Wide Regional Disparities in Rural Healthcare Centers Nationwide

ISLAMABAD, November 15, 2010: Wide regional disparities in infrastructure, basic equipment, services and facilities at Rural Health Centers (RHCs) across provinces necessitate prompt government action for allocation of equitable resources and enforcement of effective oversight mechanism to ensure improved access to healthcare to more than 60% of population residing in rural areas, says Free and Fair Election Network (FAFEN) in its monthly Public Health Institution Monitor.

As part of its unique Governance Monitoring initiative, FAFEN monitors visit schools and colleges, heath facilities, police stations and other public institutions in 150 National Assembly constituencies of 108 districts in Punjab, Khyber Pakhtunkhwa (KP), Balochistan, Sindh, Federally Administered Tribal Areas (FATA) and Islamabad Capital Territory (ICT) to monitor and evaluate their efficiency and efficacy. Trained FAFEN Governance Monitors fill out standardized checklists during their monitoring visits, employing interviewing and observation techniques, and then transmit the data to the FAFEN Secretariat in Islamabad for data entry, cleaning and analysis.

In September 2010, FAFEN Governance Monitors visited 83 RHCs nationwide — 36 in 25 districts of Punjab, 22 in 18 districts of KP, eight in eight districts of Balochistan and 17 in 14 districts of Sindh.

According to FAFEN Monitors, RHCs monitored in Punjab were generally well-equipped, providing adequate services to patients. However, monitoring of RHCs in Balochistan, KP and Sindh suggested varying degrees of weaknesses in infrastructure and services, requiring urgent government attention.

Monitored RHCs in Balochistan were most deficient in female staff, maternity and family planning facilities. In the province, female staff was not on duty in half of the observed RHCs and family planning counseling staff was absent in three fourth of the RHCs on the day of monitoring. The province has no sanctioned posts for nurses at the RHC monitored, while one forth of the sanctioned positions for doctors was vacant. In addition, more than three fifth of the facilities had no labor room and nearly two fifth did not have the delivery kit to facilitate childbirth. In comparison, the situation at KP and Sindh RHCs was better, but still deficient when compared to the monitored RHCs in Punjab.

All provinces were somewhat short on staff except Sindh, where male and female doctors were in excess by 16% and 25%, respectively. Likewise, 53% paramedic personnel and 50% nurses were in addition to the sanctioned posts in Sindh. The excessive staffing may be a result of deputations within healthcare system.

Even though 98% of all monitored RHCs were appropriately setup, the buildings of one fourth of the monitored facilities were in dilapidated condition – 41% in KP, 37.5% in Balochistan, 35% in Sindh and 8% in Punjab, requiring government resources and attention.

One fifth of the monitored RHCs across provinces were lacking in cleanliness and basic hygiene – 50% in Balochistan, 23% each in KP and Sindh, and 9% in Punjab. This was despite the fact that 94% had serving sanitary workers. Only three of 16 RHCs where cleanliness was an issue did not have serving sanitary workers. Better management and oversight and an increase in the number of sanitary workers may improve the hygiene conditions. Almost one third of the monitored RHCs either did not have latrines or had latrines without running water — 63% of RHCs in Balochistan, 50% in KP, 35% in Sindh and 11% in Punjab.

While all RHCs monitored in Punjab were equipped with oxygen tent, three fourth of RHCs in Balochistan, half of RHCs in KP and two fifth of RHCs in Sindh did not have this essential and low cost life saving device.

As many as 37% of the RHCs visited nationwide did not have arrangements of clean drinking water for patients — 63% in Balochistan, 47% in Sindh, 45% in KP and 22% in Punjab.

Weak oversight by the government and elected representatives may be one of the causes of the current state of facilities at RHCs in Balochistan, KP and Sindh. FAFEN data establishes a relationship between the poor state of RHCs with weak or nonexistent government oversight. No relevant government official or elected representative had visited over the last three months the 10 RHCs found to be the most deficient in infrastructure and services in the country. In contrast, RHCs where officials had conducted monitoring appeared to be relatively better in infrastructure and services.

Better situation of RHCs in Punjab may be linked to more effective oversight, where 36 visits by relevant government officials or elected representatives were reported to have been made in the monitored RHCs over the past three months. The number of such visits recorded for Sindh was 11, eight for KP and one for Balochistan.

Patient satisfaction levels at the monitored RHCs across the country remained high. An overwhelming majority was satisfied with the behavior of doctors and support provided by the RHC staff. Availability of free of cost medicines from the in-house pharmacies was also confirmed from over 90% of the observed RHCs nationwide.


The Free and Fair Election Network (FAFEN), a coalition of thirty leading Pakistani civil society organizations, was established in 2006 to observe election processes, educate voters, and advocate for electoral and democratic reform.