16 May 2004	Sunday	25 Rabi-ul-Awwal 1425

KARACHI: Out of a total Rs640 million budget for the country's oldest and biggest government hospital, the Civil Hospital Karachi, almost 80 per cent - Rs 540 million - goes to salaries of doctors and paramedical staff , and the remaining Rs100 million is shared by the patients and hospital's other requirements.

Not necessarily, the entire amount of Rs100 million is spent for the welfare of patients and hospitals' maintenance. As in other departments, quite a big amount is squandered away.

No wonder than patients are asked to buy medicines and costly injections because the amount of Rs64 million provided for drugs is insufficient for more than 800,000 patients in a year. The allocation for diet and consumables is Rs5.5 million and Rs4.8 million, respectively per annum.

CHK Medical Superintendent Dr Mirza Raza Ali told Dawn that the bed strength had gone up by seven times to 1,740 from 250 in 1898. The hospital has 604 doctors, 3,500 other staffers and 600 nurses. He says that no manpower had been recruited since 1992.

The CHK has identified at least 13 new key requirements in the annual development plan for 2004-05 in order to improve the facilities at the hospital, he adds.

"Despite claims by the provincial and federal governments, the overall health situation has not changed in the country. Successive governments had been claiming for spending more money on the health of the nation, but the fact is that the majority of our population has no access to primary healthcare, emergency obstetrical care or emergency healthcare throughout Pakistan," the Pakistan Medical Association (PMA) feels.

Perhaps, Pakistan is the only country where the budget allocation for the health sector is below one per cent, out of a total allocation in the public sector and only 3.2 per cent of GDP in the private sector, which are extremely low.

Secretary generals (Centre) and (Karachi), Pakistan Medical Association, Dr Shershah Syed and Dr Qaiser Sajjad, attributed the pathetic conditions of public sector hospitals to the non- availability of "competent and honest men".

Dr Qaiser says the people have to arrange everything like medicines and other equipments for their patients admitted in government hospitals.

He says corruption in public sector hospitals are at its peak and situation will remain the same until sincere and honest staffers are not hired.

Dr Shershah says that federal health ministers and provincial health departments have no real sense of direction and the political leadership of federal and provincial governments have not shown any commitment or political will to addressing the real health issues in Pakistan.

"The government should spend at least six per cent of GDP in the public healthcare system to make it effective," he said, adding that it was also very important to decentralize the healthcare system. A method of local accountability and local audit is required.

Dr Shershah says that 340 women, out of every 100,000 die during pregnancy because of non-availability of emergent obstetrical care in Pakistan. More than 80 per cent women are delivered by traditional birth attendants in subhuman conditions all over the country. Maternal morbidity (fistule, infertility, loss of uterus, etc) is increasing because of lack of healthcare facilities for under-privileged women in cities and rural areas, he says.

Pakistan has an annual fertility rate of 4.7 per cent with a life expectancy of 63 years (only) at birth. Even worst the under-five, mortality rate remains high at 110/1000 and infant mortality rate an abeyance 83/1000.

"While 78 per cent of our one-year-old children are immunised against tuberculosis, only 54 per cent are immunised against measles. Hepatitis vaccination is not available to whole of the population. The number Hepatitis B and C patients are increasing geometrically," a recent PMA annual health report reveals.

"Despite more than 40 rounds of polio vaccination, the country continues to report new polio cases," Dr Shershah says, adding that more than 78,000 people are infected with HIV virus and there is no organized plan to fight the disease.

Two per cent of the country's population is blind, of which 80 per cent is said to be preventable. Around 11 per cent of the population suffers from diabetes having a 90 per cent chance of developing retinopathy in their lifetime, he says.

With the exception of five to six governments health facilities, majority of government eye hospitals do not have a working laser therapy unit. Sindh and Balochistan have no laser equipment in government sector hospitals.

There is one nurse for eight doctors, and only one doctor is available for 2,300 patients. The PMA report says that both the federal and provincial governments have no plans to produce adequate number of nurses and paramedical staff.

More than 5,000 doctors in Punjab, 3,000 in Sindh, 1,200 in Balochistan and 1,000 in NWFP are unemployed and the government has no policy for utilization of these doctors. Provincial governments are hiring doctors on contract basis.

Despite suffering heavy hardships, 70-80 per cent of the population rely on public sector hospitals as they cannot bear huge expenses of private hospitals. At least a third of the population, out of over 14 million is living under the poverty level.

The high rate of doctors' fees coupled with massive rates of various tests at hospitals keep the people of middle income and lower income away from private hospitals.

Dr Shershah thinks that absence of any control of their fees structure and lack of a regulatory body on private hospitals are the main reason of keeping a vast population away from private hospitals. Besides, there is also no quality control authority which could inspect and check the services at the hospitals.

With the exception of a few private hospitals, the majority are not providing standard healthcare facilities. They are exploiting young doctors by paying them minimal salaries. Private hospitals, laboratories, clinics and nursing homes should be made responsible in case of negligence on the part of hospitals and doctors, the PMA report says.