaction. The level of satisfaction of the patients with the outpatient health services provided showed a gradual increase from 34.4% to 82.0% over the 1-year period

Social marketing of the insecticide-treated bednets: the case for Pakistan

With an estimated half a million cases of malaria annually in Pakistan, and drug resistant cases on the increase, more practical preventive measures such as insecticide- treated bednets are essential. Social marketing through commercial channels has become an important cost- effective means to deliver health products and services to low income people and to motivate them to use these services. It has been demonstrated that social marketing of insecticide- treated bednets has saved the lives of millions of people in malaria- endemic regions at a cost as low as US$ 2 per person. Social marketing could be an effective strategy for getting insecticide- treated nets to poor communities in Pakistan who are most vulnerable to malaria

Women's empowerment and health: the role of institutions of power in Pakistan

Women's right to health has been reiterated many times. However, there are social and cultural barriers in developing countries that hinder their empowerment. Women's low status, deprivation of education and lack of control over their own lives and bodies have a negative impact on their health status and that of their families. This paper discusses women's empowerment and health within the framework of the 4 institutions of power in a society-family, community, health care systems and the state-with special reference to the situation in Pakistan. It concludes that to improve women's health status, concerted efforts are needed by all these institutions of power to work towards gender equality and the greater empowerment of women

Health workers for change: a tool for promoting behaviour change among health providers

Sensitizing health providers to customers' needs and women's health remains a challenge to the Pakistani health system. The Health Workers for Change methodology has been demonstrated to improve provider-client relationships in certain African and Latin American countries. This paper describes the experience of using Health Workers for Change participatory workshops in Pakistan to sensitize male and female health providers to gender issues. Health care providers identified the unmet needs of women clients as a function of individual, household and social factors, and, unlike the African experience with this tool, not predominantly confined to factors associated with the health facility

Health management information system: a tool to gauge patient satisfaction and quality of care

The health management information system [HMIS] is an instrument which could be used to improve patient satisfaction with health services by tracking certain dimensions of service quality. Quality can be checked by comparing perceptions of services delivered with the expected st and ards. The objective of the HMIS would be to record information on health events and check the quality of services at different levels of health care. The importance of patient assessment is a part of the concept of giving importance to patient's views in improving the quality of health services. Expected benefits include enhancing patient satisfaction through improved communication; greater provider sensitivity towards patients; enhanced community awareness about the quality of services; and overall better use of services in the health system

district health system: a challenge that remains

The health care system in Pakistan has been confronted with problems of inequity, scarcity of resources, inefficient and untrained human resources, gender insensitivity and structural mismanagement. With the precarious health status of the people and poor indicators of health in the region, health care reforms were finally launched by the government in 2001. There are, however, numerous challenges and constraints in the system. The future health of the nation depends on this decentralization initiative. All our efforts should be concerted to support and facilitate the new system, which will mature into institutionalization of the health services at the district level. Most importantly, it will help in strengthening the primary health care services catering to the major fraction of the population. Besides political commitment, we ought to maintain attitudinal, behavioural and cultural conditions conducive to letting this system flourish