Family Medicine: Indispensable for an effective health care system

Abstract

Pakistan is beset with enormous health care problems including the quadruple burden of disease that includes both communicable and non-communicable diseases posing a major public health challenge for all stake holders.[i] The existing health care system consists of a tier of primary, secondary and tertiary care in the public sector composed of dispensaries, basic health units (BHU), rural health centres, district hospitals and larger tertiary care hospitals.[ii] Despite a well-defined structure of the public health care system, 80% of the general public uses the private sector for their health care with out of pocket expenditure incurred. The low utilization of public services could be driven by multiple factors like deficiency of appropriately trained health care personnel resulting in poor quality and poor access, lack of availability of personnel and resources like medicines, cost and distrust in the government health care system. As a result, BHUs’ are underutilized whereas the tertiary care system is overwhelmed with patients who could easily be dealt with at the primary care BHU level.

A strong primary health care can address upto 90% of a population health needs.

[i] Nishtar S, Bhutta ZA, Jafar TH, Ghaffar A, Akhtar T, Bengali K, et al. Health reform in Pakistan: a call to action. Lancet. 2013; 381: 2291-7.

[ii] Basharat S, Shaikh BT. Healthcare system in Pakistan. In: Rout HS (Ed.) Healthcare system - A global survey. ed. 1st, New Delhi: New Century Publications; 2011.p.434-54.