Perfunctory healthcare

In areas such as the health and education sectors where the Punjab government seemingly intends to do little, it keeps introducing new experiments and hiring consultants for structural changes. Health-sector reforms have been suggested many times but seldom carried out.
Now the provincial government has decided to hand over administration of primary and secondary public healthcare facilities – such as basic health units, rural health centres, dispensaries, tehsil headquarters hospitals and district headquarters hospitals – to private parties in 10 districts, implicitly admitting its failure in administering the public healthcare system.
All over the world the running of primary and secondary healthcare system is not considered a commercial proposition but a basic responsibility of the state towards its citizens. It is hard to imagine that profit-oriented private parties would be able to provide this basic healthcare service free of cost to the low-income and poor groups in the country.
The Punjab government also apparently intends to divide the provincial health department into two departments for which it has taken the services of the United Kingdom’s Department for International Development (DfID), which in turn has further hired the services of consultants to suggest an alternative model for the bifurcation.
During the 1990s, a similar experiment was carried out by dividing the health department into urban and rural departments which led to so much confusion and maladministration that the decision was soon revoked. Now the government is reinventing the wheel.
Let’s assume the provincial health department is divided into two departments, one for dealing with tertiary care and another for primary and secondary healthcare. The administration would still be highly centralised in the provincial capital. A small matter of purchase of medicine and equipment or transfer of a doctor would be dealt with in Lahore.
A much easier and better option has always been available in the form of devolution of primary and secondary healthcare to elected district governments, but the bureaucracy and the political leadership want to retain all administrative and financial powers in their hands. They would do anything to keep empowerment away from the local governments.
Two years ago, the provincial government promulgated a new local bodies’ law taking out health facilities from the purview of the district governments and decided to form health boards in the districts for running healthcare facilities, but did not implement this scheme either.
Ahead of the 2013 general elections, there was hype that a health insurance system would be introduced in the province, but now this scheme has been relegated to the backburner and reduced to just a pilot project. The experiments and propaganda campaigns go on and on while little improves on the ground.
Credible evidence suggests that a majority of government-run hospitals are deficient in infrastructure facilities, equipment, medicines and human resources. Scan machines, ultrasound equipment and ventilators remain out of order most of the time. Most basic health units and rural health centres are ghost entities.
Availability of medicines for ordinary patients at public hospitals is but a dream, operation theatres are poorly maintained with high risk of infection, and senior doctors seldom visit indoor patients in the afternoon or at night.
The poor state of Lahore’s so-called teaching hospitals can be gauged by a small incident last month when the city’s Mayo Hospital could not provide treatment to its own medical superintendent when he had chest pains. He was shifted to the Punjab Institute of Cardiology because Mayo did not have trained staff and its angiography equipment was in disrepair.
In the gynaecology wards of Lahore’s government-run teaching hospitals such as Lady Wellington Hospital and Ganga Ram Hospital one finds three to four women on each bed. Serious heart patients are treated on wheelchairs, stretchers or lying on floors in the emergency department of the Punjab Institute of Cardiology (PIC) in Lahore.
At the Dental Hospital in Lahore, one of the oldest institutions in the Subcontinent, doctors are working in a dilapidated building officially declared dangerous nine years ago and without adequate number of necessary equipment such as autoclaves. The same is the dismal state of nearly a century-old Moolchand Hospital for children in Lahore and the newly-launched General Hospital in Faisalabad.
Deficiency of human resources adds further insult to injury caused by the deficiency of infrastructure. In Lahore alone, what to speak of the less-privileged far-flung parts of the province, 2,783 posts of doctors are lying vacant. At the Shaikh Zayed Hospital in Lahore more than 90 seats of medical officers have been vacant for long. More than 2000 posts of nurses are vacant all over the province.
Mismatch in the spatial distribution of healthcare facilities is quite pronounced with the concentration of tertiary care hospitals in bigger cities such as Lahore and Rawalpindi; however, these facilities too are in a bad shape. There is not a single teaching hospital or tertiary care health facility in 24 out of 36 districts of Punjab.
Keeping in view the acute deficiency of public healthcare facilities, one expects that the government would focus its attention and resources on the development of healthcare facilities and improvement in their administration, but this remains one of the most neglected areas in Punjab.
In 2014-15, the Punjab Assembly approved a development budget of Rs23.6 billion for health facilities, but the government actually spent nearly Rs14 billion. During the preceding four years (2010-2014), the cumulative spending on the provincial health sector’s development has been less than half of the original budgetary allocations – Rs31 billion against an allocation of Rs65 billion.
In areas such as building roads, the government acts quite promptly, but that is not the case in the health and education sectors. In 2012-13, the Sharif government saw to it that Lahore’s metro-bus project got completed in 10 months and the metro project in Rawalpindi-Islamabad has recently been completed in a year.
In contrast, there are at least one dozen health projects that were launched five to ten years ago but they have not been completed and made functional on time because funds were not released to them. At the start of the year, the tuberculosis vaccine for children, BCG, went out of stock in government-run facilities all over the province; it was not replenished for three months.
A surgical tower at Mayo Hospital has been under construction since 2004, the Cardiology Institute in Wazirabad since 2006, a burns unit at Jinnah Hospital, Lahore since 2006, a burns unit at Faisalabad’s Allied Hospital since 2006 and an outdoor patient department in Lahore’s Services Hospital since 2008.
Be it primary and secondary healthcare facilities in villages and small cities or tertiary care hospitals in big cities, all are in poor shape mainly because health practically figures much low on the priority list of the rulers. A strong political will is needed to set things right, not propaganda campaigns at the expense of the national kitty.
Email: adnanadilzaidi@gmail.com