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Pakistan has had a shortage of nurses, doctors and other health professionals for a long time and this lack of medical staff could have severe consequences for Pakistan now. According to the World Health Organisation (WHO), for every 1,000 people there needs to be at least eight nurses, two doctors and one dentist to take medical care of them at any time.

For a country with a population of 220 million, Pakistan officially has 230000 doctors, 145000 nurses and 24000 dentists according to Government records which creates a shortage of 1.6 million nurses, 0.4 million doctors and 0.2 million dentists. For the ongoing COVID-19 crisis, experts predict that Pakistan has a shortage of 1.4 million nurses and 0.2 million doctors which could have a detrimental impact on the healthcare system and economy. So why has Pakistan’s healthcare system been deprived of medical professionals and could the system collapse during the current coronavirus outbreak?

Closure of Pakistan Medical and Dental Council (PMDC)

In October 2019, President Arif Alvi ordered to dissolved the PMDC, stating that PMDC had failed to regulate the medical industry or were unable to curb malpractices, and ordered for the formation of a new medical body known as ‘Pakistan Medical Commission (PMC)’. This sudden decision to shut down the PMDC and create a new medical organisation left many medical fresh graduates and doctors without medical certification or license renewal for work.

As per expert estimates, up to 15000 fresh graduates are awaiting medical certification to start working while 30000 doctors wait for their five-year medical license renewal – without which they cannot work. The decision to close the PMDC and open a new medical organisation may have its benefits, but the inability to continue the work of the PMDC has caused a temporary shortage of doctors. The Pakistani Government must find a quick way of solving this crisis or temporarily allow these 30000 doctors (and 15000 fresh graduates) to continue working, so that the healthcare system’s labour capacity can be increased.

The trend of having a doctor as a spouse

As per PMDC’s 2018 report, 75% of students in Pakistani medical universities are female but only 23% of registered doctors are female. When both these statistics are analysed, one realises the alarming rate at which most medical students in Pakistan end up not practising medicine.

A recently graduated medical student Ayesha Mirza told Crux, “Medical colleges in Pakistan are highly competitive with most of them having acceptance rates of 1% to 5%. Girls end up occupying more admission spots as we tend to stay at home and study more than boys, since the culture is for females to stay at home to work or learn and for boys to go out and do as they wish”. Ayesha said the following regarding why female medical students are less likely to become doctors, “Look, whether you are male or female, there is no denying that being a doctor significantly increases your chances of getting a good marriage proposal. Becoming a doctor is like getting a golden ticket in the Rishta world”.

The owner of a Rishta agency in Lahore told Crux, “Yes, young ones with medical degrees are in high demand in the Rishta and marriage industry, especially females. We do notice that some females never wanted to work as doctors, they just wanted a medical degree to get a good proposal, but many actually want to continue working in their fields but are told by their own families not to – which is why we have a lack of doctors in Pakistan”.

This trend of having a spouse with a medical degree is the biggest reason for why Pakistan observes a massive shortage of doctors. To counter this trend, the PMDC tried to place a quota of admitting 50% male and 50% female students in medical colleges across Pakistan, but the change in law faced plenty of scrutiny eventually causing it to be repealed and abandoned.

However, PMDC has declared that the situation is improving as the percentage of newly registered female doctors is increasing – up by 8% since 2008. The Government has also made efforts to close the gap between supply and demand of doctors in Pakistan by requesting Pakistani expats doctors to return to Pakistan and serve the Pakistani healthcare system. The Government has recorded an upsurge in expatriate Pakistani doctors returning to the country and the Government has gone as far as hiring such doctors to work in certain hospitals for high salaries.

What impact has a shortage of doctors had?

A shortage of doctors and medical staff has had plenty of negative consequences on the Pakistani health industry. To obtain skilled doctors, certain hospitals have gone as far as guaranteeing to turn a blind eye on illegal practises such as taking commissions for advocating certain tests or prescription medicines. Moreover, some hospitals are forced to hire under-skilled and untrained doctors or nurses as a result of this shortage of medical staff. If you take a quick look at google reviews of many hospitals in Pakistan, a common complaint you would find is, ‘nurses do not know how to use needles’.

A resident of Lahore Ali Nasir had this to say regarding the quality of hospitals in Lahore, “In general, the quality of healthcare in Lahore is poor and much of it is down to a shortage of skilled doctors and a lack of accountability/responsibility. Hospitals here end up hiring under-skilled doctors without ethics or manners that blankly write you a ton of medications and tests for the smallest problem. I once had a minor stomach bug and the general physician at National Hospital (the closest hospital to my home) told me to perform 8,000 rupees worth of tests. I was doubtful that the doctor probably takes commissions for these tests, so I never ended up performing tests. On another occasion, I got dengue and the nurses did not even know how to put needles in my wrist. My wife noticed that blood was dripping from my wrist, she told the nurses about it and they did nothing, so my wife fixed the IV drip herself.”

What else can be done to deal with the lack of medical staff?

The SARS-CoV-2 outbreak will and has already put a lot of pressure on Pakistan’s healthcare system and the lack of skilled medical staff will become glaringly obvious during this crisis. Pakistan is not the only country dealing with such a problem, in fact most other countries are too. Some medical universities in Malaysia have trained their third-, fourth- and fifth-year students to become temporary nurses or basic doctors, so that they can perform certain duties in hospitals. Such an approach can also be taken by Pakistan too deal with a temporary increase in demand for doctors and nurses.

Could the healthcare system collapse during this crisis?

Experts predict that the huge shortage of medical staff will not be the reason for the healthcare system’s collapse, but rather the shortages of medical and personal protective equipment (PPE). Pakistan currently possess 3,000 ventilators which are enough to deal with a maximum of 50,000 COVID-19 cases, while India and China’s decision to stop the export of medicines temporarily has caused shortages of some medications in Pakistan. Combine this with a lack of PPE for doctors and the Pakistani healthcare system could have a huge storm coming its way.

The healthcare system faces lots of problems right now but the biggest one the Government needs to deal with right away is the lack of ventilators because if the number of people requiring ventilators crosses 3000, hospitals may have to begin making tough decisions – decide who should live or be left to die.