KARACHI, June 27: The provision of healthcare has long been a matter of public concern but steps taken to improve planning and coordination show little evidence of success.

Despite having been in place for a substantial period of time, the provincial health management information system (HMIS) has not been able to develop into a useful tool to address health delivery issues, Dawn has learnt.

Even where some positive developments have taken place, such as some primary care facilities that needed immediate attention, the authorities were unable to move in time because of delayed reports.

Part of the trouble appears to lie in the fact that HMIS generates and reports data on a quarterly basis, which an official in the health department suggests be changed to a monthly basis.

Furthermore, healthcare facilities lag behind in submitting data. According to a source in the health department, during the last quarter of 2006, over 1250 facilities across Sindh were expected to report through HMIS but only 76 per cent fulfilled the requirement.

Worryingly, said the source, Kashmore, Tando Mohammad Khan, Tando Allahyar and Matiari districts did not send in a single report in all of 2006.

Sources told Dawn that HMIS, which has been operative in the province since 1994, was meant to develop into a fundamental tool to manage the health sector, facilitate decision-making and promote the flow of related information on district, provincial and federal levels. However, the project is plagued by issues such as delayed reports and erroneous information. Furthermore, all public and private hospitals — including teaching hospitals — must be incorporated into the system, while the instruments acquired need to be updated and their users trained.

The efficiency of the system can be gleaned from the fact that while HMIS data concerning the period from October to December 2006 presented analyses and recommendations, the final report was forwarded to the relevant quarters five months into 2007.

According to this report, 3660821 out-patients visited public sector health facilities during the three-month period, reflecting a decrease in out-patient department turnover as compared to earlier months. However, incidences of various ailments — including acute respiratory infection, clinical malaria, meningococcal meningitis, probable poliomyelitis, suspected viral hepatitis and suspected AIDS cases – showed an increase.

The Oct-Dec 2006 HMIS report stated that of the 45 cases of suspected cholera in the province, 30 cases had been reported in Larkana district. This number, it concluded, was far too high and needed urgent verification. Furthermore, it pointed out that the 11 suspected AIDS cases — four each from Hyderabad and Jacobabad, two from Nawabshah and one from Umerkot — needed to be verified by health related executive district officers (EDOs) and relevant project managers.

The report also concluded that the monitoring of the growth of young children is not improving, given that of the estimated 395,620 children under one year of age, only 34,303 (8.7 per cent of the total number) were registered across the province.

Similarly, healthcare facilities have fallen behind on registering women for prenatal care, said the report, adding that poor service was evident even in large urban settlements such as Karachi, Larkana, Nawabshah and Ghotki.

It further pointed out that only 26 per cent of Sindh’s new mothers made postnatal visits to health facilities, an indicator that must be improved since such visits encourage the timely vaccination of newborn children.