Non-communicable diseases in Pakistan; a health system perspective

Global shifting of disease burden from communicable to non-communicable diseases [NCDs] has led to large proportion of deaths in developed and developing countries. Gravity of the situation is further intensified in low and middle-income countries due to major health system inadequacies in responding to the emerging challenge. Similar situation is being faced by Pakistan where despite availability of comprehensive National Action Plan, no significant improvement is seen at policy level. Prior to development of any intervention, there is need to assess the issue of NCDs through health system perspective. This will help us to understand interplay of various factors crucial for health system's response to NCDs. World Health Organization [WHO] framework of six building blocks will help us in identification of bottlenecks in our system and areas that are not performing well. Gaps and inadequacies in the system can be tackled through appropriate measures like development of knowledge, skills, system thinking and leadership to enable our system to respond to NCD challenges effectively and efficiently. Political commitment, good financing, collaborative working, comprehensive integrated NCD plan, team-based services to patients through care pathways, incorporation and incentivization of general physicians, efficient logistics support, integrated health information system with development of population based surveillance system and use of multi-sectorial and holistic approach can lead to efficient control of NCDs in the country

Capacity building on health diplomacy: a training experience from Pakistan

Modern-day globalization means that many health issues cannot be resolved by the affected country alone, and this necessitates political consultations, diplomatic negotiations and cross-border solutions. A few examples that require health diplomacy efforts are: halting resentment towards immunization, addressing the burden of noncommunicable diseases, enabling access to drugs and technology, and liberalizing trade to reduce the cost of drugs. The agenda of Sustainable Development Goals [SDGs] demands a concerted effort to achieve the ambitious targets. This article reports the experience of health diplomacy training imparted to mid-level and senior officials in the public as well as private sector in Pakistan. Training was geared to inculcate an understanding of global health diplomacy and governance, and to develop an appreciation of the relationship of global health with other disciplines such as foreign affairs, economics, trade, climate change and human rights. Participants included health professionals, experts from departments other than health, government officials and diplomats. This training was expected to enhance their knowledge of health systems dynamics that are influenced by foreign policy and diplomatic discourses

Team based learning in pathology: effect on test scores and student satisfaction

Objective: The objective of this study was to compare the impact of team based learning [TBL] on student's test scores in comparison with didactic lectures. We also wanted to assess to the level of students satisfaction regarding TBL as a teaching methodology

Study Design: Quasi experimental study

Place and Duration of Study: Department of Pathology, University Medical and Dental College Faisalabad, from May to July 2013

Material and Methods: Fourth year undergraduate medical students attending Pathology course at University Medical and Dental College [UMDC], Faisalabad in year 2013 involved the portion of Haematology were divided into two halves. The first half [H-1] was covered in two TBL sessions of two hours and 15 minutes duration each

The second half [H-2] was covered in 8 lectures of 45 minutes duration each

After completion of the course, students took test comprising of problem based SEQs regarding Hematology. The test comprised of two segments with questions of equal difficulty, representing the two halves of the topic

Students scores in these two segments were compared by using paired sample t-test

The students were given a validated questionnaire. This data was analyzed by using SPSS version 20

Results: The test scores were highly significant [p=0.000] in TBL as compared to lecture group. In addition to positive significant relationship, majority of students also agreed that TBL motivated them to learn Pathology [71.72%], promoted better understanding of the subject matter [68.92%], helped to gain in depth knowledge of the subject [62.06%] and helped to remove misconceptions about the topic [65.51%]. Sixty two percent students preferred TBL to didactic lectures

Conclusion: Our study proved to have a significant impact of TBL on student test scores as compared to didactic lectures. Majority of the students were satisfied with TBL as a teaching methodology in Pathology and preferred it to didactic lectures

Healthcare in Pakistan-A systems perspective

Health system in Pakistan has witnessed evolution and dates back to the medieval, traditional health care, health for all approach, primary health care approach and health systems strengthening approach for better health outcomes. The main objectives of health system are improvement in health, fairness in distribution of risk and finances and responsiveness to the non medical needs of the population. With decreasing expenditure on health care, booming private health sector and flourishing pharmaceutical industry, government can only reduce catastrophic health expenditures by the poor and impoverished through an efficient, effective, accessible and responsive public health system. Inter sectoral collaboration, community participation, social protection, equitable distribution of resources, people centric health policy, health work force development, evidence based health information system and quality assurance of essential medicines will strengthen health system in Pakistan

Teacher's perspective on the modular system of education - a study on government medical college teachers and their views on educational systems

Objective: To assess the level of satisfaction about different systems among medical college teachers. To compare their preference among the modular and annular system and to assess percentage of faculty in favor of reverting back to old system

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at the Department of Community Medicine, SMC, JSMU, Karachi from January to May 2016

Materials and Methods: A study was conducted on a sample of 122 teachers from 3 government medical colleges [DMC, SMC and DIMC]. Of these, 65 were male and 57 were female. From DMC 52, SMC 43 and DIMC 27 teachers participated in filling the questionnaire. The sample was taken through Non-Probability Purposive sampling from the three medical colleges. An informed verbal consent was taken from the candidates. Pilot study was conducted to assess the authenticity of the questionnaire. A structured questionnaire was then distributed, got filled, data was entered and analyzed using SPSS version 21, with 95% confidence interval and 0.05 p-value

Results: A total of 122 teachers from 3 government medical colleges [DMC, SMC and DIMC] were asked to fill the questionnaire. From the total teachers 54.7% believed that modular system focused more on theoretical learning while 42.6% said that it focused on practical learning. 72.6% of teachers said that modular system is more stressful compared to 27.04% who disagreed. 51.6% said that the stress affected their teaching and 48.4% said otherwise. 91% teachers said that there was a need that teachers should be trained on how to teach according to the modular system while 9% said there was no need for training the teachers. 62.3% teachers said that the modular system did not allocate enough time to each subject as allotted by PMDC while 37.7% disagreed. 69.3% teachers said that the annual system gives sufficient time to each subject per PMDC guidelines while 30.7% disagreed. 64.8% teachers said that their institute should revert back to annual system of teaching while 35.2% disagreed. 64.8% teachers chose 'annual system' as their preferred system of education while 35.2% opted for the 'modular system'

Conclusion: The study concluded that the teachers of government medical colleges where module system has been implemented would like their institutions to revert back to the 'annual system' of teaching, declaring the latter their preferred system of teaching. They believed that the modular system was more stressful and focuses more on theoretical learning rather than practical learning

Out of pocket cost born by patients of type 2 diabetes mellitus in private diabetic clinics of islamabad

To estimate the direct cost and its determinants in type2 diabetic patients visiting outpatient department of private tertiary care hospitals. A descriptive cross sectional study. This research was carried out in the diabetic outpatient department of Shifa international hospital and AN medical Centre from 15 November 2014 to 15 February 2014. The descriptive cross sectional study was conducted on 108 diabetic patients [male 52%, female 54%]. By employing simple random sampling technique the data was collected from patients having diabetes from at least 5 years, with age limit between 30 to 80 years, with or without having complications through pretested interview administered questionnaire. The structured questionnaire was used for collecting data. SPSS 20.0 was used forrflata analysis. The percentages and frequencies were drawn in order to draw the results. The results showed that the average direct cost spent by a patient was 7704 PKR per month. More than half [66.7%] of the study subjects have suffered from diabetes since 5-10years. A larger group of respondents [50%] was treating diabetes with oral hypoglycemic. Medication, consultation, and lab investigation charges were the main determinants of diabetic cost. Per month medication charges were 3997 PKR, followed by lab investigation charges of 2441PKR per visit and consultation cost was 1298 PKR. Most of the patients [86.1%] were having one complication due to diabetes. The cost of treatment increased with the increasing age and morbidities. Diabetes is very expensive disease to manage. The affluent charges of managing diabetes and its day by day increased cases will put tremendous burden on the society