KARACHI, Oct 25: The Abbasi Shaheed Hospital (ASH), the largest healthcare facility in control of the city government, is beset with many problems. Many of its departments remain underutilized as it faces a host of administrative and financial difficulties.

Over the years, the number of people visiting the hospital's outpatient department has declined steadily. The number of people being admitted to its wards has also shown a sharp decline, with only about one-fourth of its beds being occupied at any given time, sources told Dawn.

All this is despite an annual budget of more than Rs300 million. The patients and their attendants routinely have to buy medicines from the market even though at least Rs80 million is allocated every year under the budget for contingencies and surgical disposables. At least Rs150 million is set aside every year for payroll and other establishment expenses.

The consultants, professors and assistant professors working for the hospital cannot be held accountable for their performance by its medical superintendent. These officers report directly to the principal of the Karachi Medical and Dental College (KMDC) and not to the medical superintendent, said the sources.

As a result, the head of ASH can only advise them to improve their performance but cannot take any disciplinary action against them. The resident medical officers (RMOs) and other staff who do fall under the jurisdiction of the MS get wrong signals from the professors and consultants - often their bosses - and are generally not pushed to improve their performance.

On the financial side, even though the MS has officially been given the power to authorize expenditure of up to Rs20,000, payment is subject to approval from senior officials, including the EDO Finance. This causes unnecessary delay in payment of money needed to run the hospital, the sources added.

According to the medical superintendent of the hospital, Prof Masood Javed, the situation obtaining at the facility has been poor for the last more than a year. "And no meaningful step has been taken to improve the situation, except for the provision under which discretionary funds of up to Rs20,000 can be approved by the MS," he said.

Prof Javed added that payments under this category were subject to 'concurrence' by the EDOs concerned. "This is the only notable development taking place in recent months but it is debatable if this step can bring about the desired improvement in the system, given the delays caused by the long process after which approval is granted."

The deputy medical superintendent, Dr Faizur Rehman Farooqui, and the assistant medical superintendent, Dr Masood Raza, were of the opinion that if the above administrative and financial problems were resolved, the performance of the hospital could be improved drastically.

Citing an example, Dr Farooqui said 50-odd people had been taken recently to the hospital's casualty department following a terrorist attack near a seminary in Site. "Our casualty department," he said, "worked like one man to save the lives of those injured. And we did manage to save a number of lives."

He said the organizations supplying medicine to the hospital, and also the pharmacies situated near it, cooperated wholeheartedly with the hospital management and provided the badly-needed drugs on credit. "We had to persuade a lot of people to supply the medicine on credit but we did manage to acquire the needed supplies."

Dr Farooqui, who is on a one-month leave, said the episode showed that wonders could still take place at the hospital. He was of the opinion that the MS was a respected person and as such the city government could trust him with sizable amounts.

In response to a question, Dr Farooqui and Dr Raza said the hospital had a capacity of 815 beds. But generally only about 250 beds were occupied at a given time.

Answering a question, both the DMS and the AMS said the budget allowed to the hospital was a decent one.

The Executive District Officer (Health), Dr Fazal Elahi Memon, agreed with this contention. He added that the real problem lay somewhere else.

"The problem is not the budget but how the hospital is run financially and administratively. In my opinion, the biggest problem facing the hospital is political in nature."

He hinted that the hospital was suffering as a result of a tussle between two political parties, one controlling the city government and the other the provincial government. However, he did not elaborate.

"Look, the hospital is facing a number of problems. But I think none of the problems are such that they cannot be resolved through dialogue. There is a need for everyone concerned to sit around a table and discuss. Solutions to these problems can be worked out."

When contacted, Naimatullah Khan, the nazim of Karachi, said: "The problems at the Abbasi Shaheed Hospital have been politicized." He did not explain what he meant by this assertion.

He acknowledged that a proposal had indeed been floated by the MS and the EDO Health in which a governing body had been proposed to look after the hospital's affairs. "Yes, there is such a proposal but a decision is yet to be taken on this issue."

The nazim did not say when a decision on this question would be made.