The approach to healthcare in many countries is based on a systemic approach with primary health services in every neighborhood. If a person falls ill, he or she visits this facility as the first point of contact where he is given a prescription if required following a diagnosis. If a specialist consultant is required then a referral is given and the patient is connected to the specialist. In Pakistan, however, the concept of primary healthcare is barely present and lacks representation at the overall government health system dynamics. As demand has outstripped the supply for many years, private healthcare has become the norm in many urban localities.
Karachi has between 18 and 20 million inhabitants. In this city, private healthcare services run mainly by a single doctor have become the norm rather than a systemic approach as the government cannot meet the demand of a city the size of Karachi. This approach has two main downfalls. Firstly, it does not ensure that all doctors provide a quality service to the patients. The type of diagnosis a doctor provides will depend on how ethical he or she is about his work – with cases of malpractice arising through incentives provided by pharmaceutical companies. Whilst most doctors are qualified, there are some quacks who start practicing with fake degrees. Secondly, if a doctor relies more on instinct and no longer uses a protocol-based approach, there are chances he or she could be wrong and lead to a wrong diagnosis.
In many well developed localities, doctors who are general practitioners, are well respected members of communities and give excellent diagnosis polished from years of experience. Most of these doctors hold a post in government facilities as well. In underdeveloped localities, this is not the case. Whilst there are good doctors working selflessly, there are also doctors who take advantage of the poor and uneducated by prescribing endless expensive tests and low quality medication.
A solution to this problem has been to establish clinics which provide all of the services related to primary healthcare to the poor under one roof. Since 1998, SINA Health Education and Welfare Trust has been working in such localities to provide primary healthcare facilities. Each of its clinics has its own lab testing and ultrasound facilities. The doctors and staff who work at the clinic are qualified and follow a protocol-based approach to diagnosing ailments. This practice ensures that a systemic approach is followed reducing the chances if incorrect diagnosing of patients. Medical records are maintained and checked through an IT based system which ensures the quality of approach. Patients are prescribed high quality medicines from the clinic’s own dispensary which enable patients to recover quickly. Other than the token fee of Rupees 20, the services provided at the clinics are free of cost. More than 80% of the patients receiving treatment are zakat eligible, majority being women and children.
With this approach to primary healthcare, SINA hopes to enable communities to live healthy and productive lives. It is currently treating more than 800,000 people through 30 clinics in these localities. The World Health Organization has identified primary health care has been proven to be a highly effective and efficient way to address the main causes and risks of poor health and well-being today, as well as handling the emerging challenges that threaten health and well-being tomorrow. In these localities, communicable diseases are a main culprit. Having an organized primary healthcare system can reduce this impact on these communities and lead to healthier neighborhoods.
It has been estimated that 50% of Pakistan’s population will live in cities by 2050. To look after a population this size will require a systemic approach to healthcare. SINA has identified and developed a solution which enables cities to look after its poor in a systemic manner.
Such solutions can have far reaching impacts, as they seek to reduce the gap between the rich and poor by focusing on access to basic and necessary facilities such as healthcare.
