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Surgery, part of neglected NCDs

Updated: Aug 31, 2018

By Ihtiram-ul-Haq Khattak


He hailed from a remote village in Jamshoro, Sindh, Pakistan’s southern-most province. Six-year-old Abdul Raheem was in the hotbed of misfortunes. When he was two-years-old, his father committed suicide as a way of escaping extreme poverty, thereby transferring all his burdens to his wife—a mother of 4 minors with neither education nor employable skills. Determined not to expose her children to the torments of orphanage, the brave mother, started working as a daily wager on agricultural lands earning as low as less than Rs. 230 PKR (less than $US 2.5) a day. They managed somehow with the meagre income—and then health disasters struck.


At the age of 4, Abdul Raheem started losing consciousness, off and on. The family roved from hospital to hospital in their local area to get Abdul Raheem treated but his symptoms aggravated with the passage of time until he became critical. Finally, at a Neurosurgery hospital, 200 kilometers from their village, he was diagnosed with Hydrocephalus caused by tumor (Hydrocephalus is a condition in which there is an accumulation of fluid within the brain, which causes increased pressure inside the skull). By the time of the diagnosis, the family had spent all they had, as well as the borrowed 10,000 PKR (around $US 90) and had sold their only two goats, which provided milk for the children.

The Neurosurgery unit was a Heartfile Health Financing registered site; and we felt privileged to be able to help with the cost of the brain operation, but we were also mindful that the needs of poor patients usually compound after prolonged hospitalization.


The mother—who was also the breadwinner—while tending to the child in hospital wasn’t able to earn. As anyone would have, we also arranged for them to have assistance for food, medicines and cash for travel back home through our mobile wallet assistance channel. The family went back home with the child healing from a painful disease. But the poor boy’s health problems didn’t end there.


A few months after his brain surgery, the family discovered that Abdul Raheem needed a Urethroplasty operation for ‘Hypospadias major’ (an ectopic position of the urethral meatus). This time the family landed in a child surgical hospital in Karachi, another Heartfile-registered site. The patient’s mother was pleasantly surprised when she received a similar SMS on her cell phone as she previously experienced in the Neurosurgery unit, informing her that the cost of the operation would be covered. When the Heartfile’s socio-economic verifier based at Karachi came to assess the patient, the family could immediately recognize the red file and Heartfile logo.


Universal Health Coverage—both the geographic and financial access aspects—is incomplete without access to surgery for NCDs, this is particularly important for children, as in the case that has been highlighted.


According to official statistics, 5 billion people do not have access to safe, timely, and affordable surgical care. 9/10 people in the LMIC do not have access to surgical care when needed. And this may just be the top of the iceberg. This is simply unacceptable. We need to address this as part of our efforts to address NCDs and UHC. The WHA resolution 68.15 was passed unanimously in 2015 calling for "strengthening of emergency and essential surgical care and anesthesia as a component of UHC"… It is time we took it seriously.



Ihtiram ul Haq Khattak is the leading Senior Manager of Heartfile Health Financing

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Heartfile Health Financing (HHF) is an access to treatment program for non-communicable diseases. It provides financial access for high-cost treatment for those who are unable to pay, are likely to spend catastrophically or forgo treatment. HHF's mobile phone-driven process is fully transparent and offers help to patients with dignity. HHF currently operates in selected hospitals in Pakistan and is being prepared for scale-up.  

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