Health is an important sector in human life. In Pakistan, attempts have been made to improve the health conditions of the people through availability of trained personnel, adequate supply of medicines and establishment of health services. Yet the health care system as a whole is not encouraging. The main health problems are preventable communicable diseases, severe malnutrition and high incident of birth resulting of high proportion of infant and maternal mortality. There are also clear differentials in health conditions by rural and urban areas and socio-economic groups. Malaria, Tuberculosis and wide variety of childhood diseases such as diarrhea, measles and tetanus etc. still continue to pose potential threat to the health of millions of people in the country. Unsanitary condition, polluted water and illiteracy among rural mother, urban slum and high fertility, small budgetary allocation and inadequate administrative structure have been identified as the main hurdles in the progress of health conditions.
Amongst the population of Pakistan, the burden of diseases can be classified under two broad categories: half due to communicable diseases, reproductive health and malnutrition while the other half due to non communicable diseases, injuries and mental health disorders. Polio and hepatitis B & C are endemic and Pakistan ranks 6th amongst the 22 highest TB burden countries in the world. In parts of Pakistan, malaria and dengue fever are prevalent and HIV is increasing among some segments of the population. At least one quarter of Pakistani adults are obese, have cardiovascular conditions and over 40% of men are smokers. Injuries and accidents account for more than 11%of the burden of diseases. Nutritional disorders are common and particularly effect women and children.
Pakistan also needs to be prepared for emerging global diseases like swine flu and other viral infections. Pakistan has a high fertility rate with 4.2 million new births annually. This rapid population growth will further strain an already overstretched and underperforming health care services delivery system, including deliveries by skilled birth attendants. Efforts made over the years to improve health standards have been partially neutralized by the rapid growth of the population. In addition, gender bias and limited access to health services further compromise health of Pakistanis.
Sub-optimal performance of the health sector in Pakistan is primarily because of low level of health spending. Total expenditure on health as percent of GDP is only about 2 percent of GDP, which is much lower than other countries with similar income levels. The government contributes about a third of this and the remaining 70 percent is paid out-of-pocket by citizens at the points of service delivery.
A number of non-financial constraints have played an equally important role in the underperformance of health systems. Health workers are demotivated and distracted from their work by conflicting interests. Weak governance, imbalance of human resource, lack of equitable service delivery, absence of social safety nets, lack of effective implementation of regulations particularly in a large unregulated private sector are some of these factors having an adverse impact on the performance of the health sector. Pakistan faces numerous problems in the health section which are discussed herein.
Cleanliness / Hygiene
About 80% of all major diseases such as diarrhea, cholera, typhoid, hepatitis are due to unsafe drinking water, inadequate sanitation and poor hygiene. Health and hygiene are causing major disruptions in the lives of people of Pakistan. Outside the houses, you will see the reckless disposal of wastage. Just outside the boundary wall of house, there will be the waste of that or other houses in the street. The streets are littered with garbage, which include papers, polythene bags, stale meals, dung, debris and other weird things.
People habitually throw things in street after cleaning their houses. Commuters throw wrappers and other things from the vehicles while traveling. Picnic spots and parks have converted into a heap of dung. You will commonly see people urinating on the sidewalks. There are many roads and streets which are suffering from the disorder of sewerage system. Cleanliness has been declared as an element which comprises the half part of faith of Muslims. Ironically, more than 98% of Pakistanis are Muslims.
Water is an essential element for our survival. Unfortunately, while Pakistan is blessed with adequate surface and ground water resources, rapid population growth, urbanization and unsustainable water consumption practices have placed immense stress on the quality as well as the quantity of water resources in the country. Deterioration in water quality and contamination of lakes, rivers and groundwater aquifers has resulted in increased waterborne diseases and other health impacts. Per capita water availability in Pakistan has decreased from 5,000 cubic meters per annum in1951 to 1,100. The principal source of drinking water for the majority of people in Pakistan is ground water. About 80% of the Punjab has fresh groundwater, but in Sindh, less than 30% of groundwater is fresh. In NWFP, increasing abstraction has resulted in wells now reaching into saline layers, and much of Balochistan has saline ground water. As per Government figures, the Punjab has the best rural water supply amongst the provinces. It is stated that only 7 % of the rural population depends on a dug well or a river, canal or stream. In Sindh, some 24% of the rural population depends on these sources.
The rural water supply situation in NWFP and Balochistan is worse; about 46% and 72% respectively of the rural population depend on water from a dug well or from a river/canal/stream. Unchecked use of hazardous chemicals, vehicle emissions, and industrial activity has contributed to a number of environmental and health hazards, chief among them being water pollution. Much of the country suffers from a lack of potable water due to industrial waste and agricultural runoff that contaminates drinking water supplies .There is very little separation of municipal wastewater from industrial effluent in Pakistan. Both flow directly into open drains, which then flow into nearby natural water bodies.
There is no regular monitoring programme to assess the water quality of the surface and ground water bodies. There is no surface water quality standard or drinking water quality standard in Pakistan. It is estimated that 40 million residents depend on irrigation water for their domestic use, especially in areas where the groundwater is brackish. The associated health risks are grave, as bacteriological contamination of irrigation water often exceeds WHO limits even for irrigation.
Major industrial contributors to water pollution in Pakistan are the petrochemicals, paper and pulp, food processing, tanneries, refineries, textile and sugar industries. Only a marginal number of industries conduct environmental assessments (about 5 % of national industries).The sugarcane based industry, the 2nd largest in the country, is a major cause of industrial water pollution. The problem of industrial water pollution has remained uncontrolled because there have been little or no incentives for industry to treat their effluents.
The salinity level of groundwater is increasing. Industrial waste water including toxic chemicals, organic matter and heavy metals is discharged directly into public sewers without prior treatment. There is reported leaching of wastes into groundwater, causing outbreaks of water-borne diseases. At present, irrigation uses about 93% of the water currently utilized in Pakistan. The links between water quality and health risks are well established. An estimated 250,000 child deaths occur each year in Pakistan due to water-borne diseases. Apart from the human losses, these diseases are responsible for substantial economic losses.
Human Resource in health care is not appropriately planned in Pakistan, with the result that here are more doctors than nurses, lack of trained midwives, urban concentration, brain drain from rural to urban areas and abroad, along with other issues related to curriculum, quality of graduates and their continuing supervision. The service structure for health workers is poorly defined. It favors tenure over competence, largely ignores technical capacities and does not allow incentives or rewards for performance. There is absence of doctors in government hospitals and clinics and medical staff only comes to mark their attendance and go away and are not available at the time of need or emergency. Furthermore, quacks are destroying the health of innocent people. More than 600,000 quacks are operating across the country.
Quacks trap credulous people by making false claims and through media campaigns. These practitioners advertise through hoardings inscribed with misleading claims and through wall chalking in commercial and residential localities across the country. Many of these quacks are rapists and lure naïve patients towards them with the intention of raping them. Unhygienic conditions and use of unsterilized equipment by quacks sitting at different localities are spreading a number of diseases including cancer, hepatitis B and C, and AIDS. A number of quacks are doing business unchecked while the main cause for spread of these diseases is dental treatment.
HIV/AIDS spreads through unscreened blood transfusion, reuse of used synergies and unsafe sexual behavior. The disease also spread through use of used razors and needles mainly amongst drug addicts. There is a dire need to create awareness among people, of the disease for their protection.
Child Health Issues
Child health in Pakistan is among the most important national issues that have been given much attention. Nutritional disorders are common and particularly effect women and children. According to statistics, 27 infant deaths occur per thousand, 19 child deaths per thousand and 11 percentage babies are born with low birth weight. The child mortality in Pakistan is a major cause of concern, with every 1among 10 children dying before reaching the age of five and 1 among30, just after they are born. Pneumonia and air pollution seem to be the factors affecting the health of the children .
Some other reasons of why child birth issues arise are:
High fertility rates
Lack of skilled birth attendance
Insufficient availability of proper maternal and child care services
Low female literacy poverty
Insufficient emergency obstetric and newborn care system
Lack of clean water and hygiene milk
Ours is a male dominant society where only very few females enjoy full rights and have access to opportunities of even very basic human needs. This is even more true in the health sector, where unfortunately there is a great lack of female doctors combined with a large number of female 'quacks' in the country and the situation is at its worst in some rural areas where there is only one or two qualified female doctors. The female doctors are neither easily available nor easily affordable and women do not prefer to be examined by male doctors.
There are a lot of government hospitals which provide free or low fee treatment to women but those are not preferred because of:
The casual and offhand behavior of doctors
More than one male doctor examining the patient at one time
The fear of crowds of medical students present at time of examination
The fear that doctor may misuse this opportunity for some evil deed
Women in rural Pakistan have lesser access to health care than men, because of absence of female doctors. Factors like lack of awareness regarding women’s health requirements, low literacy ratio, low social status and civil constrains on females are responsible for women’s below standard health.
Intra-household bias in food distribution leads to nutritional deficiencies among female children. Early marriages of girls, excessive childbearing, lack of control over their own bodies, and a high level of illiteracy adversely affect women's health. More than 40 percent of the total female population is anemic.
The maternal mortality rate is high, as only 20 percent of women are assisted by a trained provider during delivery .
In rural areas, women are unaware of contraceptives, thus sexually transmitted diseases and bad health in women are common. They are at a risk of contracting HIV-AIDS and other sexually transmitted diseases (STDs) because of male dominance in sex relations and lack of access to information. In these areas, women are like slaves subject to drudgery. They are there just to obey their fathers, brothers and husbands. They do not have the right to decide about themselves because women are considered as foolish creatures according to the dominant social and cultural norms. Likewise marriage is also a sort of trade between different families both in the rural and urban areas. They are highly vulnerable to violation of their rights to life. Many women lose their lives in the name of honor killings.
There is a direct link between the health statuses of women and women’s low societal standing in Pakistan. For instance, the maternal mortality rate in rural Balochistan is 800 maternal deaths to 100,000 live births. This ratio in the end adversely strikes at the health of her children as well as national economy. Not only can these but evident differences among health status of women and men are visible in Pakistani polity. The poor women’s health is as much a social plight as much it is medically.
Factors like lack of awareness regarding women’s health requirements, low literacy ratio, low social status and civil constrains on females are responsible for women’s below standard health in Pakistan. Men and women both are poorly educated about family planning consequently affecting the health of mother and child. Perhaps the greatest loss to the family and economy of a country as one need to comprehend that woman is the glory of all that is created.
Health according to Islam
From an Islamic perspective health is viewed as one of the greatest blessings that God has bestowed on mankind. It should be noted that the greatest blessing after belief is health, as narrated in the following Hadith:
The final messenger of God, Prophet Muhammad (PBHU) mounted the pulpit, then wept and said, "Ask Allah (SWT) for forgiveness and health, for after being granted certainty, one is given nothing better than health."Related in Tirmidhi
Islam emphasizes on not taking health for granted. God has entrusted us with our bodies for a predestined period of time. He will hold us to account on how we looked after and utilized our bodies and good health.
The preservation of this blessing can only be achieved through taking good care of one’s health and taking every measure to maintain and enhance it. With this in mind every Muslim should make sure they undertake all necessary actions which are conducive to the preservation of good health. Healthy living is part and parcel of Islam, introduced with the inception of Islam more than 14 centuries ago. Furthermore, the Quran and the Sunnah outline the teachings that show every Muslim how to protect his health and live life in a state of purity. Numerous examples in Islam instruct its followers to live a healthy life by performing actions such as:
Ablution / Ghusal
Taking good / healthy diet and nutrition
Prohibition of intoxicants
Islam places great emphasis on cleanliness, in both its physical and spiritual aspects. On the physical side, Islam requires the Muslim to clean his body, his clothes, his house, and the whole community, and he is rewarded by God for doing so. Prophet Muhammad (PBHU) said, for example:
"Removing any harm from the road is charity (that will be rewarded by Allah)." [Bukhari]
While people generally consider cleanliness a desirable attribute, Islam insists on it, making it an indispensible fundamental of the faith. A Muslim is required to be pure morally and spiritually as well as physically. Through the Qur'an and Sunnah Islam requires the sincere believer to sanitize and purify his entire way of life.
In the Qur'an Allah commends those who are accustomed to cleanliness:
"Allah loves those who turn to Him constantly and He loves those who keep themselves pure and clean." [2: 22]
In Islam the Arabic term for purity is Taharah. Books of Islamic jurisprudence often contain an entire chapter with Taharah as a heading.
Allah orders the believer to be tidy in appearance:
"Keep your clothes clean." [74:4]
The Qur'an insists that the believer maintain a constant state of purity:
"Believers! When you prepare for prayer wash your faces, and your hands (and arms) to the elbows; rub your heads (with water) and (wash) your feet up to the ankles. If you are ritually impure bathe your whole body." [5: 6]
Ritual impurity refers to that resulting from menstrual release, menstruation and the first forty days after childbirth. Muslims also use water, not paper or anything else to after eliminating body wastes.
Prophet Muhammad advised the Muslims to appear neat and tidy in private and in public. Once when returning home from battle he advised his army:
"You are soon going to meet your brothers, so tidy your saddles and clothes. Be distinguished in the eyes of the people." [Abu Dawud]
On another occasion he said:
"Had I not been afraid of overburdening my community, I would have ordered them to brush their teeth for every prayer." [Bukhari]