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PAKISTAN AIMS AT IMPROVING HEALTH STRATEGY TO ENSURE LIFESAVING SURGICAL CARE FOR ALL

“An estimated 16.9 million people die each year from surgically preventable causes of death, with 95% of these deaths occurring in South Asia and sub-Saharan Africa. Safe surgical and anesthesia care in low and middle-income countries (LMICs) has not progressed during the last 25 years despite significant advancements in global health. Worldwide, 5 billion people lack access to surgical care due to a paucity of health facilities, poor infrastructure, inappropriate health workforce, and low financial protection,” according to experts at the virtual launch of the National Vision for Surgical Care 2020-25 in Islamabad on July 12, 2021.

Dr. Faisal Sultan, Special Assistant to the Prime Minister on Health; Dr. Nausheen Hamid, Parliamentary Secretary on Health; DG Health; Executive Directors of ICT hospitals and others were present along with Dr. Abdul Bari Khan, Chief Executive Officer, Indus Hospital & Health Network (IHHN) and Dr. Lubna Samad, Senior Consultant, Pediatric Services, IHHN were present at the event conducted at the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C). The event was co-hosted by MoNHSR&C and United Nations Institute for Training and Research (UNITAR), supported by IHHN, the Global Surgery Foundation (GSF), and Program in Global Surgery and Social Change (PGSSC).

Dr. Faisal Sultan started the proceedings by discussing Pakistan’s commitment to Universal Health Coverage. “We are determined to make sure that not only services are provided but standards and safety are met especially for those going under the knife,” he said. “The Pakistan Medical Commission, which is the regulator of physician education, is a framework that not only is modern but builds on the idea of a continuous learning environment for practicing physicians to ensure safe and effective care to their patients. This environment of an accountable and documented ability, whether surgical or medical, is part of the agenda of this event.”

Nikhil Seth, Assistant Secretary, and Executive Director UNITA, while addressing the launch event from Geneva said that the event highlighted the commitment by the Government of Pakistan to integrate surgical care within its key health systems strengthening strategy – the Universal Health Coverage – Essential Package of Health Services. “Through the integration of surgical care into the national health strategy, Pakistan is leading the way in finding solutions to increase access to

surgical, obstetric, and anesthesia care – solutions that will ultimately save thousands of lives.”

He added that Pakistan’s National Vision for Surgical Care 2020-25 is a pivotal step forward to achieving Universal Health Coverage and meeting the health-related SDGs, both of which are not possible without the inclusion of safe and affordable surgical care systems.Seth also commended Dr. Faisal Sultan and his team for their efforts in striving forward and finding solutions for providing universal health coverage for Pakistan – and through the National Vision for Surgical Care, making surgical care a key priority for his Ministry.

He hoped that Pakistan’s pioneering efforts as the first country in Asia to develop a national surgical plan will lead as an example for other nations of the world and will benefit many vulnerable populations in the future. He further said that UNITAR looks forward to seeing the implementation of this plan and the impact it will have on Pakistan.

“UNITAR, along with the Global Surgery Foundation are committed to working with all stakeholders to achieve this goal,” he added.

Experts also stressed that with a population of around 227 million, the need for surgical care is rapidly increasing in Pakistan and the current surgical systems are unable to cope with this growing demand.

“Pakistan has only 6 surgeons, obstetricians, and anesthesiologists (SOA) per 100,000 population against the minimum target of 20 per 100,000 proposed by the Lancet Commission on Global Surgery (LCoGS). Pakistan has a high maternal mortality rate of 276 per 100,000 population. Many of these deaths could be prevented if the country had ready access to obstetric surgical care, particularly at the secondary level,” Dr. Lubna told at the launch.

She added, “An estimated additional 10 million surgeries need to be performed every year to address this unmet need. Pakistan lacks utilization of services due to inappropriate distribution of workforce and resources, especially at the secondary level of healthcare.”

Dr. Geoff Ibbotson, Senior Health Advisor, UNITAR who serves as the Executive Lead of the Global Surgery Foundation, joined in the event from Geneva, Switzerland to celebrate the launch of Pakistan’s National Vision for Surgical Care. “The GSF stands committed to support Pakistan on the long road ahead. Pakistan’s National Surgical Plan in Universal Health Coverage and Essential Health Services

implementation is a unique model that has the potential to truly integrate surgery as part of universal health coverage and set a precedent globally. The entire team at the GSF are excited to see this approach materialize in the coming months and years and are prepared to extend all possible support to make this initiative a success.”

Dr. Nausheen Hamid said that the event highlighted that surgical care delivery needs to be approached as an important part of public health and policy. “In a resource-constrained country like Pakistan, it is all the more important to approach health systems improvement based on evidence so that limited resources — both financial and human resources — are used efficiently and the most advantage is gained for every rupee spent.”

She added that it was very encouraging to see surgeons, obstetricians, and anesthetists taking a leading role in developing and implementing this surgical plan. “Their [surgeons, obstetricians, and anesthetists] understanding of the needs of the surgical patient and the current surgical system in Pakistan is unparalleled. I encourage all surgeons, anesthetists, and obstetricians to look at patient care beyond the confines of the operating room and the hospital, and support our Government’s efforts to improve surgical systems especially for the poor and those that live in remote areas.”

She added, “I am very grateful to Dr. Bari and his team at the Indus Hospital & Health Network for taking a lead in this.”

Recognizing the gap, in May 2015 the World Health Assembly passed a resolution (WHA68.15) that commits to “strengthening emergency and essential surgical care and anesthesia as an essential component of universal health coverage”. In the same year, the LCoGS published its findings and highlighted the inequity in surgical care. The LCoGS proposed the national surgical, obstetric, and anesthesia plan (NSOAP) as a strategic framework to guide countries to strengthen surgical platforms, and emphasized the need for collection of defined surgical indicators to track progress. Subsequently, four out of these six indicators were adopted as part of the World Development Indicators.

As a signatory to WHA Resolution 68.15, Pakistan has taken a lead as Asia’s first country to develop a national surgical plan. Pakistan has a devolved health system with a federal ministry of health and four provincial health departments, working autonomously to implement their strategic plans developed under NVSC2025. Surgery and surgical services were not a priority area and subsequently overlooked by planners and policymakers at key forums. Utilizing the NSOAP framework,

Pakistan’s National Vision for Surgical Care was developed by a broad spectrum of relevant stakeholders to highlight current gaps in surgical care delivery and provide a strategic direction to strengthen surgical systems in the country.

The NVSC process was led by the Indus Hospital & Health Network in collaboration with the MoNHSR&C, with technical support provided by the PGSSC and the World Health Organization. A National Stakeholders’ Conference was convened in November 2018 to develop a board stakeholder engagement with public and private, national, and international stakeholders committing to a roadmap for improving surgical care in Pakistan through a “Consensus Statement” that was released at the end of the conference. This summary statement was expanded based on stakeholder input provided during the two-day conference as well as during provincial consultations held in March 2019, leading to the finalization of the NVSC2025 document. Subsequently, this draft document was finalized and approved by MoNHSR&C in April 2021.

The implementation of the Universal Health Coverage-Benefit Package (UHC-BP) Pilot Project in Pakistan provides a unique opportunity for integration of surgical systems strengthening as a key component of overall health system optimization. Technical expertise on the surgical component of UHC-BP was provided by IHHN team; in particular, the need for surgical care for children is an essential part of this package. Thus, UHC-BP provides a timely vehicle for the implementation of NVSC.

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Indus Hospital & Health Network is a not-for-profit company registered under section 42 of the Companies Ordinance 1984. The company has tax exemptions under the Income Tax Ordinance 2001.

Charity Registration No. PCP-R2/2019/234 National Tax No. 3162706-4

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Zakat is one of the five pillars of Islam. It is the specific amount of wealth that a mature Muslim, who is Sahib-e-Nisaab, gives to the poor with the intention of Zakat, upon the completion of the Zakat year.
“And those in whose riches there is a specified right. For the one who asks and the one who is deprived.” (Qur’an 70:24-25)

The meaning of Nisab is a specific amount of four types of wealth, which if owned by a mature Muslim, Zakat will be compulsory upon. The four types of wealth are:

  • Gold (7.5 Tolas, 87.48 Grams)
  • Silver (52.5 Tolas, 312.36 Grams)
  • Business wealth (value of which equals 52.5 Tolas Silver)
  • Currency/Cash (value of which equals 52.5 Tolas Silver)

Zakat is not just a fundamental pillar of Islam. It is also a revolutionary concept with the potential to ease the suffering of millions around the world.
As Allah (SWT) tells us in the Holy Qur’an:
“And be steadfast in Salah (prayer), and give Zakah. Whatever good you send forth for yourselves, you will find it with Allah. Certainly, Allah is watchful of what you do.” (Qur’an 2:110)
It is also a right that the poor have over us.
“And those in whose riches there is a specified right. For the one who asks and the one who is deprived.” (Qur’an 70:24-25)

Zakat is 2.5% of the wealth one possesses above the Nisab.

If someone is a Muslim, non-Sayyid, and they do not possess 52.5 Tolas silver, or its value in gold, currency, business wealth, or wealth surplus to their needs, they are eligible to receive Zakat.

No, Zakat is only obligatory upon Muslims.

There are eight categories of people who are eligible to receive Zakat:
  1. The poor
  2. Needy
  3. Administrators of Zakat
  4. Those whose hearts have been recently reconciled
  5. Those who have been enslaved
  6. Those in debt
  7. In the cause of God
  8. Travellers (including refugees)
As Allah (SWT) tells us in the Holy Qur’an: The Sadaqat (prescribed alms) are (meant) only to be given to the poor, the needy, to those employed to collect them, to those whose hearts are to be won, ¹⁹in the cause of the slaves and those encumbered with debt, in the way of Allah and to a wayfarer. This is an obligation prescribed by Allah. Allah is All-Knowing, Wise.

‘Hawl’ refers to a lunar year. E.g. When a person achieves the Nisab for the first time, then from this date till the same date in the next lunar year his ‘Hawl’ is complete.

For Zakat to be due, it is a condition for one lunar year to have passed. If one lunar year hasn’t passed on someone’s wealth, then Zakat is not due.

Yes, Zakat will be due at the time of Zakat due date for this amount. Even though a year hasn’t passed on having the amount. This is known as ‘Maal-e-Mustafaad’ in Shariah terms, as in wealth received midway through a year.

The midway of a year is not taken into consideration, but the zakat due date is considered. For example, you Zakat due date is the first of Ramazan , and before the first of Ramazan, your wealth decreased to below the Nisab, but on the coming of the first of Ramazan, your wealth met the Nisab criteria, then Zakat will be due. The drop earlier in the year beneath the Nisab criteria will not be considered

Yes, you will still be required to pay Zakat of 2.5%. For the payment of Zakat, ‘intention’ or ‘Niyyat’ is mandatory and common charity/donation cannot be considered as Zakat. Therefore, you are required to calculate your Zakat on your Zakat calculation date and then the calculated amount may be given to the identified Mustahiq-e-Zakat either in full or in tranches throughout the year, with the intention of that amount being considered as Zakat only.

For every year that you owe Zakat, take 2.5% from the total wealth you had at the end of that year and pay that in Zakat. If you are not sure how much wealth you had, you must estimate it to the best of your ability. For example, it is now Ramazan 2022. You have not paid Zakat for the last 5 years. You need to work out how much wealth you owned every Ramadan for the last five years and pay 2.5% of that.

There is no Zakat on the wealth of a minor.

The best way for you to do this would be to take the jewellery to a jeweller and ask them to value just the gold and silver parts of the jewellery. The valuations they give will be the total on which you have to pay Zakat. Precious stones are not liable for Zakat.

If money for Hajj has been paid and the place has also been confirmed, then there is no Zakat on this amount. But if the Zakat date falls before payment, then there will be Zakat due on this amount.

Yes, Zakat is due on this amount. But it is up to you – you can either pay Zakat on the amount each year, or when the money is received, you can pay for the previous years.

If your friend accepted that he had the debt and did not deny it, then Zakat is due on this amount. Calculate your zakat here

Yes, you can exclude this loan, but if your wealth increased by Zil-Qadah, then Zakat will be due on the extra amount as well.

In this scenario, there is no Zakat due on the house value. However, whatever rent was received, add this to your other wealth on which Zakat is due and pay the total due Zakat amount for the Zakat year. Also, there is no Zakat on the house until you sell it. Once you have sold the house and received the money, then there will be Zakat payable on that amount, if it remains in your possession till your Zakat due date.

Every year at the time of paying Zakat, you would need to calculate the total selling price for all the goods for sale in your shop. For example, all the clothes for sale in your shop add up to a total selling value of a particular sum of money. You would add this to your other wealth when calculating your total payment.

If you haven’t received the funds, then Zakat isn’t due. But if you have received the funds, Zakat is due.

This amount is the group’s collective ownership. Thus, each participant will pay Zakat on his/her share, or permission can be given to one person who will pay Zakat from the fund on behalf of everyone.

In Shariah terms, poor and needy is classified as someone who does not have the Nisab amount in their ownership. The meaning of Nisab here is 52.5 tolas silver or the equivalent of that in cash/gold, or extra to what is needed.

Zakat cannot be given to ‘Usool’ and ‘Furuu’. ‘Usool’ is parents, grandparents and so on. ‘Furuu’ is children, grandchildren and so on. Similarly, Zakat cannot be given to husband or wife. Besides this, Zakat can be given to other relatives.

If the orphan doesn’t possess the ‘Nisab’, and he isn’t a ‘Sayyid’, then he can be given Zakat. If he possesses something of the value of nisab, he cannot be given Zakat.

Zakat can only be given in those projects wherein possession is achieved of the Zakat amount. This means the person who can claim Zakat and is eligible for Zakat payment becomes the owner of the amount. Thus, to give food, clothing, medicine etc. to a poor person from the Zakat money is permissible. And those projects wherein ownership of the Zakat money is not achieved, Zakat cannot be given for example, spending in Masajid, digging wells etc.

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