It is not surprising that Pakistan has around 80 million patients suffering from chronic disease, one of the highest numbers in the world. The rapid rise in morbidity and mortality rates needs to look into it. Although advancement in medicine and technology has controlled the rates to an extent, we still face the patient barrier. In the past few decades, the unwillingness of patients to follow or continue treatment has pushed organizations and physicians to work towards treatment adherence.
The term treatment adherence is defined by the World Health Organization as the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider. It is also known as medication adherence or patient adherence, and sometimes wrongfully termed as compliance. Although used synonymously, compliance differs from adherence. It is because Compliance is the extent to which a patient’s behavior matches the prescriber’s advice. It implies patient obedience to the physician’s decision, whereas adherence requires patient and physicians’ cooperation for the treatment plan by integrating the patient’s lifestyle, values, and preferences to the physician’s medical opinion.

It is a very common but easily ignored aspect of treatment. There is a need to tackle the problem of non-adherence, especially in our society to decrease the morbidity and mortality rates. To overcome this, a need to cross certain barriers in our society as described below is essential.

Health Illiteracy

Ignorance or the lack of awareness had always topped the list of problematic issues. The lack of knowledge about adherence and its importance is one of the major causes of rapidly rising cases of death due to chronic diseases. The lack of knowledge stems from an irresponsible attitude. The forgetfulness to take medicines on time, skipping medicines due to side effects, doubling the dose later, stopping the medication when symptoms lessen are few examples of behaviour emerging due to unawareness about the importance of treatment adherence.
Health illiteracy is a major factor causing non-adherence in our society as highlighted by a survey done by health literacy survey-Asia (HLS-Asia) in 2013 in which Pakistan scored the lowest with a health index of 26.72

Poor Doctor-Patient Relationship

A doctor-patient relationship is one of the core elements of medical ethics. Good communication, trust, empathy holds a significant impact on the treatment of patients. A good relationship also ensures treatment adherence. It is the lack of coordination, untrustworthy behavior, and poor communication that frustrates the patient and pushes them towards non-adherence. Lack of encouragement and poor understanding of the treatment plan forces the patient to either stop their medications or changing physicians.
With Pakistan having a doctor-to-patient ratio of 1:1300, as compared to the standard 1:1000 stated by WHO, it faces higher rates of treatment non-adherence due to the overburdened setup that causes unavailability of proper counseling time.

Financial constraint

Although Pakistan has successfully decreased its poverty rate since the start of the 21st century, many people still live under the poverty line. Along with the problems of a poor health care system and corruption, affording health care facilities is considered a privilege rather than a need. The expensive cost of medicines, diagnostic tests, and hospital care are factors causing treatment non-adherence. Lack of knowledge also plays a role here as patients put other less significant factors before their health due to financial constraints.
The lack of health insurance facilities for all is also a contributing factor. A need for awareness regarding prioritizing health and availability of affordable treatment can significantly decrease the rate of deaths due to chronic diseases.

Malpractice and mistrust

A few years back, the broadcast media and newspapers were filled with updates of fake degrees and malpractice. The vast number of cases had a huge impact on the trustworthiness of the population as it implanted the seed of mistrust, a seed that has grown steadily through the years. The mistrust of health care providers and hospital management along with poor health care systems has forced the people to either avoid physicians or to seek alternative treatments like homeopathy, acupuncture, Ayurveda, etc.
The mistrust also leads to the poor doctor-patient relationship and contributes significantly to the low rates of treatment adherence in Pakistan.

Poor health care system

The health care system of Pakistan has always been debated with the population to health facility ratio being 1:1,413. The vast contrast between public and private hospitals also plays a major role. As the facilities provided at public sector hospital has always been questioned as being cheap and affordable but unhygienic and contaminated. Whereas with 70% of the population being served by the private health sector overshadowing the public sector in terms of service quality and patient satisfaction, the issue of expensive treatment remains. The improved but costly treatment provided by the private sector as compared to the cheap but insufficient treatment by the public sector will always pull the health care system down.
The disparities among the two thus affect treatment adherence as patients avoid going to a public hospital but cannot afford private systems.

These are the different factors but are highly linked. The need for awareness programs to highlight the importance of adherence, doctor-patient relationship, and to remove the negative image of health care providers is essential. Pakistan needs to overcome these problems and to provide cheap and effective treatment for all. It is only by overcoming these factors treatment adherence can be ensured. And by effectively treatment adherence Pakistan can hope to control the morbidity and mortality rates.

Written by: Maryam Fatima

About the author: A medical student following her dreams. Passionate about football who prefers to spend her time reading and writing.

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