Healthcare in Pakistan is administered mainly in the private sector which accounts for approximately 80% of all outpatient visits. All health responsibilities (planning and fund allocation) were devolved to provincial Health Departments in 2011. Like other South Asian countries, health and sanitation infrastructure is adequate in urban areas but is generally poor in rural areas. About 19% of the population and 30% of children under age of five are malnourished.

In public sector hospitals, though there are no consultation fees, it has often been highlighted that the quality of medicines and accuracy of lab tests is questionable. Though this is a debatable generalization, there is a general psyche in the society that tends towards private sector. Apart from that, the rush and the long wait in queues often forces the patients to go to private sector HCPs. It is also shown in the WHO report that the cost of health care in public versus private sector is not very different.

What happens if you need to see a doctor?
When you need to see a doctor, you have a choice of either going to a public or private hospital/clinic. Though we have public infrastructure that provides free consultation, 80% of the health care load is taken up by the private hospitals. This is mainly due to lack of capacity and quality assurance in the public sector settings. You need to pay for your medicines and all investigations. Some medicines may be available free or at subsidized rates at the public sector settings. The doctor to patient ratio is very low.

Who decides what medicines a doctor can prescribe?
Drug regulatory authority has the control over deciding what drugs can be prescribed by the doctors. However, there are no national guidelines on when and how to prescribe specific drugs. It is largely based on the trainings that the doctors receive during their studies or otherwise.

Practically, what is it like to live with type 1 diabetes in Pakistan?
Practically, there are many problems. Firstly, there is a lack of well-trained multi-disciplinary health care teams who can treat diabetes and teach self-management. The concept of diabetes educators and diabetes nurses is relatively new and not very widespread. Many people with type 1 diabetes really do not understand how to manage their day to day challenges. There are no well-founded peer support groups and no camping programs.

60% of our population lives under 2 USD a day. The cost of a vial of insulin may range from 5 USD to 30 USD, depending on the type. On average, if you want to use modern therapies with frequent blood glucose monitoring, you need to spend around 60 USD on insulin and an added 20 USD (approx) for blood glucose testing. For most people, this means that they will hardly have anything to eat if they spend money on insulin and supplies. Most type 1s would likely only check their blood glucose once a month, or not at all. It is also extremely hard for the poor to get any healthy snacks/meals. Mostly they rely on sugared tea to keep them going through the day.

Other problems include a lack of hypo treatment options (like glucose tablets), lack of awareness of ketone testing, and poor storage for insulin. Due to the energy crisis, supplies like insulin requite special care, often needing to be stored in clay pots with water to keep them cool.

What about getting admitted to hospital?
If you are going to a public sector hospital, you’ll need to pay for your bed and some of the medications. You might also need to pay for some specific procedures. If you are going to a private hospital, everything needs to be paid for out of pocket.

How does diabetes care and technology vary throughout the country?
Currently there are neither pumps, nor CGM available in any part of Pakistan and care is as described above.

We are so grateful to Sana Ajmal for offering information about diabetes in Pakistan.

To learn more about diabetes in Pakistan, check out our interview:
Interview: Access to Insulin in Pakistan