EVOLUTION OF CRITICAL CARE IN PAKISTAN

IN LAST THREE DECADES

Dr. S.Tipu SultanProfessor of Anaesthesia &Critical Care S.I.U.TAtia General Hospital,Koohi Goth Hospital.

ISLAMABAD LAHORE

PESHAWAR QUETTA

PAKISTAN

KARACHI - PAKISTAN

KARACHI - PAKISTAN

SOME FACTS

Population of Pakistan 1947 – 31 million

Population of Pakistan 2015 – 180 million

Registered Doctors (2015) 149,201

Registered Nurses (2015) 18000

No. of Tertiary Care Hospitals in Pakistan – 1947 - Teaching – 2- General hospital (upto 100 bed) 8 – 10- General hospital (upto 50 bed) 30 – 50

No. of Hospitals in Pakistan in 2015> Public sector – 972> Private sector - 8000

SOME FACTS

No. of I.C.U Bed in Pakistan in 1947 – None

No. of I.C.U Bed in Pakistan in 1985 – 50 – 100

No. of I.C.U Bed in Pakistan in 2015 – 1550 – 1600

Budget of health in Pakistan – 0.6% of GDP

Health Care Providers & Population

Human Resources

One Doctor - 1206 persons

One Nurse - 2368 persons

One Hospital bed - 1665 persons

One I.C.U bed - 120,000 persons

One Nurse VS 08 Doctors

I.C.U STATUS 30 YEARS BEFORE

Multidisciplinary I.C.U ProvidingoMedical Care (all disciplines)oPost Surgical Care (all disciplines)oCoronary CareoChildren and Neonates

No dedicated intensivist.

Severe lack of financial resources.

“Disease & Poverty” They are an

unfortunate coincidence.

“Critical illness & Poverty” are also an

unfortunate combination resulting in

misery with very high morbidity &

mortality.

Dilemma of a Developing Country

FACTORS INFLUENCING THE EVOLUTION OF CRITICAL CARE

Increasing awarenesss for I.C.U.

More funding for I.C.U managements.

More investment in Private Sector I.C.U.

More dedicated specialist availability.

Increased facilities for Training.

FACTORS INFLUENCING THE EVOLUTION OF CRITICAL CARE

Work Load

Still rampant Pathologies like, Tetanus, Eclampsia, Ruptured uterus, T.B., Sepsis.

Increasing no. of organ Transplants like, Kidney & Liver.

Increasing incidence of Poly-trauma due to bomb blast, Firearms & Burns.

STATUS 1985 - 95

Unidisciplinary & Multidisciplinary I.C.U.

Invasive & non invasive monitoring.

I.C.U support for Postoperative sick patients

needing system support.

Lack of adequate premises with controlledenvironment.

Shortage of trained staff & specialist.

STATUS 1995 - 2005

Increase in number of critical care units.

More accurate ventilators & monitors.

Better infection control.

Efficient & trained work force.

More potent medicines.

STATUS 2005 - 2015

Better understanding of Pathophysiology.

Adaption of evidence based medical practice.

Shortage of trained I.C.U work force (Brain drain)

Adaption of International Guidelines.

Efficient + Lab support.

Efficient equipments & tools.

Training Programme for I.C.U specialist (fellowship)

PRESENT SCENARIO

State of art Critical Care Units in Major Cities

only (7 cities).

All cities (21) have average I.C.U.

Majority I.C.U in Private Sector.

Very costly management in I.C.U ($300-$1000)

per patient / day

Low Budget for health in Govt. sector hospitals.

Very Low Budget for I.C.U in Govt. Hospitals.

Severe shortage of health care givers in I.C.U.

Acute shortage of critical care specialists.

TYPES OF CRITICAL CARE UNITS IN PAKISTAN

Multidisciplinary I.C.U ------ Private & Public Sector

Surgical I.C.U ------------------ Public Sector

Medical I.C.U ------------------ Public Sector

Nephro I.C.U ------------------- Public & Private

Neuro I.C.U --------------------- Public Sector

Paediatric I.C.U ---------------- Public & Private

Neonate I.C.U ------------------ Public & Private