Public health issues in pakistan: Human Resource Development,Management and Leadership in Health Sector Emerging Communicable Diseases,Emerging non-communicable diseases,Environmental Threat,Regulatory Frame Work,Overwhelming population burden and socio-economic growth

1. Public Health Issues in Pakistan
Quality Medical Education:
Present system of medical education in Pakistan is the one which has its roots in the
colonial era. Since independence in 1947, medical education in Pakistan has witnessed
very little or almost no change at all. As a result of the rigid attitude of our policy makers,
lots of problems have appeared which need to be sorted out and remedial actions be
taken.
General Problems of Medical Education, Educationists believe that information
disseminated in mother tongue is easily comprehended. But the situation in our country
is such that our mother tongue is not used as a medium of instruction in majority of
educational institutions, because of unavailability of textbooks and reference materials in
Urdu. English is used as the medium of instruction for all professional as well as
postgraduate programs. So, the students with very sound knowledge of science but with
some weakness in English find it difficult to understand or express themselves in English.
In most of the medical colleges of Pakistan students-teacher ratio is very inappropriate.
Usually the number of students in a class is around three hundred. Hence communication
between faculty and students in most medical schools has not been one of the strong
point of our system. Moreover, with increasing awareness of personal rights, lesser
number of patients allow themselves to be examined by medical students, especially so
in private medical colleges. In modern world live or mechanical simulators are substituted
for patients. But in the absence of any such facility medical students in Pakistan are
devoid of the opportunities to practice their clinical skills and they are left with mere
theoretical knowledge of the subject.
In Pakistan national politics exerts influences on each and every institution in medical
colleges students as well as teacher’s selection is highly politicized. Merit is no longer the
criteria resulting in lowering of standard of medical education as a whole. The standard
of medical education is directly related to the standard of teaching manpower, financial
inputs and available facilities. Due to wrong planning and policy making financial inputs
for medical education are scarce and the facilities for teaching/learning i.e. reference
books, journals, laboratory equipment are not Upto the standard and inadequate as well.
We do not have the potential of research neither in our undergraduate medical institutions
nor at the postgraduate level.
Human Resource Development:
Human resource development (HRD) plays a central role in the economic growth of any
country. Currently, Pakistan is facing some serious challenges with regard to this
profession. Though the government has created an HRD ministry, since it has primarily

2. evolved from the labour ministry it will take some time to acquire in-house expertise to
understand the dynamics of HR and its implications for the revival of industry.
With regard to the growth of HRD, there are some major challenges which, if handled
well, can promote a climate for economic recovery and reverse the process of brain drain
in this country. The biggest challenge to this profession in Pakistan is that the country
does not have an institution to regulate human resources.
It is a fact that HRM is a newly emerging profession. But developing countries have rapidly
sensed its significance and formed institutions to standardise and regulate the profession.
For example India and China have taken an institutional approach.
Another challenge to HR in Pakistan is that it has very limited workforce management
legislation. Industrial relations and related laws primarily focus on the labour class, leaving
aside white-collar workers. The country needs enactment of laws addressing workplace
discrimination issues, equal opportunities, a code of conduct on employees’ data-sharing,
diversity, disabilities and retirement benefits.
Management and Leadership in Health Sector:
Th e aim of good management is to provide services to the community in an appropriate,
efficient, equitable, and sustainable manner. Th is can only be achieved if key resources
for service provision, including human resources, finances, hardware and process
aspects of care delivery are brought together at the point of service delivery and are
carefully synchronized. Critical management considerations for assessment and
planning, managing the care process, human resources, interacting with the community,
and managing information are covered in the Planning, Human Resources, Integration
and Monitoring chapters. Th is chapter first discusses good management and leadership
in general, then outlines relevant considerations for managing relations with patients and
the district team, as well as finances and hardware and management schedules.
Management and leadership are important for the delivery of good health services.
Although the two are similar in some respects, they may involve different types of outlook,
skills, and behaviors. Good managers should strive to be good leaders and good leaders,
need management skills to be effective.
Leaders will have a vision of what can be achieved and then communicate this to others
and evolve strategies for realizing the vision. They motivate people and are able to
negotiate for resources and other support to achieve their goals.
Managers ensure that the available resources are well organized and applied to produce
the best results. In the resource constrained and difficult environments of many low – to
middle-income countries, a manager must also be a leader to achieve optimum results.
What are the attributes of a good leader? Leaders often (but not necessarily always):
have a sense of mission; are charismatic; are able to influence people to work together

3. for a common cause; are decisive; use creative problem solving to promote better care
and a positive working environment.
Emerging Communicable Diseases:
Emerging infectious diseases pose a serious threat to public health security; this is
especially true in the underdeveloped world because of limited resources to combat them.
These emerging pathogens are characterized by a novel mode of pathogenesis and, in
some cases, a broad host range.
Over the past few decades, Pakistan has suffered a great deal from infectious diseases
such as dengue, Crimean-Congo fever, hepatitis, measles, and polio. Changing climate
conditions, environmental degradation, global warming, loss of biodiversity, and other
ecological determinants have a direct effect on these diseases and result in the
emergence and reemergence of infectious entities.
The causes of such disease outbreaks are complex and often not well understood.
Dealing with an outbreak requires an integrated and coordinated approach, with decision
making by various state departments. Stringent biosecurity and biosafety protocols can
help to reduce the chances of infection dissemination.
In order to mitigate the risks associated with emerging pathogens, there is a greater need
to understand the interactions of pathogen-host-environment, to monitor molecular
evolution and genomic surveillance, and to facilitate the gearing up of scientists across
the globe to control these emerging diseases.
Many diseases are common in Pakistan, including endemic and epidemic infectious
diseases, emerging infections, and an increasing burden of non-communicable diseases.
An estimated people in Pakistan are infected with the hepatitis C virus (HCV),
tuberculosis, malaria HIV/AIDS, Poliomyelitis, Dengue
Emerging non-communicable diseases:
Pakistan is a country with rapidly growing population. Increase in population, rural to
urban migration, changing dietary patterns and reduction in physical activity is leading to
increase in modifiable risk factors of NCDs in Pakistani population. Consequently,
Pakistan is experiencing double burden of disease due to upsurge in NCDs in addition to
already prevalent communicable diseases. Same is evident from data regarding the
global burden of disease that 62% of the crude deaths and 77% of the age standardized
deaths in Pakistan occur due to NCDs and injuries
Time trends illustrate that there is steady rise in premature deaths in Pakistan due to
NCDs in both males and females. These trends necessitate immediate public health
actions, if delayed; the NCD epidemic is projected to cost the lives of 3.87 million people,
aged 30-69 years, from 2010 to 2025. Moreover, it is estimated that cumulative financial
loss for Pakistan will be US$ 358 billion to 862 billion for these 3.78 million pre-mature
deaths6. Though, based on global concern over NCDs, some realization has been felt to
initiate work on the control of these diseases. This work should cater for short and long

4. term aspects because there is high prevalence of risk factors like unhealthy diet, physical
inactivity, use of tobacco and alcohol, increase in obesity especially during childhood,
cholesterol rise, diabetes mellitus and hypertension amongst population. Consequently,
it is anticipated that the scenario of co morbidities will be more complex for Pakistan than
estimated now. Moreover, proportion of NCD prone population i.e. 65 years or older, is
also projected to increase from 3.9% in 2000 to 5.4% in 2025 leading to rise in NCDs in
parallel to the aging population. Currently, available data on NCDs shows a substantial
amount of risk factors in Pakistani population which are estimated to rise rapidly, if current
life style patterns continue.
Environmental Threat
Pakistan is facing many environmental challenges, which pose serious threats to human
health and life. First of all, climate change is a non-traditional threat for Pakistan. Pakistan
has been declared among top ten countries most affected by climate change. Climate
change is negatively impacting health, agriculture and overall economy of the country.
The main reasons are carbon emission, deforestation, population explosion and lack of
finances to mitigate and adapt to climate change effects.
Water scarcity and clean drinking water is the talk of the town these days. Pakistan is a
water scarce country. The main causes are climate change, lack of enough reservoirs to
store water, water issues with India, and old irrigation system and water wastages in
domestic consumption and lack of awareness. Air pollution, poor waste management and
population bomb are major hurdles behind the availability of clean drinking water for
everyone in Pakistan.
Similarly, one of the biggest issues is the increasing deforestation in the country. Pakistan
could not achieve the UN’s set target of 25percentof forest cover on its total area, besides
two plantations drives annually. The reason behind deforestation is energy crises,
commercial benefits and domestic use. Though certain plans have been launched to
increase forest cover, which includes Green Pakistan Program, Billion Tree Tsunami and
REDD Plus, but it will take some years for these plants to grow and replace already cut
big trees.
Pakistan is facing a lot of climatic and environmental issues, including Water pollution,
soil erosion, and land pollution, shortage of water, global warming, air pollution and
natural disasters. The major reasons of these environmental issues are carbon emission,
increasing populations, and deforestation. The unavailability of water is the main issue,
according to the recent report of International monetary fund (IMF) Pakistan ranks third
in the list of countries facing cute water shortages. The main reason behind this water
shortage is urbanization, ever-growing population, climatic changes, lack of water
management and the lack of political will to deal with the issue. The issue of water scarcity
is accompanying by the acute climatic changes. In May 2015, Karachi experienced the
deadly heat wave Pakistan has seen over 50 years. At least 1,200 people died during the

5. extremely hot weather. The increased temperature is also the biggest reason of melting
glaciers in Pakistan.
Regulatory Frame Work
Over the last two decade, Pakistan has significantly reformed its regulatory framework,
though more needs to be done still. It has privatized a number of public enterprises and
intends to privatize the remaining public enterprises including utilities, some of which may
still be considered as natural monopolies. With minimal direct intervention of the
government in the economy, there is a need to ensure that private sector allocation of
resources is in accordance with the national priorities and that the monopolists do not
indulge in fleecing the consumer. Accordingly, the incentive structure has to be reformed
so that it promotes dynamic comparative advantage, ensuring consistency between the
protection afforded and the fiscal incentives. Similarly, the regulatory authorities will have
to be protected against the vested groups, and efficient outcomes ensured. Reforms in
the financial sector have been rather significant. Autonomy of the State Bank has been
the major achievement, and one hopes that the
spread between deposit and interest rates would be narrowed down as a result of the
guidelines provided by the State Bank to the financial institutions. The reforms in the
exchange market have been substantial and the floatation of Pakistani rupee through
active monitoring of the State Bank would ensure exchange rates in line with long-
run equilibrium. Similarly, supervision by the Securities and Exchange Commission would
be helpful in encouraging firms to go public, and give confidence to the investors
Overwhelming population burden and socio-economic growth:
There is divergence of opinion regarding the consequences of population growth for
economic development. Some view rapid population growth as a real problem while
others assert that it is not a matter of grave concern. Cross- national evidence on the
relationship between population growth and economic growth is inconsistent because the
under- lying parameters and assumptions vary across countries. Country-specific studies
are more useful for illuminating unique features of a country. In this article, I examine
Pakistan's case of population growth and economic development. Between 1950- 2001,
Pakistan's population increased 430 percent. Multivariate analyses of 1981 to 2005 data
from the Pakistan Economic Survey and from the International Financial Statistics
yearbooks found significant and negative relationship between population growth and
measures of economic advancement. These results demonstrate that rapid population
growth is a real problem in Pakistan because it contributes to lower investment growth
and diminishes the savings rate. Today foreign investment and export promotion have
only a small impact on Pakistan's economic growth. Owing to its rapid population growth,
Pakistan has among the world's highest dependency ratios. Policy makers can address
these serious economic consequences of rapid population growth by investing in family
planning services. Development of independent media and liberal education in
educational institutions will in time also help by encouraging an ideal size smaller family