Population-growth

Health Under Pressure: Population Growth Challenges and Solutions for Pakistan’s Healthcare

Faridah Amir Ali, Nizahat Zehra Zaidi

Indus College of Family Medicine and Public Health, Indus University of Health Sciences

Background

The “World Population Day,” established by the United Nations in 1989, is marked to raise awareness about the global interplay between population, environment, and socioeconomic development. Interestingly, it took thousands of years for the world’s population to reach 1 billion and only 200 years to reach 7 billion! Projections indicate it will increase to around 8.5 billion by 2030 and 10.9 billion by 2100. (1)

Population Growth in Pakistan and the Health Sector

Pakistan ranks 5th among the most populous countries in the world. The current population of Pakistan is around 245 million, constituting 2.99% of the global population. With a 2% annual growth rate, which is in contrast to a 1-1.5 % growth rate in other South Asian countries, the population density is 312 people per km². (2) Pakistan is a low-middle-income country with a Human Capital Index of 0.4, which highlights the economic challenges of the population. (3) Amid the crises, the education and health sectors suffer the most. The life expectancy in Pakistan is 66 years, even lower than other South Asian countries. (4,5)

This massive population growth, which has increased by more than six-fold since independence, poses serious socioeconomic and health-related challenges. This alarming rise in population is multifactorial. Among South Asian countries, Pakistan has the lowest contraceptive rate. Almost 20 % of married women cannot access effective family planning methods. Also, weak healthcare service delivery cultural and religious norms are contributing factors. (6)

A robust and steady health sector is critical for the progress of a nation as it directly impacts the population’s well-being. A healthy workforce is directly proportional to a country’s economic output; at the same time, it fosters social stability by providing essential services to individuals and their families. Optimal investment in health infrastructure, research, and services leads to improved public health outcomes and, hence, better quality of life in communities.

Impact of High Population Growth on the Health Sector in Pakistan

  1. Health Infrastructure
  • Overburdened Healthcare

Pakistan’s rapidly growing population places huge pressure on its healthcare infrastructure. The public sector barely caters to the population’s healthcare needs, and the private sector charges a fee for services that most people cannot afford. (7) As a result, government hospitals and primary care clinics are operating beyond their capacity. The poor quality of care due to a shortage of beds, wards, long waiting times, and the inability of the patient to afford private healthcare compromises the quality of patient care. (8, 9)

  • The Shortage of Medical Facilities

The increase in population is leading to a mismatch in the supply-demand ratio of basic medical facilities and procurement of necessary equipment. Public healthcare institutions lack advanced diagnostic tools, sufficient medications, and even life-saving equipment. (8, 9) Rural areas are even worse, where basic healthcare facilities are underfunded and under-resourced. Therefore, patients from far-flung areas have to travel long distances to access basic medical care. (10)

  1. Healthcare Workforce
  • Scarcity of Qualified Healthcare Professionals

The healthcare professional (doctors, nurses and paramedics) versus the patient ratio is critically low in Pakistan. The quality of healthcare services diminishes as the patient-to-healthcare professional ratio widens. The current patient-doctor ratio in Pakistan is 1:1300, which is quite low compared to the ratio of 1:1000 by WHO. (11) The productivity of exhausted professionals may lead to diagnostic errors, incomplete treatments, and poor patient outcomes, leading to frustration and a lack of trust in the healthcare system. Hence, achieving sustainable development and universal health coverage goals is increasingly challenging. (8,9,11)

  • Brain drain

The overwhelming workload and stressful conditions lead to burnout and job dissatisfaction among healthcare professionals, affecting their mental and physical health. Reduced healthcare professionals’ productivity and high turnover rates further strain the limited workforce, consequently compromising quality of care. (11, 12) Moreover, due to the current economic crises, qualified healthcare professionals migrate abroad for greener pastures and better quality of life. (12)

  • Challenges in Medical Education and Training:
    The capacity of medical education and training institutions is not keeping pace with the population growth. There are not enough institutions to produce the required number of healthcare professionals. (11) On the other hand, the regulatory bodies for education are unstable due to political instability in the country. The challenges of unregulated growth of healthcare institutes charging an arm and a leg yet unable to deliver quality education are immense in Pakistan. The training often lacks practical exposure and modern techniques, resulting in a workforce unprepared to face contemporary challenges. (11)
  1. Healthcare Services
  • Lack of Preventive Care
  • Public health is a developing field in Pakistan, yet it cannot cope with the increasing population load. Due to unavailability and meager preventive healthcare services, patients often present with overt diseases and complications, leading to a vicious cycle where non-affordability and inaccessibility lead to delays in seeking care, increasing the cost of care and leading to disability and, hence, further reduced productivity. (13)
  • Spread of Infectious Diseases

Overcrowding, lack of awareness, delay or unacceptability of childhood vaccinations, and inaccessibility or unavailability of preventive services have resulted in epidemics and endemics of diseases like measles, malaria, tuberculosis and polio, just to name a few. (15)

  • Maternal and Child Health

Pakistan has one of the highest maternal (154/ 100,000 live births), (15) and infant mortality rates 51/ 1000 live births) (16) in the region. The need for maternal and child health services is overwhelming due to population growth. As a result, many women lack access to skilled birth attendants or emergency obstetric care, leading to complications during childbirth. Even access to pre-natal and post-natal care is limited, which increases morbidity during the perinatal period. Due to high fertility and low contraception, the fertility rate in Pakistan is 3.4 births/woman (17). Well-baby clinics are rare, and people cannot afford basic needs, which puts an additional negative impact on childhood nutrition and development. Hence, the healthcare system struggles to provide adequate nutritional support and early childhood development programs, perpetuating the cycle of poverty and poor health.

Challenges in Addressing High Population Growth in Pakistan

  • Cultural and Social Barriers to Family Planning

Deep-rooted, diverse cultures and obsolete thoughts and social barriers are some of the significant challenges in addressing high population growth in Pakistan. Early marriages provide a high fertility window for women, and cultural values discouraging contraceptive use lead to one having a bigger clan. In part, these practices can be attributed to poor health literacy and lead to unsustainable control measures for the population. (18, 19)

  • Lack of Awareness and Education about Reproductive Health

Many people, especially those living in rural areas, have less or no knowledge regarding the importance of reproductive health. Low literacy rates and limited access to information exacerbate this lack of awareness. Misconceptions and myths about contraceptives, such as fears of infertility or adverse health effects, further hinder their use. Informed decisions related to family planning and contraceptives will not see increasing numbers unless these people are properly educated and made aware of the risks that are associated with high birth rates. (19)

  • Insufficient Government Policies and Funding

Lack of political will, ineffective government policies and inadequate funding are among the major reasons hindering rampant population growth. Implementing existing family planning programs is also hampered by non-existent funds and resources. Government initiatives, at times, are unable to reach the masses due to insufficient advertisement and publicity, particularly in remote and far-fetched areas. There is also a lack of policies and incorporation of reproductive health programs into broader health and developmental agendas. (18)

  • Political and Religious Influences

Political and religious influences are crucial in shaping views and strategies towards family planning in Pakistan. Influential religious scholars and organizations significantly affect the perspectives of the public and governmental policies. It has been seen religious explanations discouraging or prohibiting the use of contraceptives have an enormous effect on the acceptance and implementation of family planning programs. Political leaders may also be reluctant to prioritize family planning due to concerns about hurting religious schools or facing backlash from conservative segments of society. This political and religious landscape creates an environment where family planning initiatives struggle to gain support and validity. (18, 19)

Strategies For Controlling Population Growth

The world’s population is growing at an annual change of 0.8%, with the current population being 7.95 billion at a fertility rate of 2.27 births per woman ‎(2021). (20) Pakistan is one of the top five contributors to the increasing world populace ‎(2021). (21) The rapid expansion in human numbers is draining the world of its resources faster than one can imagine. According to the United Nations Population Fund (UNFPA), half of the pregnancies worldwide are avoidable. (22) The World Health Organization (WHO) states that 164 million women of reproductive age do not have access to contraceptives. (23) Following are a few recommendations to address the challenges:

  • Expansion of Family Planning Services

Establishment of more clinics in rural and far-fetched areas are needed to expand the reach of reproductive health literacy programs. Affordable and accessible contraceptive options for the masses are essential. Health literacy campaigns need to be conducted far and wide to prevent family planning from being a taboo topic.

  • Promotion of Contraceptive Use

Contraceptive products must be free or subsidized to cater to the lower-income populace. The government must offer counseling services and sessions for a better understanding of contraceptive use and benefits.

  • Education and Awareness Campaigns

Campaigns should be launched with the help of our vast team of Lady Health Workers (LHW) to reach people in far and distant areas and promote general awareness regarding family planning and reproductive health. Religious scholars and leaders must accompany the LHW to address concerns and myths related to contraceptive use.

  • Health Education and Awareness in schools

Integration of Reproductive Health Education should be done in Schools’ curricula to increase the knowledge among teenagers. Teachers should be trained to deliver reproductive health education effectively and culturally sensitively to address students’ queries. Social media platforms can be utilized to disseminate information on family planning and reproductive health. Mobile Health applications can also be developed to scatter information and resources regarding family planning.

  • Government Policies and Initiatives

Reviewing and strengthening existing population control policies is important to ensure they are effective and up to date, while budget allocation for health sector need to be increased. Moreover, transparent and efficient utilization of funds allocated for population control programs should be guaranteed.

  • Improving Health Services

Spending on the upgradation of existing primary healthcare facilities, establishing new ones in underserved areas, and improving the supply chain management to ensure a consistent supply of medical and contraceptive supplies is the key to increase community access to family planning methods. Providing continuous training and professional development opportunities for healthcare professionals in reproductive health and family planning would ensure quality of the programs.

Conclusion

Addressing the challenges of high population growth in Pakistan requires a multifaceted approach considering cultural, social, educational, and policy-related factors. Community engagement and education campaigns are essential to overcome cultural and social barriers. These initiatives should involve local leaders, influential and religious figures, to foster acceptance and support for family planning. Improving awareness and education about reproductive health through comprehensive sex education and public health campaigns can empower individuals to make informed choices.

Moreover, the government must develop and implement robust policies prioritizing family planning, including allocation of sufficient funding to family planning programs, expanding access to contraceptives, and integrating reproductive health services into the broader healthcare system. Political leaders must demonstrate the political will to address population growth, working collaboratively with religious and community leaders to find culturally sensitive solutions.

Ultimately, tackling high population growth in Pakistan is not just a matter of health but also of social and economic development. By addressing these challenges comprehensively, Pakistan can pave the way for a healthier, more sustainable future for its population.

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