Public health sector provides economic accessibility to selected areas and social classes while excluding other areas and social classes by providing them uneconomic accessibility. The public health sector ensure opportunity for private health sector to monopolize the excluded areas and social classes. By Marxist perspective, this model is designed to ensure economic benefits of capitalist class. Private hospitals are owned by capitalists and policies for public hospitals are also made by capitalists. This model contradicts with human rights of citizens and one of the main goal of sustainable development. In the short term, this Model depicts that some areas belong to upper class (mostly mainstream urban areas), will cost relatively minimum to access public health services, while other areas belong to middle and lower classes (peripheral urban and rural as a whole), will cost maximum to access public health services.
In modern world, one of the primary duties of a nation state is to provide balanced health services to its citizens without any discrimination. The constitution of Pakistan put responsibility of socio-economic development of citizens on state, based on the eighteenth Amendment, provision of health services is a shared responsibility of federal and provincial governments. Pakistan spent 43 US$ per capita for health in fiscal year 2020-2021. Islamabad capital territory by having over two million population and 906 Sq. KM territorial area allocated 25,186.820 Rs. In Million budget estimated for year 2020-2021.
The existing health service model in the ICT is imbalanced and concentrated, not only between urban and rural but also among urban sectors as well. There are few renowned public hospitals in Islamabad city i.e. Pakistan Institute of Medical Sciences (PIMS) and National Institute of Rehabilitation Medicine (NIRM), located in G-8 sector while (poly clinic) in G-6 sector. All these hospitals are accessible to mainstream urban populations, while peripheral urban sectors are excluded. Rural Islamabad has only one hospital (Federal General Hospital) located in Chak Shahzad.
Inaccessibility to public hospitals in ICT resulted in a monopoly of the private health sector in the capital and particularly in excluded rural areas. More than a hundred private hospitals, working in ICT. There is no efficient mechanism for registration and regulation of these private hospitals generally in urban areas and particularly in rural Islamabad, to ensure the quality of services.
There is a larger rural area with approximately 400,000 population, located on both sides of GT Road in the west of Islamabad city known as Tarnol. Comprised of many villages ( Johd village, Dhok-kashmiria, Dhok- Abasi, Dhok- paracha, Sang Jani etc…) facing the lack of public hospital and BHU. Still, no evidence exists that the government or city administration is trying to bring it under coverage in services circle.
As a result, women and children are the primary victims of the inaccessibility to public hospitals. Most families living in Tarnol rely on the economic activity of male members only, and males must leave the house each morning and return late in the evening. The male has to skip his daily activity for bringing his sick family members to far located public hospitals. If it is not possible for him, then acute diseases of women and children will grow into chronic diseases at the end which will again suffer family economy in such inflation crises.
The concentrated Public Health Services Model in the ICT has multiple negative impacts on the people’s economy. Public hospitals have uneconomic accessibility and poor performance while private hospitals charge huge money for medical and laboratory examination. If a family from Tarnol or Dhok-Abasi want to be benefitted from public hospital, they need to visit PIMS hospital while using expensive transport, instead of this they can take services from private hospital located up to 2 KM distance from their locality. Where they pay a fee for medical examination while transport expense and time consumption are minimized.
The current model needs to be replaced by the Balanced Health Services Model (BHSM), which will ensure the rights of citizens and the seriousness of state with health issues. Under BHSM, governments must divide federal territory into five or six equally populated zones and establish public hospitals in each one. The model will ensure access for all people to public hospitals, including Tarnol, and a monopoly on the private sector can be reduced. Each of these public hospitals must have multiple branches like, general OPD, Maternity hospital, and children hospital. Provision of these services will result in sustainable socio-economic development, prosperity in the lives of citizens and their contribution towards national economy.
