Health System Under Strain: Malnutrition’s Ground Effect

Malnutrition.

Malnutrition is a condition in which children are deprived of essential nutrition, resulting in incomplete mental and physical development. Consequently, they may face additional health issues such as tuberculosis, typhoid, and malaria.

There are several methods to assess malnutrition. These include measuring a child’s weight, height, and the circumference of the head or arm, and then comparing these with the average measurements of healthy children of the same age.

At primary health centers, the mid-upper arm circumference (MUAC) is used to assess malnutrition. UNICEF and WHO have donated medical supplies and tools, including MUAC tapes, to all government health centers. However, this method is applicable only for children aged six months to five years.

Based on MUAC measurements, there are three possible outcomes:

1. Normal – MUAC greater than 12.5 cm

2. Moderate Acute Malnutrition (MAM) – MUAC between 11.5 cm and 12.5 cm

3. Severe Acute Malnutrition (SAM) – MUAC less than 11.5 cm

Now let’s discuss the treatment for children with the last two types of malnutrition at basic and rural health centers:

For Moderate Acute Malnutrition (MAM): Children are given multi-mineral sachets (image attached). These sachets are rich in essential minerals and vitamins, which not only help address the nutritional deficiency but also increase appetite. Each box contains 30 sachets, to be mixed daily with milk, Cerelac, or similar food. These children typically show improvement within one month and return to normal MUAC levels within three months.

For Severe Acute Malnutrition (SAM): In addition to the multi-mineral sachets, these children receive a unique, peanut butter-like paste called Plumpy’Nut or Ready-to-Use Therapeutic Food (RUTF) (image attached). This paste is imported from France and made from peanuts, vegetable fat, milk, and soy. Children suffering from SAM enjoy eating it. With regular use, they gain significant weight, and I have personally observed noticeable improvements in their MUAC measurements.

We have both systems and resources in place, yet implementation is lacking. For instance, the government and NGOs are providing valuable resources, but most people are unaware of them due to poor execution and lack of awareness. As a result, rightful beneficiaries are deprived of their rights. It's also true that the government has not provided adequate attention or resources to crucial sectors like health and education. Even the resources that are available often fall victim to mismanagement and corruption. This is the unfortunate state of most government departments, where those in power control the resources, and the public is left with nothing.

Government Action on Healthcare Privatization In Punjab

Authorities have decided to outsource the Basic Health Units (BHUs) and Rural Health Centres (RHCs) in all 37 districts of Punjab, including the Rawalpindi district, under the status of Maryam Nawaz Health Clinics (MNHC), retain current regular staff of these centers at other government hospitals, regularise non-regular staff, and terminate the employment of staff working on specific health projects once the projects are completed (via The Express Tribune 13th March 2025). Privatization or outsourcing of government hospitals is not a new concept. Public-private partnerships (PPPs) have gained popularity around across the world for a long now. Those institutions that are state-run are handed over to private organizations/individuals to look after their matters and are governed by them, yet monitored by the state. This is also known as outsourcing. Some individual affairs of the institution can also be outsourced rather than the whole institution. 

The question is what are those employees who have served for decades going to do? What is their future? Sudden terminations will bring havoc to their state of affairs. Also, the transfers of those regular employees working for long at their home stations are going to be cumbersome. Especially when someone is not prepared for such a drastic change. Policies are made, approved, announced and implemented with a methodical approach. We can learn it from civilized nations. For instance, like the United States, the UK also wanted to make their foreign medical licensing exams like USMLE rather than Plab. But, to do so, they adopted a somewhat reasonable methodology, a model for many. Policymaking should be a joint task. All stakeholders should be taken into confidence. The public should be made well aware. Implementation should be in phases, with the pilot phase replaced by the mass phase. What is happening here is too quick and too late. Too quick for health professionals to handle, and too late in what we might call public interest. 

For an institution that has failed, there should be no fault in seeking help from some other institution. Public and private sectors working in harmony for their mutual interests should not be a problem. Many types of research have shown the benefits of Public-Private Partnerships. Countries that followed the healthcare outsourcing framework had far better results in terms of efficiency, improved patient outcomes and financial security. KP province of Pakistan also followed this model for many years which led to better results in every aspect. 

Maryam Nawaz Health Clinics is a name given to all government hospitals. Isn't it a mediocre decision? Naming a public property, a public welfare scheme by oneself and in the best of one's own "political" interests is no more than a 

kingly decision, a monopoly and a political scoring. This melodrama is to stop otherwise the future of this province and country is not going towards progress and development!

In addition to BHUs and RHCs, future models of THQs and DHQs are also being prepared for outsourcing and privatization. These models need to be refined and in the best public interest.