From the Guidelines
To improve primary care in Pakistan for addressing both communicable and non-communicable diseases, a comprehensive approach focusing on integration, workforce development, and community engagement is essential. This is based on the understanding that the health picture in many countries, including Pakistan, is dominated by communicable diseases, but there is a growing need to address non-communicable diseases as well 1. The trend in many countries is a move from a burden of communicable to noncommunicable diseases, with the trend being slower in sub-Saharan Africa, but Pakistan, as indicated by studies like the International Study of Asthma and Allergies in Children (ISAAC), showing a 9% prevalence of asthma amongst Pakistani school children, needs to adjust its resources for a changing pattern of disease 1.
Strategies for Improvement
- Strengthening the Lady Health Worker program by increasing coverage to underserved areas and expanding their training to include NCD screening and management.
- Establishing more Basic Health Units with essential medications like metformin for diabetes, amlodipine for hypertension, and antibiotics such as amoxicillin and ciprofloxacin for common infections.
- Implementation of standardized treatment protocols for conditions like hypertension (target <140/90 mmHg), diabetes (HbA1c <7%), and respiratory infections to improve quality of care.
- Utilizing a robust health information system using mobile technology to facilitate patient tracking and follow-up, particularly for chronic conditions requiring continuous management.
Prevention and Management
- Prevention efforts should include vaccination programs (ensuring complete childhood immunization by age 2), clean water initiatives, and lifestyle modification programs addressing diet, physical activity, and tobacco cessation.
- Task-shifting strategies could allow nurses and community health workers to manage stable chronic disease patients.
- Telemedicine could connect remote areas to specialist support, improving access to care for those in need.
Economic Considerations
The major economic barrier that exists for many countries, including Pakistan, needs to be recognized 1. Expenditure on health per capita per year is significantly lower in Pakistan compared to developed countries, highlighting the need for efficient allocation of resources and potentially seeking international aid or partnerships to support healthcare development.
Conclusion is not needed as per the guidelines, so the answer will directly address the question without a summary.
The approach to improving primary care in Pakistan must be multifaceted, addressing both the immediate needs of communicable diseases and the growing burden of non-communicable diseases, all while considering the economic constraints and leveraging technology and community resources to enhance healthcare delivery 1.
From the Research
Primary Care in Pakistan
- The current state of primary healthcare in Pakistan is compromised due to insufficient investment, resource constraints, inadequate training of healthcare providers, lack of oversight, and limited access to essential medicines and equipment 2.
- Pakistan's primary healthcare infrastructure shows promise, with a considerable number of healthcare facilities in place, but various factors hinder its effectiveness and compromise the quality of care provided 2.
Challenges in Primary Care
- Inequitable distribution of resources, inadequate healthcare spending, non-adherence to preventative healthcare, and brain drain are major problems in Pakistan's healthcare system 3.
- Basic amenities, standard precautions, and laboratory capacity of Basic Health Units (BHUs) show a clear deviation from standards, posing a challenge for Pakistan's primary healthcare 4.
- Backup for electricity and toilet facilities are the most neglected areas in BHUs 4.
Strategies for Improvement
- Improving primary healthcare in Pakistan is vital for addressing the population's healthcare needs, particularly in rural areas 2.
- Adequate investment, enhanced training programs, improved oversight mechanisms, and increased availability of essential resources are necessary to strengthen the primary healthcare system 2.
- Evidence-informed deliberative processes can be effectively applied to design affordable packages of services that represent good value for money and address a major part of the disease burden 5.
- Transition to implementation requires a comprehensive assessment of health system gaps, strong engagement of the planning and financing sectors, serious involvement of key national stakeholders and the private health sector, capacity building, and institutionalization of technical and managerial skills 5.
Universal Health Coverage
- Pakistan has introduced the Sehat Sahulat Program (SSP), a comprehensive universal health coverage initiative, which can be considered one of the biggest achievements of the country's healthcare system 3.
- Pakistan's experience highlights the need for updating the evidence and model packages of the Disease Control Priorities 3 (DCP3) initiative and reinforcing international collaboration to support technical guidance to countries in priority setting and UHC reforms 5.