PUBLIC HEALTH RESEARCH IN PAKISTAN

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Public Health Research in Pakistan

Background Information

Pakistan is a country that is working hard among developing countries to take the Millennium Development Goals (MDG). Since secession, the healthcare sector has progressed in Pakistan that could not be overlooked. Also, improvements have been made in the social, agriculture, and financial sectors (Ghaffar et al., 2000). The advancement of Pakistan’s healthcare industry cannot be overlooked since secession time. Besides, improvements in the social, agricultural, and economic sectors have been achieved (Ali, 2000). Pakistan’s medical system is in advancement and has been trying to boost its medical system significantly. It has also carried out several policies changes this year (Manzoor et al., 2009).

In Pakistan, there are very few vital points in providing medical care, such as healthcare programs, participation in the Millennium Development Goal program, Implementing and creating a privately managed joint venture, improving human resource development and facilities through the Basics Health Unit (BHU) and Centres for Rural Health The RHC) (Shaikh & Hatcher, 2005). Since the national health agenda was rearranged with elements of healthcare policy related to Primary Health Care PHC in 2001, the system was more deeply committed to investing in MDGs’ work. Because of these alterations, the administration has started implementing the radial prevention programs, such as the Extended immunisation program for large scale populace, and reinforcing the mothers and children’s Health campaign by educating Lady Health Visitors (LHV’s) on medical problems. Through these initiatives, the metrics of wellness have enhanced; for example, the child mortality rate has fallen from 220 per thousand live births in the first quarter of 2014 to 72 per 1,000 live births in the second quarter of 2008 (“National Programme for Family Planning and Primary Health Care”, 2015).

Pakistan’s healthcare sector usually has local government departments, except for federal health care areas. The federal government is still responsible for the coordination and execution of public health policies. A health ministry has been formed in each provincial government to provide prevention and treatment facilities to facilitate its civilians’ welfare. Province healthcare facilities also regulate private medical services. Public health care expenditures all over territories are subject to significant variants. The lowest amount of healthcare expenses is used in Baluchistan and Khyber Pakhtunkhwa. In Baluchistan, this number has declined gradually in recent years  (Akram & Khan, 2007).

Healthcare professional researchers in Pakistan are scarce. This is one of the main reasons why medical research is insufficient in the nation (Ghaffar et al., 2013). Fewer than 8 per cent of the graduate school supervisor holding a Ph. D. have a health certificate despite the Higher Education Commission’s creation in 2002, which has helped to generate more developments in current science in Pakistani medical colleges. Therefore, the lack of clinicians’ in Pakistan must be highlighted. However, the causes of the issue and policies that can revive medical science traditions in Pakistan need to be sought (Mushtaq et al., 2012).

The decreased number of doctors seeking a research career may be clarified in many ways. For example, junior doctors will have trouble cultivating research interests. With certain exceptions, medical research is not included in medical diploma programs at the national level. Another reason for this would be the absence of an MD/PhD. Programs in other countries, such as the USA, have been useful to medical research (Andriole et al., 2008). The healthcare professionals’ fellowship in research from the National Health academic institutions, which was well appreciated by medical students and proposed to enhance medical investigations, is an example of programs to improve studies at the university level in the United States of America (Solomon et al., 2003). The medical student fellowship scheme in the NIH has been commonly rated by students as examples of programs for study up to the USA’s graduation stage and proposed improving medical research. There are examples in Pakistan that need to be built in the sense of study behaviours to achieve adequate health care strategic planning. Highly centralised strategies and activities are desperately required to support medical research and to improve science providers. Pilot projects are necessary for the excitement of students, teaching groups and government agencies. The current state of medical society research can change by creating, strengthening, and supporting Pakistan’s research.

Communicable and non-communicable problems in Pakistan Status

Non-communicable diseases (NCDs) include all illnesses that do not pass from person to person. Many of them have asthma, high blood pressure, cancer, psychiatric disorders, asthma, accidents and injuries (WHO, 2013). Such infections emerged as a critical problem to human health with catastrophic consequences on preterm mortality, death, and financial damage (Khuwaja et al., 2007). According to Merson et al. (2011) Study is to determine the burden of diseases and deterioration of healthy life in Pakistan in 1990 from a range of everyday situations. Although in 1990, infectious diseases decimated Pakistan’s illness burden, non-communicable diseases also took a massive toll in the highest conditions, resulting in the loss of life. The share of non-communicable diseases cannot be increased except in non-communicable diseases (NCDs). Lesions must also be accepted in the nation as a significant public health problem.

With 7.6 per cent hepatitis B and C endemicity, Pakistan is faced with a dual disease burden, the fifth-largest burden of TB globally, and the focus region of malaria-endemic areas. Pakistan is the world’s largest. The total Prevalence of HIV is 21.0%, while sterile injection equipment is used by 77.0% of those who inject drugs. The approximate reportage of antiretroviral treatment is 9.0%. Moreover, unscreened organ transplants in the region are high. Drug-resistant tuberculosis among cases reported is projected at 4.3%. In newly diagnosed patients, it is predicted at 19.0%—improvement of preventive diseases and emerging infections. Vaccine monitoring and response system for disease. High government and partners dedicated to the commitment caused the number of polio cases to drop dramatically to just eight cases reported. In 2017, 7 districts comparison to 20 in the previous year from 14 districts. Another majority of the burden of disease now consists of non-communicable illness alongside injury issues and psychological health. Injuries constitute more than 11% of the global disease burden. They will undoubtedly increase as travel, population development, and tension continue to grow. Pakistan’s diabetes incidence is ranked seventh in the world. Hypertensive, combined with high smokers, is one in every four adults 18 years and over. Blindness and other reasons are also highly handicapped, and facilities are restricted to the affected people, including support to enhance their quality of life (“World Health Organisation”, 2018).

Maternal, baby and children’s health status in Pakistan

Pakistan seems to be the sixth nation in the world to be the most densely populated. Child protection is very impoverished, and child death rates are very significant at all age groups. Pakistani mothers’ and baby’s health are progressing very slowly. The slowest percentage of decrease in infant mortality is in Pakistan among Asian nations. Improvements should be made on essential factors such as maternal teaching, gender inequity, proper secondary, and third-party care that affect child mortality. As the NMR (neonatal mortality rate) represents around half the country’s downfall under 5, any NMR reduction initiative would also help reduce the mortality rate to less than 5, improving child health (Shoukat et al., 2015). While its metrics are daunting, the mother mortality ratio (MMR) is a leading international determinant of mother’s disease. About 5 million women in Pakistan are annually pregnant. There are probably also neonatal and health care risks in these 700,000 (15% of all expectant mothers). Approximate thirty thousand women have died per year of prenatal. However, the MMR is 276 of every 100 000 live births each year, most recent estimates reveal (Khan et al., 2009).

As a developing nation, Pakistan is the dull portrait of mortality rates, maternal and newborn. The suppose continuum of treatment is given organised during the first week of conception and delivery.  In that case, many maternal and newborn deaths can be prevented (Iqbal et al., 2017). In meeting its treaty commitments, Pakistan has faced enormous challenges and concurred on Millennium Development Goals to reduce infant and perinatal deaths. Although maternal and infant death risks are already decreased, the overall numbers are only slightly higher than the content changes. The mortality rate is still slow. Success inaccessible care aspects of profitability, malnutrition, safe drinking water, and proper healthcare and education for women is not sufficient. Not astonishingly, population growth is hampering national development in the economy. The transfer of life quality of the territories formed both issues and problems for initiative (Bhutta & Hafeez, 2015). Pakistan currently suffers from a 59,109-death rate per 1000 live births in 2020, down 1,84 per cent from 2019. The newborn fatality rate was 60.219 per 1000 births for Pakistan in 2019, a decrease of 1.81 per cent in 2018 (Macrotrends, 2020). The data show the risk of sudden infant death between 2008 and 2018 in Pakistan. In 2018 Pakistan had about 57.2 fatalities per thousand live births in child mortality (Plecher, 2020).

The Priority Areas for Public Health Interventions in The Local Population in Pakistan

Public health projects thrive and survive as groups and coalitions tackle six primary areas. Programs such as control of infectious diseases, prevention of measles, tobacco prevention, and polio have succeeded with these seven fields. Innovation will help optimise the management of services to extend, disseminate, and promote high impact initiatives. Smallpox was removed by a relentless adoption and application of technologies, such as new organisational techniques, new techniques for looking for smallpox outbreaks, new tactics for recruiting vaccinated populations, new forms of needles, and various means of vaccinating multiple classes of citizens. A technological kit guarantees that the intervention is most efficient, practical, and viable, with the elements’ synergy. The pressure to include any solution will make it impossible to set up a technological package; it would undoubtedly struggle to produce a specialised package that will incorporate approaches.

The key is to define highly productive and flexible components that can be retained over the long term to meet communities of diverse sizes, demographic composition, or geographical locations. That may mean that specific strategies with proven feasibility data are not included as they have no effect, are not viable, or cannot be scaled up to have population impacts for economic, administrative, or other purposes. The administration of human capital in public health is involved. Budget deficiencies, wages, and vocal resistance to policies in public health will demoralise the workforce. Career improvement actions may be beneficial, which rely on an organisation. Overall, successful public health programs, by role sharing, have resolved the constraint of human capital. The use of health practitioners in the region and more extensive collaborations will better manage the problems. It can be challenging for government and municipal health systems to coordinate funding and obligations. Experts agree that acknowledging mutual and shared responsibility is necessary for productive relationships. Governments and non-governmental partners should collaborate to achieve shared priorities and retain emphasis (“Centers for Disease Control and Prevention”, 2013) Many that serve with public health and help the health of residents and neighbourhoods strengthen their health. Public health’s greatest asset is its unique focus on good health to ensure the culture meets the highest standards: children’s development and growth as a whole, health and student preparation, safe and productive worker’s well-being, encouraging parents to help their children meet their full potential, reducing health inequality and reducing health concerns.

Related Studies Conducted in Public Health Research in Pakistan

In public health education programs, Pakistan has lately seen substantial growth. The system of these programs or the adequacy of provincial health systems requirements is not recognised. The study conducted by Zeeshan et al. (2018) showed mixed-method research around January 2015 and March 2016. For conceptual and educational attributes, 17 public health degree programs were evaluated. There were 13 key participant interviews to explore healthcare system necessities and public health workers’ complexities. Significant differences were found in public health academic programs regarding offered courses, credit hours, teachers’ numbers, and tuition expenses. About 70% (i.e., without an integration system track) of public health services were bland, and just 18% were practical. The total cost for medium school fees was US$ 10,350 in 2016. Aspects for obstacles surfaced during key-informing interview sessions that included lack of technical public health skill sets, limited understanding of the newest scientific concepts, poor effective communication, and low IT alignment. Included system-oriented thinking, care IT skill sets, leadership skills, and identifying areas of expertise and skills to communication-based public health issues in Pakistan.

In another study undertaken by the Aga Khan University, Karachi group of Pakistani medical students on Pakistani medical students know and practice health research. The results showed that both perceptions and awareness had improved considerably with more and more years of medical school study. Advanced preparation and understanding enhancement is correlated with this—learners’ health research perceptions. The study involved a section-wide pilot study, performed through prescribed, organised, and verified surveys by random sampling (Khan et al., 2006).

Meo et al. (2013) investigated the research on the graduation of research in Pakistan from 1996-2012 in medical sciences. The results show that in Pakistan, the overall number of medical research papers is 25604. The citable records were 23874, 128061 and 6.45 in the mean ledger. Pakistan is proposed to take strategic steps towards increasing the culture of research and increased expenditure on research and development. The upward trend in worldwide medical science articles was between 1996 and 2008. The movement has declined significantly since 2008

Governments must resolve poor health professional competence among medical students. It is necessary to revise the medical curriculum to enhance excellence to promote interprofessional collaborative projects and avoid medical mistakes. It is critical to creating the sensitivity, possession, and affirmation quality in physicians. In the study conducted by Jalil et al. (2020) on youth qualified Physicians’ perceptions in Pakistan. The findings show the fundamental aspects of inadequate healthcare competence: the hardness of views, the inappropriateness of different perspectives, self-importance, and supremacy over all other sectors and physicians. The fact that social sciences subjects are considered unimportant to medication and are assessed perfectly logical; most young physicians believed that the medical curriculum does not need to be subject to competence and humanity programs.

For biomedical scientists and global health security in general, dual-use research poses an enormous challenge. The need to improve medical research management is increasing. Scientists’ expertise and resources necessary for medicinal product growth are increasingly more available and cheaper. Mitigation from misusing facilities, equipment, operatives, and science needs high knowledge, beginning with newly qualified researchers and recent graduates of the concept of dual-use research. In the final research conducted by Sarwar et al. (2019) on research students’ knowledge and behaviours to conduct dual-use research in Pakistan: a transversal questionnaire, the analysis results indicated that researchers throughout Pakistan had restricted dual-use awareness research. Nevertheless, the participants were well informed of its influence even if they were not officially declared on dual-use research.

Areas That Need Further Research in Public Health Research in Pakistan

In this area, a comprehensive study was proposed to encourage medical institutions to establish a culture of innovation in Pakistan. The institution should include appointments and faculty encouragements solely for academic achievements and research achievements, establish research support units in all medical institutions, and recognise leading project scientists after the project. However, the shortage of scientific facilities and the lack of medical science as advisors are significant issues that need urgent consideration, indicating that many doctors understand the value of scientific (Aslam et al., 2004). Furthermore, Medical science flourished in that country with the help of a powerful political will. Numerous nations around the world adopted this course, and essential research should be developed. Unfortunately, the government played an indispensable role in Pakistan for science in general and medical research. Established more than 50 years ago, the PMRC primarily aims at organising national medical studies and providing the federal government and state governments with recommendations on all facets of health research and medical attention (Pakistan Medical Research Council, 2008). Despite the financial restrictions, it led to the creation of recommendations for several national committees and services, carried out the Pakistan National Health Survey, awarded limited grant money (Rs 200,000), and launched in 1958, the PubMed health research Article. There are 26 national institutions and six provincial research organisations in the Indian Center for Regenerative Medicine to address the national health problems. It creates a decent impact factor in the Indian J Med Res. The Indian Council for regenerative medicine (ICMR) has only 14 PhD students (Indian Council for Medical Research, 2006). The dearth of doctors in Pakistan is a national and broader issue because of the lack of financial resources for doctoral students interested in postgraduate studies. Although several PhD scientists in different PMRC institutes, ICMR has tackled this problem by providing retired medical scientists with the chance to continue studying various medical ventures to adjunct professor researchers.

Public Health Research Gaps in Pakistan

Years have been neglected in the public sector. The continuing low indications of the populace’s key metrics have resulted from the lack of cohesive long-term policies and human capital development. The per average spending of US$ 480 in southeast Asian nations is higher than average. According to the UNDP list of nations, Pakistan ranks 138 out of 174 countries is based on its Human Development Index (HDI)2. The healthcare system’s program/project method is used to address the vast population of health complications. These programs and projects were specifically targeted and were mostly enforced perpendicularly. All programs have had three critical weaknesses: knowledge reference failure, lack of motivation by the society, and an absence of a multi-sectoral action plan. Consequently, not many changes have taken place despite years of struggle (Akhtar, 2000). A recent paper on this topic recommended a list of suggestions for research institutes in Pakistan that include professional consultations and advocacy on the grounds of education and professional achievement, the establishment of study aid units in all healthcare facilities, the acknowledgement of distinguished researchers at Annual Research (Jawaid, 2015).

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