A public hospital for every district? No?

January 16, 2022

The proposal to shut down district headquarter hospitals has attracted much criticism

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Prime Minister Imran Khan has announced that district headquarter hospitals in the Punjab will be decommissioned to facilitate the private sector to provide healthcare facilities to the public even in far-flung areas. Medical associations have called this a slip of the tongue and hope that the Punjab government is not considering such a course of action in the near future.

More than 62 percent of the population of Pakistan lives in rural areas which are mostly undeveloped and face serious challenges in terms of health facilities. Perhaps, it is on account of this realisation that the prime minister has asked the private sector to invest in healthcare facilities and promised to incentivise such investment by offering help in acquiring land and duty-free import of medical equipment. “The government wants to facilitate the poor and to help them,” the prime minister says.

The prime minister believes that the DHQ hospitals are not serving the people well. This is in part on account of the reluctance of doctors to serve in rural areas. “Why should the government spend its money if doctors are not going to DHQ hospitals to serve the people?” he reasons.

The Young Doctors Association (YDA) general secretary, Dr Salman Kazmi, says the prime minister has been misguided by his advisors about the services provided by DHQ hospitals and the number of patients benefitting from these facilities.

“The prime minister seems ill-informed when he asserts that most of the doctors do not treat patients at DHQ hospitals,” Kazmi tells The News on Sunday. “The Health Department data should be enough to show how many patients are being served on a daily basis at each DHQ hospital as well as the number of doctors performing their duties,” he adds.

Currently, 34 DHQ hospitals are providing healthcare facilities across the province. DHQ hospitals are public health facilities having 125-250 beds that cover a catchment population of 1-3 million. According to the Health Department, DHQ hospitals provide promotive, preventive, curative, advanced diagnostic and specialised in-patient services.

These health facilities are broadly divided into the following groups: Basic Health Units (BHUs), Sub Health Centres (SHC), Rural Health Centres (RHCs), Maternal and Child Health Centres (MCHCs), Tuberculosis Centres (TCs), dispensaries and hospitals. The hospitals are divided into three types: tehsil headquarters (THQ) hospitals, district headquarters (DHQ) hospitals and teaching hospitals.

Ensuring access to primary and secondary health facilities for the population and providing an efficient medical care system are among the prime responsibilities of the government. However, the prime minister apparently believes that “the health card scheme will help create a robust healthcare structure across the Punjab. Now the private sector will come forward and establish hospitals across the province.”

Currently, 34 DHQ hospitals are providing healthcare facilities across the province. The DHQ hospitals are public health facilities with 150-250 beds that cover a catchment population of 1-3 million. DHQ hospitals provide preventive, curative, advanced diagnostic and specialised in-patient services.

The Punjab government does not seem to agree with this approach. A DHQ hospital is considered a very important pillar in its healthcare facilities. Hanif Khan Pitafi, the advisor to the chief minister for Health Department, says that no one can claim that patients are not being taken care of as they should be in public healthcare facilities. He says for certain reasons patients have to wait for heart surgery for at least six months or so, which is very unfortunate. Despite these drawbacks, the government is not planning to shut down any healthcare facility, including the DHQ hospitals,” he tells TNS.

Pitafi says that all the vacancies in DHQ hospitals have been publicised and are being filled. He says most of the seats for consultants are occupied. “However, it is always a challenge for the government to establish such an infrastructure in public healthcare and maintain its effectiveness, efficiency and responsiveness to the needs of all socio-economic groups. Low-income communities are the hardest to serve,” Pitafi adds.

According to him, the Sehat Card scheme will give patients an alternative to receive satisfactory medical treatment.

“The huge investment in the Sehat Card scheme will help create a robust healthcare structure across the province. The government will thus be relieved of the need to establish more hospitals,” the prime minister said in a Sehat Card distribution ceremony held at Governor’s House.

The Naya Pakistan Qaumi Sehat Card provides two packages: secondary care coverage for hospitalisation of up to Rs 60,000 per family per year and coverage for a major priority disease for hospitalisation of up to Rs 400,000 per family per year. This coverage can be extended to up to Rs 1 million under unusual circumstances.

The Pakistan Medical Association (PMA) Lahore, president, Dr Ashraf Nizami, considers the introduction of the Sehat Card is a good step. However, he believes that the system it provides should be critically analysed. “This Sehat Card does not provide financial support to outdoor patients who account for almost 96 percent of those visiting the public healthcare facilities,” he tells TNS.

Punjab’s health statistics show that 170 million patients were treated in the public health facilities during the calendar year 2019 and 167 million during 2020. The health facilities include hospitals, dispensaries and basic health units, etc.

Rs 440 billion has been allocated for the Sehat Card scheme for the Punjab. “The government should collaborate with all the stakeholders to make this scheme efficient and productive. Otherwise, the huge amount will eventually benefit insurance companies and nobody else,” Dr Nizami warns.

Besides, an upgrade of the existing health facilities to improve the quality of services being rendered is necessary, he says.

About the prime minister’s announcement about shutting down the DHQ hospitals, both Dr Nizami and Dr Kazmi are certain that if the government decides to opt for such a policy, their associations and other relevant bodies will resist it.

The writer is a staff member. He can be reached at warraichshehryargmail.com

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