THE department of health is planning to launch two special programs for the southern Punjab in close collaboration with the community and health experts to address provision of health services to the population and specifically target the poor looking at options to provide them services through the private hospitals also.” This was stated by Director Punjab Health Reforms Program, Doctor Amjad Shehzad, in a workshop ‘Protecting Pakistan’s Poor Against Health Shocks In Disasters’.
A survey of 6000 households in the southern districts of Punjab for household health expenditures revealed that the poor households reported lower levels of private consultation compared to the non-poor households, poor households were more likely to cite cost as a barrier to accessing health care than non-poor households: 38.9% for poor households versus 33% for non-poor households. Higher rates of impoverishment were recorded for rural households compared to urban households: 15.8% versus 9.4% based on national poverty line. Another important fact was that although the floods affected all the population it is the poor who still have more health issues compared to the non poor.
Dr. Amjad said that the department of health has arranged for the consultation on policy option and as a first step the relevant technical experts have been called to initiates a dialogue on the policy options to address the situation. He said that The Punjab department of health has demonstrated the capacity to respond to all types of emergency and disaster situations and in cases where the capacity required strengthening serious efforts have been undertaken to enhance the department’s capability, e.g. the dengue unit in response to the dengue epidemic.
He said that there have been concerns regarding Punjab Health Department’s capacity to respond properly to disasters; however, a detailed analysis of the PSLSM (Pakistan Social Living Measurements survey) data that the 2010 floods did not worsen the difference in access to health between flood affected and non-flood affected districts, and led to improvement in the health services delivery in flood affected districts. The 2010 floods increased the likelihood of households in flood affected districts receiving treatment for diarrhea by 10 percent. The floods did not affect the access to pre and post-natal care. The data also does not show an increase in Out of Pocket Expenditures for health care post flood which proves that the health response to the disaster was adequate.
A very important aspect is that although the floods hit the poor and rich equally, it is the poor which are still struggling with health related issues and require continued attention. Data from the PSLSM indicates an overall decline in the percentage of children suffering from diarrhea over time; from 12.3% in 2005-06 to 11.1% in 2010-11. There is nevertheless an increase in diarrhea incidence between the last two rounds, driven mainly by an increase in diarrhea incidence in flood affected districts (9.9% in 2007-08 to 12% in 2010-11).
Dr. Amjad said that despite the overall progress in access to maternal health services, the level of service delivery remains low, particularly for women seeking post-natal care within 6 weeks of last delivery. “Predictably, these figures are higher for the non-poor in comparison to the poor,” he said adding that the flood affected districts also shown a consistently lower level of service utilization for Antenatal Care, Post natal care and skilled Birth Attendant across all 3 rounds.
“Although over time we see improvements in the immunization rates, interestingly theimmunization rates for the non poor in the flood affected districts are systematically lower than those for the poor in the non flood affected districts, which shows that the system is not able to reach a majority of the people in the districts which later were also affected by the floods,” Dr. Amjad added.
He said that the Government of Punjab is working on health sector reforms and has prepared a detailed strategy to supplement the ongoing efforts the department of health initiated a study to look at the impact of the floods and disasters on the population of Punjab. The funds to support this initiative were provided by the Rapid Social Response (RSR) trust fund which has been generously supported by the Russian Federation, Norway, the United Kingdom and Australia.