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Health policies and human capital: the case of Pakistan.


 Economic progress leads to improved nutrition, which in turn improves health, which in turn leads to higher output, better use of education, and the capacity to secure still further improvements in health by changes in the environment and behavior. Investment in the health of mothers and children, for example, is an investment in the labor force of the future by preventing the wasted physical, mental, and social potential of stunted growth. Strong political commitment to economic and social reform is essential to push development toward meeting basic human needs. The rural sector needs to achieve a political weight more commensurate with its numbers. Decisions about health services also confront the political problem of selectivity versus universality. Should services favor any particular age or sex group or should they apply equally to all? There is a particularly strong case to be made for promoting maternal and child health care. The health service system of Pakistan is fragmented and underfunded, with an urban bias. The health situation in Pakistan is characterized by high infant and child mortality, malnutrition, high communicable disease morbidity, and wasteful fertility patterns. Pakistan spends only 1/5 of what other low-income developing countries spend on health care. It is difficult to see how Pakistan can sustain high economic growth and achieve a better distribution of economic benefits without substantially strengthening its social base. Ironically, Pakistan has managed to expand its production of physicians but with little impact on rural-sector services. The medical schools socialize doctors to expect a type of job at a certain level of pay for delivering types of health services which are inappropriate, expensive, and probably ought not to exist. The fault lies with the medical system, particularly its medical schools and the government plans behind them. The rural health sector remains the problem--and the key. Any scheme which depends on doctors to extend health services to rural areas is bound to run into serious difficulties. A better alternative would use multi-purpose auxiliaries who are more extensively trained than the existing paramedicals but less than doctors.
