balancing welfare healthcare

Balancing Welfare and Healthcare

By Dr Sajid Shiek

Pakistan’s social protection programmes have helped many vulnerable families. The Benazir Income Support Programme (BISP) and its health and nutrition-linked initiatives are meant to support mothers, children, and low-income households. BISP’s Nashonuma programme is described by the programme itself as a conditional cash transfer initiative for health and nutrition, and it works through facilitation centres at government health facilities.

In Sindh, the Mother and Child Support Program, also known as MAMTA, is similarly designed to provide cash support to pregnant and lactating women while linking assistance with regular health checkups.

These efforts are important and deserve recognition. At the same time, public programmes should also be reviewed for how they affect service delivery inside already crowded health facilities.

Having worked as a Medical Officer in the Health Department since 2014, I have seen that the implementation of these programmes in government hospitals can create practical difficulties, especially in rural areas. This is not a criticism of the welfare idea itself. It is a concern about how the system is being managed.

Many rural government hospitals in Sindh already face limited space, staff shortages, and pressure on basic resources. When programme-related procedures are carried out in the same facilities, the number of visitors increases further. In some centres, outpatient attendance has risen sharply, not only because of illness, but also because beneficiaries must visit hospitals to complete formalities linked to these programmes.

As a result, outpatient departments become crowded for much of the day. Doctors and paramedical staff must divide their time between patient care and administrative work. Medicines, supplies, and other hospital resources are used more quickly, which can affect patients who come for treatment of genuine medical problems.

Crowding also makes infection prevention more difficult. The World Health Organization says infection prevention and control is essential for safe and quality healthcare, and that without effective IPC, quality health care delivery is not possible. In busy facilities, long queues and congested waiting areas can increase the risk of spreading communicable diseases, especially among pregnant women, infants, and older patients.

Another issue that deserves attention is the possible effect on family planning services. Financial support linked to pregnancy and safe delivery can encourage maternal care, but policymakers should also consider whether such incentives are fully aligned with broader reproductive health and population management goals. This is an area that needs careful assessment rather than assumptions.

The burden is not only physical. Healthcare workers are also under pressure. The WHO has noted that high levels of stress, burnout, and workforce strain are linked to staff shortages, unsafe working conditions, and stressful environments, and that at least a quarter of health and care workers reported anxiety, depression, and burnout symptoms between January 2020 and April 2022. In crowded facilities, these pressures can grow further and affect the quality of care.

The solution does not require reducing social welfare programmes. It requires better coordination.

A practical step would be to establish separate BISP and MAMTA facilitation centres outside hospitals, or at least in dedicated administrative units with separate staff. This would allow beneficiaries to receive support without interrupting clinical work. Hospitals could then focus on diagnosis, treatment, emergency care, maternal services, immunization, and disease prevention.

Better coordination between social protection and health departments would reduce congestion, improve infection control, and allow medical staff to spend more time on patient care. It would also make the welfare system more efficient and easier for beneficiaries to use.

Pakistan does not need to choose between social protection and healthcare. Both are public responsibilities, and both should strengthen each other. If welfare administration is kept separate from clinical services, hospitals can remain focused on healing, while social programmes continue to support the poor in a more effective way.

This issue deserves review at the policy level. A small structural change could improve both healthcare delivery and social protection outcomes across the country.

The writer is a senior Medical Officer. He can be reached at doctorsajid07@gmail.com

Similar Posts

  • | | |

    European colonization brought smallpox to the Americas

    Historians have believed that the collapse of Indigenous populations across the Americas was triggered largely by smallpox. The historical manuscripts and missionary chronicles provided detailed eyewitness reports of these devastating outbreaks. Molecular proof links colonial-era American epidemics directly to Old World viral strains remained elusive. Now, a study published in the journal Science provides the definitive genetic confirmation researchers have sought for generations. It’s led by geneticists at Trinity College Dublin in collaboration with biological anthropologists at the Universidad de Chile. Researchers have successfully extracted and sequenced the oldest known smallpox viral genomes ever recovered in the Americas. The ancient viral DNA was retrieved from the naturally mummified remains of two individuals buried in northern Chile during the early Spanish colonial era. The viral samples were recovered from bone fragments belonging to an adult woman (aged 30 to 35) and a young man (aged 18 to 20) buried near Camarones Cove. A coastal site in northern Chile that once marked the southern reaches of the Inca Empire. The individuals had been naturally preserved by the hyper-arid climate. They’re wrapped in camelid wool blankets and interred in traditional cloth bundles. Scientists initially analyzed DNA from 13 individuals excavated at the site. They were searching for ancient bacterial infections such as tuberculosis. Instead, they discovered preserved traces of the variola virus. Guess what? It’s the deadly pathogen responsible for smallpox. Radiocarbon analysis alongside molecular clock estimates revealed that both individuals died between 1492 and 1631 CE. The violent era of Spanish conquest led by conquistadors like Francisco Pizarro. Because the two viral genomes recovered from the mummies were virtually identical, geneticists concluded that both individuals likely succumbed to the same localized outbreak or were infected by the same circulating viral strain.  Evolutionary Trajectory of a Global Killer When researchers mapped the newly recovered genetic sequences onto a global evolutionary tree of smallpox, the results were unequivocal. The Chilean viral strain positioned directly between medieval European strains. The strains included those previously recovered from Viking-era human remains and later 17th- to 19th-century strains circulating in Europe. This placement provides molecular evidence that the virus was introduced to Indigenous American communities from the Old World. The study yielded surprising insights into how pathogens evolve when introduced to vulnerable host populations. The variola virus originally evolved from a animal-host (zoonotic) pathogen. It was undergoing extensive genetic alteration up through the 16th century as it adapted to human hosts. Surprisingly, the virus’s rate of genetic change slowed dramatically during the peak colonial expansion of the 17th and 18th centuries. Researchers hypothesize that Indigenous populations lacked any pre-existing immunity. So, the virus had reached an evolutionary optimum. It could spread effortlessly without needing further genetic adaptation. The virus’s evolution accelerated once again in the late 18th and 19th centuries. It was after the introduction of Edward Jenner’s smallpox vaccine in 1796. Therefore, the evolutionary pressure forced the pathogen to adapt once more. Why This Discovery Matters Today Smallpox stands as one of the deadliest infectious diseases in human history. It has claimed hundreds of millions of lives over millennia before its official eradication in 1980 through global vaccination efforts. In the Americas, the disease inflicted physical casualties. The virus also shattered social structures and morale. The rapid disfigurement and death led communities to feel overwhelmed by forces they could neither treat nor comprehend. This discovery demonstrates the immense power of ancient DNA research. Tracing how pathogen evolution interacts with human migration, population immunity, and public health interventions provides critical context for understanding modern infectious disease threats today.  

  • The Population Debate: Curse or Opportunity?

    By Dr Naveeda Katper Different countries have different characteristics regarding population, geography, and natural resources that shape their economic growth. Economists use various indicators to measure development, and population is one of the most debated among them. A large population is often viewed as a hurdle to economic growth. However, every issue deserves to be examined from different angles. The question, “Is a large population a curse or a blessing?” cannot be answered with a simple yes or no. We need to move beyond the idea of population as a burden and understand the concept of the demographic dividend. What appears to be a curse can become a blessing when viewed through the right perspective and supported by the right policies. Research by the RAND Corporation and the World Bank has shown that countries with a growing working-age population can experience faster economic growth when supported by sound education, health, and employment policies. Whether a large population becomes an economic asset depends on governance and public policy. A growing population is not necessarily a curse because every additional mind brings new ideas, different perspectives, and fresh solutions to existing problems. One mind can accomplish one task, two minds can accomplish two, and millions of minds can achieve far more. That is the value of teamwork and collective human potential. Every individual possesses different skills, abilities, and talents that can contribute to national development. What many consider a burden may actually become a country’s greatest strength if those human resources are properly developed. This is the essence of the demographic dividend—the economic advantage that emerges when the working-age population becomes larger than the dependent population. Development economists describe this period as a “window of opportunity” rather than a guaranteed outcome. Highly populated countries can utilize their youthful population to strengthen their economies. After India, China, the United States, and Indonesia, Pakistan is the fifth most populous country in the world. This should be seen as an opportunity rather than a challenge because more than 65 percent of Pakistan’s population consists of young people. That gives the country a significant advantage. A demographic dividend can only be realized when the working-age population is educated, healthy, skilled, and productively employed. When more people are working and contributing to the economy, household savings increase, investment grows, government spending on dependents declines, and both economic output and per capita income improve. The World Bank has repeatedly emphasized that human capital—education, health, and skills—is one of the strongest drivers of long-term productivity and national income. The real challenge is identifying the policies required to achieve this dividend. A country can benefit only if it creates sufficient employment opportunities, provides quality education and skill development, ensures access to healthcare, encourages women to participate in the workforce, and maintains stable economic and public policies. When these conditions exist, the country enjoys faster economic growth, greater productivity, increased investment and savings, improved living standards, and stronger entrepreneurship and innovation. Economic growth becomes inevitable when people are hardworking, equipped with multiple skills from an early age, and capable of adapting to changing economic demands. Skilled and self-reliant citizens become the driving force of national development. Evidence from South Korea, Singapore, and Ireland shows that investment in education and skills transformed youthful populations into globally competitive economies. However, a demographic dividend can quickly become a demographic burden if employment opportunities and skills do not keep pace with population growth. The consequences may include rising unemployment, poverty, social unrest, and migration. Economists and demographers consistently argue that a demographic dividend is not automatic; it is an opportunity that must be earned through effective governance and strong institutions. Without adequate planning and investment, a large youth population can become a liability instead of an asset. The International Labour Organization has warned that persistent youth unemployment can reduce economic productivity and increase social instability. A dynamic economy capable of creating millions of formal-sector jobs each year is essential for absorbing a growing workforce. Human capital development should remain at the center of national policy. Strong educational systems, Technical and Vocational Education and Training (TVET), science, technology, engineering and mathematics (STEM), digital literacy, coding, digital finance, and technology-based curricula should be introduced from the early years of education. Equal opportunities for girls and women in education and employment are equally important. Pakistan also needs job creation, labour market reforms, export-led manufacturing, labour flexibility, investment in high-value industries such as technology, electronics, and specialized services, support for youth entrepreneurship and microfinance, and stronger healthcare infrastructure. UNESCO has consistently highlighted that technical and vocational education equips young people with practical skills that improve employability and economic resilience. Pakistan possesses one of the largest youth populations in the region, but this advantage can only be realized through greater investment in education, skills, and employment. In conclusion, population control alone is not a long-term solution to economic growth. Developing people’s abilities, expanding opportunities, and investing in human capital are far more effective. The experiences of countries such as Italy and Japan also demonstrate that declining populations and ageing societies create their own economic challenges. The real question is not how many people a country has, but how well it prepares its people to contribute to national development. Research across both developed and developing countries consistently concludes that people become an economic asset when governments invest in their education, health, productivity, and opportunities rather than viewing population solely as a number. The writer holds a PhD from Malaysia and writes on economic development, public policy, and demographic issues. She can be reached at naveedakatper11@gmail.com

  • Sitting on floor may support healthy aging

    LAHORE – Health experts say that if you want to live up to 100 years, you should adopt some important habits that most people tend to overlook. A study published last week claimed that the maximum possible human lifespan could reach 194 years. Scientists at the Skolkovo Institute of Science and Technology in Moscow say that if researchers can discover a way to limit cell death associated with aging, the human body may be able to function healthily for a longer period. Lifestyle factors cannot stop the natural biological aging process but they can help protect the body’s cells from premature death. The result may be not only a longer life but also a healthier and more active one. According to Dr. Claire Neyland, a general practitioner associated with the Preventive Healthcare Clinic (HOOQE), the real goal of longevity is not simply to add more years to life but to maintain a healthy and fulfilling life during old age. Dr. Neyland says planning for a long and healthy life should not begin at the age of 50 or 60. It is never too early to prepare for the future. By adopting healthy habits today, people can lay the foundation for a healthier, happier and more fulfilling life as they grow older. She said that eating a balanced diet, getting adequate sleep and exercising regularly are not the only things that matter. There are also some lesser-known but highly important daily habits that adults of all ages should incorporate into their routines. She explained that people generally spend most of their time sitting on chairs rather than on the floor. Sitting on the floor may help strengthen the lower body while also improving flexibility and balance. Moving from a sitting position on the floor to standing is a simple movement but it can quietly indicate whether the body is aging in a healthy way. On average, a person spends around 10 hours sitting each day which can have negative effects on the thigh bones, hip joints and pelvic-floor muscles. Sitting on the floor and getting back up requires leg strength, hip flexibility, balance and physical coordination. If these abilities are not regularly used, they can gradually weaken with age. People who maintain these abilities generally remain more independent and have a lower risk of falling. Falls are among the major causes of hospitalization and even death among older adults. According to Dr. Neyland, this habit can easily be incorporated into everyday life. For example, people can sit on the floor while watching television, play with children on the floor or do stretching exercises while sitting on the floor. If it is safe, they can also practise standing up without using their hands for support. Even performing this exercise a few times a day may help maintain mobility, flexibility and agility as the body ages.

  • Viral video highlights risky school route in India

    Millions of children around the world go to school every day but for some simply reaching the classroom can be a dangerous journey. In India a viral video has raised concerns after showing schoolchildren taking a highly risky route to get to school in Madhya Pradesh’s Vidisha district. The students reportedly have to jump across a river embankment to reach their school while strong water flows below. The dangerous journey has shocked people on social media and raised serious questions about the safety of the children. Parents and local residents say there is no safe route for the children to reach school forcing them to take the dangerous path every day. The situation becomes even more risky during the rainy season when the water level and flow increase. Locals have urged the authorities to inspect the area immediately and provide a safe and permanent route for the students instead of waiting for a tragic accident to happen.

  • Natural sugar may help cancer spread, study finds

    A new study has revealed that fructose (natural sugar) consumed as part of the daily diet may help certain types of cancer spread throughout the body. According to the study published in the scientific journal Nature Aging, cancer cells that survive chemotherapy do not remain inactive. Instead, they release fructose which activates other cancer cells allowing them to leave their original location and spread to other parts of the body. Experts say that excessive consumption of sugary drinks and beverages containing high levels of fructose may also increase the risk of cancer spreading even in patients who are not undergoing chemotherapy. The study further found that fructose causes changes inside cancer cells that make it easier for them to move from one part of the body to another. The research was conducted on ovarian cancer but experts believe that a similar process could also occur in pancreatic, colorectal and liver cancers.

  • Electricity problems in kolaho

    Haleema Abdul Rauf I am writing to inform you that, due to the lack of electricity, we are facing many problems in our area. Without electricity, we cannot use fans, lights, the internet, or many other essential facilities. Nowadays, almost everything depends on electricity. Many poor families cannot afford solar panels because they do not have enough money or stable jobs. They also cannot afford appliances such as refrigerators. As a result, many people suffer from extreme heat, and some even become unconscious because of the high temperatures. We are facing many difficulties due to the electricity shortage. Refrigerators, lights, fans, and many modern devices all depend on electricity. Therefore, I request the government and WAPDA to ensure a proper and regular supply of electricity. Reliable electricity is very important for people’s daily lives, education, health, and work. I hope my request will be considered, and the electricity problem in our area will be resolved as soon as possible.

Leave a Reply

Your email address will not be published. Required fields are marked *