Impact of - IDL-BNC @ IDRC - International Development Research ...

The health-care system
The provision of health services in Pakistan has progressed faster than education,
but there is still considerable room for improvement. Indicators available
for recent years on health infrastructure and expenditure provide evidence of
this. At present, less than 1% of the gross national product is spent on health.
In 1985-1986, only 4.5% of total public spending was allocated to the health
sector. The poor health situation in Pakistan is reflected in its high rates of
infant mortality (95 per 1 000) and low life expectancy (61 years) compared
with other countries (UNICEF Country Classification - Pakistan Basic Data
from 1988 and earlier years).
Today, there is one public physician for every 3400 people, one public nurse
for 7.4 hospital beds or for 13 100 people, one public hospital for 150 000
people, and one hospital bed for 1 760 people. Primary health-care facilities
other than hospitals are offered by 2 468 basic-health units, 455 rural-health
centres, 869 maternal- and child-health centres, and 3 994 dispensaries (Government
of Pakistan 1987). Along with public-health facilities, some health
facilities are also made available by the private sector. However, these are
expensive and beyond the reach of most of the population. Despite the official
statistics, many physician posts remain vacant in the countryside. For these
reasons, physicians seldom have the opportunity to treat farm workers and
their experience with pesticide poisonings is often limited.
Outbreaks of pesticide poisoning in Pakistan
Several outbreaks of pesticide poisoning have been reported (Table 1). Peasants
driven by starvation to eat treated grain have been the victims in most of
these poisonings. In one instance, 34 people were affected and four died after
eating mercury-treated grain (Hag 1963). In 1976, an outbreak of organophosphate
insecticide poisoning from malathion occurred among 7 500
fieldworkers in the malaria control program. It is estimated to have affected
2 800 workers and resulted in at least 5 deaths.
Subsequent field studies have associated low red-blood cell cholinesterase
activity with the signs and symptoms of organophosphate intoxication. The
greatest toxicity was found with products containing high amounts of
isomalathion, a toxic product of malathion degradation. When malathion and
fenitrothion poisoning was diagnosed in exposed Pakistani workers, cholinesterase
activity was found to have decreased by more than 50% (Miller and
Shah 1982). This exposure was attributed to poor work practices, which had
developed when DDT was the primary insecticide used for malaria control.
These practices resulted in excessive skin contact and percutaneous absorption
of the organophosphate pesticides (Baker et al. 1978). Evidence of the
widespread effect of this has been found in the increased organochiorine
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