Primary Health Care

Dear Sir,

You have touched a very vital but distressing topic in your column “Off the Record” on September 14, 2018 issue of Pulse International. Primary Health Care (PHC) has suffered serious setbacks particularly due to 18th Amendment and due to persistent appointment of general cadre bureaucrats as Secretary Health in all Provinces & Federal Government. Bifurcation of Health Dept. In two separate entities and degrading of Director General Health Office has also contributed towards downfall of PHC. As a Chief Executive in private sector I find difficulty finding general duty Medical Officer for appointment in hospital. Every fresh graduate is ambitious of post-graduation and is running towards PCPS for FCPS Part I. He / She intends to land as a specialist. What to speak of big city hospital, priority of Medical Officer in public sector particularly in primary health care is very pathetic. Perhaps most of them do not know about PHC. In the coming years you will not find GP/FP in rural or urban localities as no fresh doctor is interested in PHC / Family Medicine. It is indeed a very alarming bell for national health system in Pakistan.

In the past when there were few public medical colleges, similar situation was tackled on the advice of donor agencies. Special Courses like health technician (1-Year) Rural Health Inspector (1-Year) Medical Technician (2-Years), Sanitary Inspector (1-Year), Medical Assistant (3-Years) were designed to manage short full of manpower for public health & primary Health Care. With the passage of time, these cadres either died or were converted or promoted into “clinicians”. Some of them retired in grade 17-18 like medical officers. Most of the vacant posts were filled by less qualified persons, on sale-purchase basis.
In short, it is high time that three types of courses should be considered to resolve the prevailing situations:

  1. Train Paramedics to man BHU, Rural /Civil Dispensaries.
  2. Produces Medics like LSMF to head RHC & act as GP/FP in the community with no conversion to full medical officer. 
  3. PHC is a dire national need and cannot be ignored. It requires a proper set up right from DGHS to UC and ward levels to provide / monitors all the components of PHC. An organized & well established Provincial Health Directorate must be responsible for planning, training, positioning & monitoring of PHC activities at all levels in the provinces.

This necessitates creation of PH Technician to play the important role of PH Care provider. Their syllabus and training should be such that these paramedics cannot covert themselves to clinical work & continue to work assigned to them.

Dr. S. Anwaar Ahmad Bugvi,
Chief Executive,
Mansoorah Hospital Lahore,
Ex-Adv. TechHealth Department,
Government of Punjab

 Proceedings of NADEP

Thank you very much for publishing the proceedings of the NADEP FOOT CON 2018 in Pakistan Journal of Medical Sciences in September-October 2018 issue. We are grateful for this special privilege to BIDE. The coverage is very comprehensive and elaborate. Publication of the proceedings in Pakistan Journal of Medical Sciences will help us in disseminating scientific knowledge to a wider audience not only in Pakistan but also in other countries. The organizing committee of NADEP FOOT CON. as well as the whole BIDE team is extremely grateful to you.

We are looking forward to a long lasting mutual collaboration in future also.

Dr. Musarrat Riaz
Baqai Institute of Diabetes and Endocrinology,
Baqai Medical University,
Karachi - Pakistan.

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