Health dept takes note of patients’ unnecessary referral to big hospitals

PESHAWAR: The Khyber Pakhtunkhwa Health Department finally took note of unnecessary referrals of patients to the secondary and tertiary level hospitals and directed the doctors not to refer any patient to other hospitals for the services available with them.

There were complaints that the government had spent millions of funds on peripheries in all the districts and raised salaries of the Health Department workers but patients were still suffering as they were being sent to the distant hospitals in Peshawar for the services already available at the tehsil and district headquarters hospitals.

The Health Department has increased the allocations from Rs18 billion in 2014 to Rs67 billion in 2017-18 along with almost doubling the number of doctors, nurses and EPI technicians.KP’s Director General Health and Services Dr Mohammad Ayub Rose held a meeting with all heads of the public sector hospitals in Mardan.

He directed them to strictly discourage unnecessary referral of patients to the secondary and tertiary level hospitals which are available in their respective hospitals. Chairman Board of Governors Mardan Medical Complex (MMC), Dr Fazle Hadi, Medical Director Dr Mukhtar Ali, Hospital Dr Mohammad Israr, DHO Mardan, MS DHQ Mardan, MS DHQ Swabi, DMS Batkhela, MS THQ Takht Bhai and Dargai, MS THQ Kalu Khan, and MS Lundkhwar attended the meeting.

They were informed about the unnecessary referral of patients from the MMC and rest of the above health facilities. The director general told them that most of the doctors at these hospitals don’t take the trouble to carefully examine patients during day and night hours and refer them to other hospitals.

He said MMC was a tertiary care hospital having all the available resources as much Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) with exception of neurological and plastic surgery services and therefore patients should not be sent them unnecessarily.

Dr Ayub Rose said that indoor, surgical, diagnostics, labour room, emergency service, etc, are at par with all other tertiary care hospitals.

“The only genuine issue is of 13 bedded gynae wards each (26 beds for both wards) as compared to 30-40 beds each in all the three wards of the three tertiary care hospitals. The three tertiary care hospitals carry at least 300 beds for gynae and obstetrics as compared to 26 as a whole in MMC, far less to accommodate referrals from 3-4 adjacent districts.

It was suggested that the newly constructed 200 bedded paediatric building should be opened for both maternal and child care with 100 beds each for maternal and child c

are in MMC.

The BoG along with others agreed with the idea and and requited the DG to help in notifying paeds hospital as maternal & child care hospital.They also decided that a portion of building in MMC currently occupied by the Bacha Khan Medical College (BKMC) should be shifted to the new college building so they can utilize four wards for patient care.

About the four DHQ hospitals, including Mardan, Swabi, Batkhela and Nowshera, it was recalled that all of these hospitals are under construction or rehabilitation/standardization process and their referral to MMC and Peshawar were inevitable.

It was also suggested that at least the DHQ Mardan can bring its 60 bedded wards and full-fledged labour room into maximum possible use.On the other hand, rests of all the nine Type-D and THQ hospitals around MMC should utilize the available resources and provide services to patients brought to them.

The DG Health assured them that maximum of the vacancies have been filled in and now it was the local managerial capacity of the DHO/MS and DMS how to bring the resources into use.

All the casualty Deptts, labor rooms, OTs & wards of all these hospitals need to be properly & adequately equipped with relevant supplies & medicine so that maximum of the needy, especially in the afternoon & night, should be given all possible emergency treatment & even admission facility to avoid unnecessary referral to both MMC & Peshawar.

The MSs & DHOs were told that unless the 24/7 services through best use of existing human & material resources are properly established, the staff would carry on the doing unwanted referrals.

The genuine reasons discussed were as under:

1. The THQs in general & Type-D hospitals in specific need filling of specialist cadre.

2. The distt nazims are not cooperating in relevant terms, e.g budget allocations.

3. Despite a huge number of MOs & nurses, the 24/7 is not adequately observed to avoid referrals.

4. One-third of the ambulances are off the roads.

5. All were of the opinion to raise the rate of ambulance service from Rs5 to Rs10 km so that it no more remains a cheaper opportunity for general public to be referred.

6. Despite huge medicine budget the emergency & labor-room would run short of medicine.

7. BKMC Swabi is also not so established to accommodate referrals & so most of south-eastren Swabi would be attracted to Peshawar

8. None availability of radiologists in Batkhela, Takht Bhai & Swabi also compel the staff to be referred on the basis of diagnostic facilities.

9. There is a dire need of developing SOPs for referral, even on case to case basis.

The BoG was also on the same page that they & rests of the DHOs, MSs would also abide by the instructions to the maximum.

The provincial team will also try their utmost to work on the human, notification of paeds hospital and extend support on early completion of construction on the

four DHQs.