PESHAWAR, Feb 3: Quality medical care in the NWFP is hampered by poor referral and drug prescription systems, absence of management training for health professionals and lack of nursing staff, health experts said on Thursday.

The government should introduce a system of incentives and penalties and hospitals need to be made autonomous step by step so they can look after their staff plan in letter and spirit and improve the healthcare delivery system, said UK-based consultant Dr Christopher Potter at a two-day workshop entitled “Evaluation of Teaching Hospitals Autonomy in the NWFP”.

The event was organized by the health department in collaboration with the German Technical Agency (GTZ).

He said that patients were directly rushed to tertiary care hospitals for minor ailments, which pushed up medical costs by nine times. Such patients can be provided better treatment at the primary and secondary level hospitals. A large number of patients adversely affected the quality of service and hygiene.

In the four teaching hospitals as well as some district headquarter hospitals in the province, according to Dr Potter and co-consultant Dr Andreas Roth of Austria, there is a lack of “performance, quality, morbidity and mortality, drugs, dedication of staff, unawareness of doctors about the cost of procedures and poor waste disposal mechanism”.

These were identified as major hindrances in the way of improvement in the healthcare delivery system.

“Paediatric services and labour rooms are insufficient. There is no intensive neo-natal care unit in the province, even though children constitute 40 per cent of the NWFP’s youth population,” he said.

“Threats of infectious diseases such as hepatitis stem from the non-availability of isolation rooms. Buildings, infrastructure, water and electricity are not up to the standard, he said.

In the absence of prescription strategy, the pharmacies are selling drugs for treatment of all diseases, he said. There is no system to decide if a patient is poor. In such circumstances, the rich manages to get free treatment while the poor are forced to pay.

Doctors of teaching hospitals are highly educated, but they lack training in management and hence are handicapped because they can’t play an active role in developing of strategies for hospitals.

“Most of the senior doctors have their private clinics in the town. It seems that patients are deviated through their private practice as well through private diagnostic facilities such as radiology and laboratories,” he said.

Dr Roth in his presentation said that hospitals were short of nursing services because of lack of service structure for nurses, low pay, no job description and their unacceptability to the society.

About the scant drug scenario in the province, he said that the sales agents of pharmaceutical companies hang around the hospital the whole day, asking the doctors to prescribe their products.

“There are incentives for doctors to do so,” he added.

The prevalent laws forbid such practices, but they happen on a large scale, he said. There is no committee at the hospital that can look into drug-related affairs, he said.

The consultants have also made recommendations to improve the situation, according to which each major hospital should specialise in a group of related diseases.

Dr Roth recommended formation of drug committees at the hospital level and issuing special licences for pharmacy shops located outside hospitals. The existing hospitals should be clear defined as primary, secondary and tertiary care level hospitals and a referral system should be put in place. A campaign must be launched to improve the overall image of nursing profession and midwives be trained at the teaching hospitals.

The hospitals should develop committees to develop regulations, he said.

Senior Minister Sirajul Haq, who was chief guest on the occasion, said that the government was committed to improvements in the healthcare network.

“We have increased the health budget from Rs250million to Rs1250million during the last three years,” the minister said.