A ONCE-A-YEAR high security health expo at the Convention Centre is hardly the effective way of promoting health awareness.

If the ministry of health genuinely wants to promote greater health consciousness among the public, this would more reliably be done by widespread health education through an integrated network of modern healthcare delivery, something that is lacking even in the planned capital city.

Far from a model healthcare delivery system, what we have in the 906 sq km Islamabad Capital Territory is a hodgepodge plethora of public and private hospitals, dispensaries and private clinics. According to the website of the Capital Development Authority (CDA), there are 16 hospitals in the ICT with a total of 1,660 beds, 35 dispensaries, three rural health centres and 13 basic health units.

Although not stated so, the 16 hospitals presumably include public hospitals like Pims and FGSH (Polyclinic), hospitals run by government organisations like CDA’s Capital Hospital, KRL Hospital and Nescom Hospital, as well as several private hospitals, the largest of which is Shifa International Hospital.

Ten of the 35 dispensaries are run by the CDA in different localities, viz., F-7 Markaz, Pak Secretariat, G-7/4, G-7/3, G-9 Markaz, G-10 Markaz, I-10/1, I-8/1, Rawal Town and Simly Dam. The other dispensaries are supposed to be run by the health ministry.

In addition to these hospitals and dispensaries, there are a number of small one-doctor private clinics in the ICT where the consultation fees range from about Rs50-Rs200 to Rs600-Rs800 per visit, depending on the location of the clinic and the specialisation of the doctor.

But despite this apparent array of medical facilities, many residents who fall sick are often perplexed, wondering where they should go to for treatment, especially for common medical complaints like diarrhoea, fever, cough, skin irritation, etc.

Another problem that many people face is confusion over which specialist they should visit when they develop an ailment like, for instance backache, in which an ordinary person generally would not be able to make a decision about whether he should see an orthopaedist, neurologist or rheumatologist.

Going to the Out-Patient Department (OPD) of popular big hospitals like Pims or even Shifa International for relatively minor complaints is very time-consuming because of the long queues. These hospitals are overburdened with thousands of patients daily (Pims reportedly receives some 3,000 patients every day many of whom come from outside the ICT as far as Azad Kashmir and Jhelum), the majority of whom suffer from minor illnesses like flu, headache, cold, etc.

At the same time, many residents find the small private general practitioners in the clinics nearest their locality usually not adequately qualified or equipped, and besides, they are usually open only in the evenings.

Given the planned nature of Islamabad city, a much better planned healthcare delivery system for its citizens was to be expected from its health authorities. In fact, the 35 public dispensaries in the ICT, together with what were originally planned to be tertiary-level referral hospitals like Pims and FGSH, were supposed to provide an integrated health delivery network which would be the envy of other cities in the country.

Unfortunately, such a network has not materialised. The public dispensaries in Islamabad today are practically nonentities frequented by only the very poor. Most residents have not even heard of these dispensaries and even if they know about them, they certainly would not make a beeline for them when they fall sick. Given the quality and standard of service offered, in terms of both staff and facilities available, combined with the stigma generally attached with the name ‘dispensary’ in our status-conscious society, it is easy to understand why these dispensaries never caught on.

According to a Dawn report in December 2004, the federal secretary of health had unveiled an ambitious programme to revitalise these dispensaries in the ICT, beginning with three of them in G-6/3-4, G-6/1-4 and I-8 sector. The aim was to reduce the burden of patients in the public hospitals like Pims. The upgrading was supposed to include equipping these dispensaries with the latest diagnostic facilities and gradually increasing their timings, eventually having them open for 24 hours.

But so far, nothing much has changed. These dispensaries remain as unknown and as unheard of to the general public as ever before. To promote greater health awareness, the health authorities need to take a second, closer look at the above dispensary revitalisation project.

Given the already planned nature of the city and the basic skeleton provided by the existing ghost dispensaries, it is not difficult to draw up and implement a healthcare delivery system for the ICT based on an integrated network of out-patient clinics and hospitals. Since the name ‘dispensary’ is an obvious non- starter, it should be changed to something better sounding like ‘polyclinic’.

Depending on the existing and projected size of the population in various sectors, as well as the existing and expected influx of patients from surrounding areas outside of the ICT, either one such out-patient polyclinic can be established in each sector (e.g., G-9 sector, G-10 sector, etc.) or several sectors can share one polyclinic (e.g., 1-9 and I-10 sectors; F-7 and F-8 sectors; etc.). This system of family physician clinics should also be implemented in those zones of the ICT which are not sectorised, viz., Zone IV and Zone V.

Each polyclinic, fully air-conditioned in summers and centrally heated in winters, should have three to five or more doctors offering medical services with laboratory services, X-ray and pharmacy.

These medical services should include chronic disease management, minor surgery, dental service, national immunisation programmes and other vaccination services, women’s health (antenatal and postnatal care), childcare, management of common childhood illnesses, growth monitoring and developmental assistance, health screening for diseases like TB, diabetes, hypertension, hepatitis, thalassaemia and HIV, as well as health programmes for Haj and Umrah pilgrims.

These polyclinics can effectively promote public awareness about health through services like smoking cessation counselling, obesity counselling, as well as support groups for patients with chronic diseases like diabetes, asthma and hepatitis. Such support groups would help patients to increase their knowledge on their illnesses and provide mutual support by meeting and sharing their experiences and ideas with other patients.

Such a system of primary healthcare polyclinics, combined with a referral system whereby doctors in the polyclinics would refer patients needing more advanced care to hospitals or specialised institutes like the National Institute of Health, would not only help reduce the load in the hospitals, but enable the latter to focus more on in-patient care and specialisation in specific diseases or illnesses.

Given the experience of some private hospitals in healthcare delivery, e.g., Shifa International, the health authorities might want to consider roping them in to help in establishing, both materially and administratively, the polyclinics system in the ICT.

In fact, one way of attracting patients to these polyclinics would be to name them after the popular hospitals, e.g., Pims Polyclinic or Shifa International Polyclinic, depending on the administration.

According to the last population census conducted nearly 10 years ago in March 1998, ICT had a total population of 805,235, which must now be at least over one million if not over 1.5 million. With five new residential sectors being developed and at least three more being planned, in addition to the 15 sectors already developed, the existing healthcare delivery system, if at all it can be called a system, will not be able to cope with the projected expansion of the city.

Expanding Islamabad desperately needs a modern healthcare delivery network just as much as it needs an efficient road network and disciplined traffic.