ISLAMABAD, May 4, 2011: The state-run healthcare facilities at district level lack many specialized medical services and facilities, pushing the administration of these secondary care hospitals to refer the patients with serious medical conditions to tertiary care hospitals in big cities, which are already overburdened and few in number.
FAFEN Monitors visited 52 DHQs in as many districts nationwide in March 2011. Twenty four (24) DHQs were visited in Punjab, 14 in KP, nine in Sindh and five in Balochistan.
Based on the data provided by district headquarters hospitals (DHQs) monitored by FAFEN during March 2011, every DHQ, on an average, refers eleven patients to tertiary care hospitals every week. These figures are only for documented cases of referrals.
The DHQs are supposed to cater to the patients suffering from serious diseases which can not be addressed at lower level health facilities, like tehsil headquarter hospitals (THQs) and rural health centers (RHCs). A single district has one DHQ, and can have several THQs. The lacks of specialist services in the monitored DHQs were similar to those observed at tehsil level in February 2011, during FAFEN’s monitoring of 46 THQs.
Forty percent (40%) of the monitored DHQS lacked chest specialist services, 31% did not have ear, nose and throat (ENT) services and more than a quarter lacked cardiology (heart) and orthopedic (bone) services. Similarly, 31% of the monitored DHQs did not have radiology (x-ray) services, and 19% lacked pathology (diagnosis of disease) services. Sixty five percent (65%) DHQs lacked psychiatry services and 48% did not have physiotherapy services, both of which are not catered to at tehsil level.
Lack of personnel available to treat patients may be another reason for the absence of specialist services, and higher number of referrals. DHQs were observed to lack senior level medical, paramedical and administrative staff. Personnel appointed to these posts were required to discharge both medical and administrative duties. Nationwide, 42% sanctioned posts for senior medical officers (MOs), one third of the posts for medical officers (MOs) and 31% of those for women medical officers (WMOs) were unfilled in the monitored DHQs.
General facilities in the monitored DHQs also left much to be desired as half did not have Sui gas connections. Conditions of health and hygiene were particularly lacking, as 15% were not clean and 17% lacked arrangements for clean drinking water for patients. Conditions of medical infrastructure, however, were met well, as all of the monitored facilities had emergency wards for outdoor patients, a laboratory for tests, standby generators (for power cuts), and dental rooms.
However, 69% of the monitored facilities did not have a kitchen in which to prepare food for the patients, reflecting an inability to cater to the needs of in-house patients. It is also difficult to guarantee the hygiene standards of food items brought from outside sources, putting the health of the patients at risk.
Free and Fair Election Network (FAFEN), established in 2006, is a coalition of 43 leading civil society organizations, working to strengthen all forms of democratic accountabilities in Pakistan. It is governed by Trust for Democratic Education and Accountability (TDEA).
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