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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
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