LAHORE: The Punjab government is planning to procure more mobile health units (MHUs) despite the fact that the existing health infrastructure of the province is largely dysfunctional forcing a huge population of rural areas to visit private or teaching hospitals in mega cities.

It initiated bidding process for 20 new MHUs at Rs1 billion even though approximately 40pc of the total positions of medical officers at small-scale health facilities were vacant for many years, including district headquarters hospitals (DHQs), tehsil headquarters hospitals (THQs) and basic health units (BHUs).

An assessment report by the Technical Resource Facility (TRF) had already declared that a scheme to launch six MHUs previously was flawed.

“The assessment team calculated that at least 11 BHUs and four rural health centres (RHCs) could be constructed at the same capital cost of those six MHUs -- Rs330 million,” according to the report.

Secondly, for the same recurring cost of the six MHUs -- Rs113 million per annum -- at least 36 BHUs and seven RHCs could be operated that would provide services to significantly more patients, it had concluded. However, the government planned to procure new MHUs without involving the TRF.

Taking advantage of the situation that the Punjab government had shifted its policy towards “container hospitals”, the grabbers have started occupying the valuable static health facilities. A shocking fact was revealed in a report prepared by the monitoring and evaluation director general of the planning and development department. The department is carrying out assessment of the current status of the existing health infrastructure in order to update the government about the state of affairs.

Its fresh report is about the Sangla Hill THQ Hospital catering to 205,836 people besides those visiting from adjoining areas. The official information stated Punjab had the best and designated health infrastructure on highly priced land in rural and urban areas. It was divided into 2,461 BHUs, 293 RHCs, 88 THQs, 34 DHQs, and 23 teaching/tertiary care hospitals.

The report titled ‘Establishment of THQ Hospital, Sangla Hill April 2015’ – a copy of which is available with Dawn -- clearly depicted that the existing health infrastructure of the largest province by population might suffer irreparable damage if its government did not review its policy.

The department shared in the report that not a single patient was admitted to the THQ Hospital in question since it was established in 2012. Some officials of other government departments had occupied a portion of the health facility permanently, its building was near collapse, all patients in the outdoor patients department were being treated by paramedics, not a single operation was performed at the health facility so far, it did not have a single specialist doctor and gynaecologist.

The report said the project was conceived by the health department in 2009. The original approved cost was Rs148.069 million – capital cost Rs89.242 million, revenue cost Rs58.827 million -- with planned gestation period of 12 months. The project was revised twice during implementation and completed in 34 months. Its major objectives comprised provision of quality healthcare services to every person of the district, especially the poor and underprivileged without prejudice.

The civil infrastructure component of the project was executed by the Punjab Buildings Department whereas the execution of revenue component was the responsibility of sponsoring agency, the health department.

It stated that execution of the revenue part completely failed to achieve the objectives in the PC-I as no sanctioned post of specialist doctor was filled due to which necessary equipment amounting to Rs58.8 million could not be installed. The posts in different cadres were not filled since the establishment of the hospital.

A large number of equipment procured was found packed in the store. The cold chain of vaccines was not being maintained because the generator was not operational during loadshedding.

The execution of capital portion was found moderately satisfactory. Multiple defects in the building were observed during field visits such as dampness, plaster cracks, structure cracks and improper backfilling.

The evaluation report provided a detailed overview of the sorry state of affairs at the health facility in order to sensitise the government about the scale of mismanagement on the part of the Punjab administration.

Procurement of equipment: The report states that out of the approved list of 268 necessary equipments, 98 could not be procured due to a delay, resulting in escalation in prices. About half of the procured equipment was found in its original packing. The equipment installed was found untouched. The purpose to establish a diagnostic laboratory completely failed as none, except CBC test, was being performed there at the time of the visit. The radiology department was not operational due to non-availability of a radiologist.

Major equipment: As per PC-I, it was planned to procure all medical equipment in 2009 but got delayed for about three years and was procured in 2012. Such delay caused an escalation in prices also due to which many major medical equipments could not be procured at all.

In the absence of a medical specialist/cardiologist, costly equipment such as a cardiac monitor, defibrillator, ECG machine and pulse oximeter were lying idle. The hospital did have a dentist but a dental X-ray machine was found packed in the store.

Other equipment like anesthaesia machine, heavy duty nebuliser, oxygen cylinder, blood refrigerator, incubator ventilator and mobile X-ray were found in the store. Washing and dryer machines had also been procured for the newly established laundry but was lying in the store and the administration had been outsourcing this service until this inspection.

“There were 140 types of major medical equipment that was procured at Rs58 million, out of which 68 were found in the store in their original packing that clearly reflects the level of interest of the health department towards provision of better health facilities to the people of Sangla Hill,” the report states.

It further states that the department is required to justify the reason for non-installment and in some cases non-operational of the medical equipment in the hospital.

Specialist doctors:

Twenty posts of specialist doctors were proposed in PC-I but only 11 were sanctioned, however, not a single post of a specialist was filled due to which objectives of the projects could not be achieved and one of the major parts of the intervention remained unsuccessful, according to the report.

“Due to non-availability of specialist doctors, no evidence of a single surgical operation was recorded except some minor procedures,” it stated. All patients were being treated by paramedics.

However, the executive district officer (health) deputed an ophthalmologist in the hospital who examined patients for two days a week. No gynaecologist for the hospital was also recruited. In the capacity of different cadres, 28 posts of medical staff were proposed in PC-I out of which only 12 were sanctioned. During the execution period, the department could only fill seven posts. Recruitment against the posts left could only be explained by the department.

In the approved PC-I, 87 posts of charge nurses were proposed but only 14 could be sanctioned, out of which only 11 were filled during implementation. Only 28pc of the proposed posts of paramedics were accorded approval and filled.

Main hospital building:

“During physical inspection of the THQ Hospital, diagonal and straight wavy cracks were observed on walls of many rooms, which were due to settlement of foundation,” the report mentioned.

The PC-I had planned construction of servant quarters and the communication and works engineer told the inspection team it could not be done due to lack of funds.

During the visit, the medical superintendent said residences for grades 18-19 senior specialists had been occupied by the assistant commissioner and those in the Medical Officer’s Colony by a tehsildar.

Severe dampness was observed on the walls and roofs of all residences also showing roof treatment and earth finishing were not carried out properly. It was also noticed that due to the dampness external and internal finishing of the residences had eroded and ultimately corrode soon. These issues also added to the cost of maintenance of the building, which was the responsibility of the communication and works department to prevent dampness during the execution stage.

Experts at the end submitted strong-worded recommendations to undertake a proper survey of facilities and equipment to identify those underutilised and unutilised and introduce appropriate measures, including rationalisation, to ensure efficient operation and optimal utilisation and continued maintenance of facilities across the province.

After a detailed study and review of the documents, physical and financial achievements, site visit and interviews with beneficiaries/officials to determine project objectives, it was concluded that establishment of the THQ Hospital, Sangla Hill remained an “unsuccessful intervention”, the report maintained.

Keeping in view observations of the evaluation team, it is recommended that a committee be constituted by the sponsoring agency comprising one member each from finance and planning and development departments, with defined terms of references to conduct a proper inquiry into the matter and fix responsibility against delinquents under PEEDA, 2006 for malfunctioning and significant loss to public exchequer.

It is further recommended that uninstalled equipment found in the store be installed instantly, specialist doctors recruited and all infrastructural defects rectified within 15 days under intimation to the monitoring and evaluation director general.

Published in Dawn, May 4th, 2015

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