Shaukat Ali Jawaid
We all enjoy criticizing the every government for doing nothing or very little to improve healthcare and other essential social services but have seldom did some soul searching. Are we doing and performing our duties and responsibilities honestly.
Last year I had a chance to visit a Basic Health Unit in a village located on the main road with less than half Kilometer distance, about ten Kilometers from the main city. It was 11.30 AM in the morning. The BHU is located at half kilometers distance from the village adjacent to the Higher Secondary School. When I enquired about the Medical Officer I was told to wait, as he is coming. The Medical Officer came after twenty minutes. When I enquired further, I was told he was sleeping in the next room. Enquiries further revealed that he runs his clinic in the city till late in the night and comes to the BHU and sleeps most of the time during the day during duty hours. The few patients who come to the BHU are entertained by the Dispenser who is the doctor for the village population.
I went to the stores and was surprised to see that it had plenty of drugs supplied by the provincial government. It had even the most expensive branded anti-hypertensive drugs, diabetic preparations, asthma medications, a wide range of antimicrobial agents apart from the drugs needed to treat common diseases. Since the patients are seldom entertained by the doctor, the patients usually prefer to go to the city which is just ten kilometers and this facility remains underused.
I went to the village and talked to people asking them why don’t they utilize the facility provided by the government. The answer was the doctor is seldom available but it is the dispenser who treates the incoming patients. During the meeting I asked the Medical Officer about the number of patients who visit the BHU every month but the figures were very disappointing. I tried to convince him that if he entertains the patients, they get proper healthcare, the number will increase manifold. It is better he should come in time and attend the patients visiting BHU regularly.
A few months later again I had a chance visiting that area, went to the school, talked to the teachers and was pleasantly surprised to see neat and clean environment, teachers busy in taking classes, the Headmaster was a thorough gentleman keen to improve the facilities available. He was full of praise for the government saying that previously we had up to 8th class but now the school has been upgraded up to higher secondary level. New buildings have been added and we are expecting more funds soon.
Then I decided to visit the adjacent Basic Health Unit which I had visited earlier and as usual the medical officer was sleeping and the dispenser was talking to a female who had brought her two children with some complaints. Otherwise it presented a deserted look. I do not know if the District Health Officer has ever visited this BHU and other BHUs under their control. Have they ever bothered to come out of their offices visit these BHUs and monitor their functioning? If the government tries to set up some monitoring committees comprising of public representative of the area, there is lot of noise created by vested interests. If such doctors who are found to be either absent or not working are punished or penalized, the doctors resort to agitation.
I have always advocated the concept of self-monitoring and self-accountability but when it does not work, someone else will come in to monitor them. The medical profession is rightly agitating against quackery but what about promoting the quackery which their actions are helping to promote. These dispensers running the service while doctors are either absent or not working. Should not they be taken to task? Complaints by the public representatives to the government might result in either suspension or dismissal of such characters. It is high time that the medical profession and its leadership in particular, the professional organizations take note of such incidents and try to put their own house in order rather than criticizing the government.
The government authorities will be well advised to go ahead with the formation of monitoring committees which should include senior healthcare professionals, health officials with representation of local Members of the Provincial Assembly. These healthcare facilities established in the rural areas must be monitored and made functioning even if it needs to be done through public-private partnership.
Dear Shaukat sab, Well said, the first and foremost responsibility is of the senior officers of the government in health department to come out of the slumber, to visit the BHUs and fulfil the duty. The second is the monitoring team or in last the Public private partnership. To improve the primary health integration can offer better prospects also. The integration of basic health unit to the district hospitals and the district hospitals to the university hospitals is also an option. The geographical areas for the admission to medical colleges are already in use and demarcated. The same educational topography may be used for health delivery. The post graduates and graduate students can be posted /rotated also in their respective districts in BHUs, through supervisors, in collaboration with government ( secretary health) and CPSP. I have described this model in my book , Health policies and public health in Pakistan.
with regard
Prof Asghar Channa