The roundtable discussion on public health issues was held with the PMLN team. The PML-N was led by prominent politician and technocrat, Mr. Sartaj Aziz, who headed their Manifesto Committee and has been an ex-Finance & ex-Foreign Minister of Pakistan. He was assisted by Mr. Salman Rafique, Special Adviser on Health to the Chief Minister Punjab. Mr. Arif Nadeem, Health Secretary to the government of Punjab. Dr. Saeed Illahi, Parliamentary Secretary Health PMLN, Punjab, Ms. Anousha Rehman, Member National Assembly (PMLN), Dr. Asad Ashraf Member Health Commission Punjab (MPA, PMLN) and Dr. Ajmal, Secretary Punjab Health Commission also participated. The discussion with the PMLN has a special significance for the international community because this is one political party that had hands on experience of running the health policy and confronting the related implementation challenges in the largest province of Pakistan, with a population over 100 million.
In terms of issues specific to Punjab, Dr. Nabeela, chief of Party, JSI drew attention of the PMLN team to the “Under 5 Mortality in Punjab and its determinants and pointed out its correlations with socio-economic status, rural urban divide and gender issues. She also pointed out that though Punjab is better administered and governed but malnutrition and poverty are rising leading to the growing challenges of stunting, wasting and underweight in children. She emphasized that confidence in the public sector health facilities is declining even in Punjab leading to rise in ‘out of pocket expenditures’ which keep lower middle class families continuously at the edge of an economic emergency. Finally she focused at length on the implications of growing internal migration, how Lahore (population 0.7 million in 1947) has grown to a city of more than 10 million, continuously expanding outwards and creating poor shanty towns inside its large unmanageable structure.
From PMLN, Khawaja Salman Rafique pointed out that many who have not dealt with the practical problems of the health management in a province as large as Punjab, or whose perspective is purely theoretic don’t understand that many challenges, not directly related to health policy, keep impacting the physical and human resources of his team. He explained how unexpected challenges cropped up in the form of Dengue epidemic and strikes by the young doctors across Punjab that kept him and his team busy. He also argued that Punjab in the last five years has seen little political interference and health spending has gone up from around Rs. 18 billion to Rs. 80 billion. Sartaj Aziz pointed out that from a government’s point of view and from a policy maker’s point of view it is important to realize that all sorts of limitations exist and not all desires can be achieved. He divulged the information, from PMLN’s manifesto, that their goal will be to reach a 2% GDP spending on health within the next five years, keeping in viewing a potentially expanding economy. He added that 18th amendment and 7th NFC awards have created new challenges and problems. These challenges have arisen at the level of both the center and the provinces and the role of international donors has increased. He argued that donors need to create new funding mechanisms and solutions to address these challenges.