Collapsing health programmes

Is health unimportant enough to depend on the generosity of strangers?

There is a public health crisis developing in Pakistan because foreign donors have cut off aid. Reproductive health and family planning, as well as AIDS and polio vaccination and anti-TB programmes are all suffering because the collapse of donor support has meant that the nation’s health is under threat not from some new disease, but old problems. Rather than individual patients, public health focuses on prevention. Pakistan already spends only 0.9 percent of its GDP on health, which is well below the 5.0 percent recommended by the World Health Organization. Much of the funding came directly from USAID, which has now been slashed, while the money received from the World Health Organization has disappeared after the USA pulled out of it.

The obvious issue is that a country spending less than a fifth of the benchmark on health has found itself placed in a false position, where public health is sacrificed, and government spending goes to showy projects. A mother who survives her pregnancy because of a spanking new expansion of an old maternity ward is a more showy outcome than if she had never conceived at all because of a family planning programme. A polio victim provided a prosthetic is a more dramatic example than that victim saved entirely from that disease by a vigorous series of vaccination campaigns. Public health has always been unglamorous, always lacking visible outcomes. One can boast about a miracle cure, but how does one boast about saving the life of someone who never got sick in the first place?

There are two commitments which have to be made. First, the government has to commit itself to ensuring that the affected programmes do not suffer. Then the provincial governments have to step up, because they are the logical executing agencies. If the federal government was to tie the funding to specific programmes, it would oblige the provincial governments to spend on prevention rather than cure. That such spending needs to be examined closely for signs of embezzlement should need no saying, but it must be guarded against. There has been talk of the provincial governments being tied to health and education outcomes through the NAtional Finance Commission. The impact of public health spending should be given a greater proportion.