Pakistan allocates just 0.5-0.8% of its GDP to the health sector, one of the lowest percentages globally. The World Health Organisation recommends spending at least 5% of GDP on health. With such limited investment, basic health needs cannot be adequately met, let alone oral health.
Oral healthcare in this country lacks a dedicated budget, reflecting its status as a neglected aspect of general health. In Pakistan, healthcare is delivered through primary, secondary, and tertiary health centers. At all levels, the sole oral health service provided is tooth extraction. Tertiary health centers also treat some patients with accidental trauma and oral cancers. However, these tertiary care hospitals are overburdened and struggle to manage the patient load, resulting in compromised quality of care.
The existing services are insufficient to meet the needs of the elderly, women, and children. A national study reveals that about half population of young children has dental decay, with most cases untreated, leading to early tooth loss and lifelong suffering from the consequences of tooth loss.
Professional services for restorative dental procedures and preventive dentistry are categorically non-existent at government hospitals. The majority of the population therefore, remains under-served by the public sector and patients are forced to seek oral and dental health from the private sector.
The operating hours of government hospitals do not accommodate the majority of dental patients, as they operate during morning shifts when people are at work and children are in their schools. Introducing evening sessions would enhance accessibility for working men and women.
The absence of a national policy guideline on oral health, combined with the inadequacies of the 2001 health policy, leaves a significant gap in the healthcare framework. The 2001 health policy does not adequately address the specific needs of oral health, resulting in a lack of structured programs and initiatives to combat oral diseases and promote dental hygiene. This oversight has led to insufficient public awareness, limited preventive care, and inadequate access to dental services, particularly in rural and underserved areas. The absence of a dedicated policy means that oral health often remains a low priority, with limited funding and resources allocated to it.
To improve the systemic health outcomes of the population, it is mandatory for the Pakistan government to develop and implement a comprehensive national policy on oral health that integrates preventive care, public education, and equitable access to dental services across the country.
The rules mandating service in rural areas are not effectively enforced by authorities, leading to a significant concentration of dentists in urban regions. This imbalance results in underserved rural communities with limited access to essential dental care. Most of the dentists prefer practicing in urban areas due to better infrastructure, higher income potential, and professional growth opportunities. Consequently, rural populations face difficulties in receiving timely and adequate oral health services, exacerbating health disparities. To address this issue, authorities must ensure strict implementation of mandatory rural service rules, provide incentives for rural practice, and invest in improving rural healthcare infrastructure to attract and retain dental professionals in these underserved areas.
The private sector, therefore, has to play a significant role in supporting oral healthcare in Pakistan. By providing services to those who can afford private care, the private sector helps reduce the patient load on public dental clinics and hospitals, allowing them to better serve lower-income populations. Moreover, investments in private dental clinics and hospitals contribute to the economic development and health infrastructure in Pakistan.
The private sector offers a wide range of oral healthcare services, including preventive care, cosmetic dentistry, orthodontics, implants, and specialized treatments that might not be available in the public sector. Private clinics and dental hospitals are more accessible, providing patients with more options for care. Private dental practices are more likely to invest in the latest dental technology and equipment, ensuring high-quality diagnostics and treatments. Private dental clinics often handle more complex and specialized cases, which can be beyond the capacity of public health facilities.
The private oral healthcare sector generates employment for dentists, dental hygienists, technicians, front-desk staff, and various related professions. Private dental schools participate in public health initiatives to promote awareness of oral hygiene and preventive care. They, through their out-reach programs, serve the remote sections of a needy section of our population. The private dental practitioners dedicate time to educating patients about their oral health, at-home preventive practices, and maintenance strategies.
Private sector healthcare, while offering many benefits, also has several disadvantages. Private hospitals/ clinics are expensive, often making it inaccessible to low and middle-income individuals and families. There is often a disparity in the quality and availability of healthcare services between wealthy and less affluent populations and it tends to be concentrated in urban areas, leaving rural or underserved communities with limited access.
They emphasise curative treatments over preventive measures which can sometimes lead to prioritising lucrative procedures over necessary treatments. This can result in over-treatment or under-treatment based on financial incentives rather than patient needs. The private sector hospitals can contribute to fragmented care, with patients receiving services from multiple health specialists without adequate coordination. This can lead to inefficiencies, duplicated tests, and a lack of comprehensive care.
In short, private sector significantly supports oral healthcare in Pakistan by providing better quality, accessible, and diverse services through innovation, professional development, economic contributions, and community outreach programs. Balancing the strengths of the private sector with the needs of the public sector is mandatory for ensuring comprehensive and equitable oral healthcare for all Pakistanis, which can be achieved by employing following strategies:
- Pakistan urgently needs to boost its healthcare budget to enhance its health infrastructure and address the issues of the workforce and prioritize building and upgrading healthcare facilities, especially in rural and underserved areas.
- Collaborations between public and private entities can leverage the strengths of both sectors. These partnerships can improve healthcare delivery, enhance infrastructure, and increase access to services.
- Effective regulation ensures that private sector activities align with public health goals. Setting standards for quality, safety, and affordability can help maintain a balance.
- Offering incentives such as tax breaks, subsidies, or grants can encourage private entities to invest in underserved areas and focus on public health priorities.
- Engaging with communities to understand their needs and priorities ensures that both sectors are responsive and effective in addressing public health concerns.
- Developing integrated care models that combine services from both sectors can provide comprehensive and continuous care, improving general health outcomes.
The Author is Dean Faculty of Dentistry, Baqai Medical University