LAHORE: The official reports titled ‘third-party validation’ of the public hospitals of rural areas of the province continued to surface while strengthening the doubts that a major chunk of the health budget was being diverted for ‘other purposes’.

A visible example in this regard was witnessed in an evaluation report on the project ‘upgradation of district headquarters hospital (DHQ) from 250-bed to 500-bed’.

Included in the annual development budget of 2006-7, the project was launched for the Dera Ghazi Khan and adjacent areas.

The original approved cost of the scheme was Rs437million (capital cost Rs287million, revenue cost Rs151million) with planned gestation period of 36 months.

The crux of official study of the scheme is being taken as a ‘significant blow’ to the Punjab government’s policy as well as the ‘double standards’ of the health managers of the province who are playing with the fundamental rights of the poor of the deprived areas.

A copy of the documents pertaining to the report is available with Dawn.

After a detailed study and review of project documents, physical and financial achievements, site visit and interviews with the beneficiaries/officials to determine project objectives, it can be deduced that upgrade of DHQ Hospital DG Khan remained an ‘unsuccessful/failed intervention’, the report said. This DHQ Hospital is the only option to meet health needs of about three million population of the DG Khan. It has been declared one of the 20 poorest districts of Pakistan with about 51pc of its population living under the poverty line.

The report said the execution of revenue component completely failed to achieve the objectives set in the PC-I as the necessary equipment amounting to Rs166m out of allocated budget of Rs174m could be procured which is around 60pc of the total proposed/approved list of the equipment. It said the procurement of 60pc equipment by utilising 95pc budget allocated for the purpose by ignoring the procurement of major equipment in each ward reflected negligence of the sponsoring agency.

“Most of the equipment procured was not found installed/operational at site,” the report said. About 40pc sanctioned posts in different cadres could not be filled.

Exposes inefficiency of Punjab govt’s health managers

“Certain number of patients visiting DHQ Hospital were interviewed by the evaluation team and it was observed that almost 70pc patients were not satisfied with the facilities and service delivery by the doctors and hospital administration,” according to the report.

Keeping in view the observations of evaluation team of the P&D Department, it was recommended that an apex committee should be constituted by the sponsoring agency, having one member each from finance and P&D departments, with defined terms of reference to conducting inquiry into the matter and fix the responsibility against the delinquents under PEEDA, 2006.

The report shared many disturbing facts, further exposing the worst-ever policy of the Punjab government towards health sector.

CIVIL WORKS: The report said as per revised PC-I, the plan was to construct store, canteen, cardiology, eye, paediatric and neurosurgery wards and physiotherapy department but during field the evaluation team’s visit no such facilities were found. The department needed to justify the reasons of non-construction of buildings, it said.

Shockingly, it was observed that one side of door of operating theater was found missing, showing the level of negligence by the authorities towards the most critical component of the hospital where surgeries were performed.

The plaster deterioration and cracks were observed at bottom of ‘beam’ near entrance of urology ward which meant it might collapse at any time.

“The overall quality of civil work was unsatisfactory as multiple defects in civil infrastructure were observed during field visit,” it said.

PATHOLOGY LAB: During the visit, the evaluation team found that the purchased equipment was not as per approved PC-I quantity and if purchased not installed yet. Only chemistry tests were being performed that are not sufficient for a best diagnosis for many diseases.

Many important equipments could not be procured despite of 50pc extra utilisation from the proposed cost.

Elisa Reader, fully automatic, used to perform many tests like HCV, HBsAg, malaria, syphilis and AIDS was purchased at the price of Rs0.84m in 2012 but it was not installed till the date of inspection, resulting in void of warranty.

Other important equipments like Cell-dyne machine and Electrolyte Analyser, proposed in the PC-I, were not even procured.

Histopathology apparatus was purchased at the price of Rs5.2m but no record of histology tests was found. The department needed to justify the reason of non-operational histology lab.

The purchased equipment was kept in the store in original packing and not installed so which clearly indicates the negligence, lack of supervision and interest by the pathologist.

The laboratory technician was found to be untrained as he was not aware and following the SOPs for working in a laboratory.

“On the basis of the observations recorded by the evaluation team, it is revealed that the pathology laboratory failed to contribute in achieving the very first objective of the project,” the report said.

RADIOLOGY DEPARTMENT: It was observed that ultrasound machine, X-ray machine and CT scan machine could not be purchased due to increase in prices/fluctuation in foreign currency exchange rate which sponsoring agency failed to forecast at the time of estimation.

Digital X-ray machine and automatic X-ray film processors were purchased at the price of Rs13.7m and Rs3.3m, respectively, but could not be made operational due to unavailability of air conditioners in the lab. Lead apron and dosimeter were not being used as observed during inspection.

The person deputed to conduct X-rays was not a certified technician, showing recruitment process doubtful. There is need to recruit medical imaging technologists for better handling of costly equipment of the radiology laboratory.

OPERATING THEATER: The emergency operating unit lacked many important equipments as proposed and approved in PC-I, the report said.

The diathermy machine, very important equipment for emergency operating theater, could not be purchased. In the surgery, the diathermy machine is used to produce extreme heat required to destroy neoplasm, warts and infected tissues and to cauterise blood vessels to prevent excessive bleeding. The machine’s absence in the theatre could cause serious life threat to patients being dealt in emergency.

MEDICAL WARD: The report said that according to multiple indicators cluster survey (MICS), the indicators pertaining to health for the area of DG Khan, were declared unsatisfactory. It ranked first in diseases like diarrhea and high fever. As the gastrointestinal system diseases are prevalent in this area, therefore the availability of gastroscope is mandatory but unfortunately, the equipment could not be purchased. Other equipment like sigmoidscope, proctoscope and ventilators, necessary for medical ward, were not proposed / taken up in PC-I.

Medical ward also suffered from acute shortage of physicians. The posts of one chief consultant physician, one principal women medical officer and medical officer and four senior women medical officers were found vacant that raised many questions.

About the surgical ward, the report said it was facing acute shortage of medial officers and in need of central oxygen system to be installed at the earliest.

About 50pc equipment could not be procured for the orthopedic ward despite of the extra utilisation of cost against the approved original PC-I.

CARDIOLOGY WARD: Establishment/upgrade of cardiology ward completely failed as almost 75pc equipments and central air conditioning system, proposed in the approved PC-I, was not be purchased.

The central oxygen system procured at the cost of Rs11.7m was not found installed in cardiology ward. The blood gas analyzer was procured but it was not found installed.

“Only one cardiologist was found examining the patients in outdoor,” the report said.

GYNECOLOGY WARD: The gynecology ward was established to reduce the mortality rate and to control complications. Fetal monitor, laparoscope was proposed in PC-I but could not be procured that needs justification by the department.

ENT WARD: The evaluation team observed that some 20 important equipments, approved in PC-I, including operating microscope and esophagoscope, could not be procured. It recommended a probe into the matter.

The eye and urology wards of the hospitals were facing acute shortage of doctors and nursing staff.

PEDIATRIC WARD: The official report said the 42 important equipments could not be purchased as per the quantity, taken in PC-I, including three cardiac monitors, two respirators and four infusion pumps.

The central oxygen system could not be purchased. Similarly, to remove secretion from the mouth of neonates to avoid aspiration, central sucker system was proposed in PC-I but could not be purchased.

NEUROSURGERY WARD: It was observed that the about 60pc equipment could not be procured despite of extra utilisation of funds.

RECRUITMENT: “It was observed that 40pc sanctioned posts could not be filled during the gestation period of the project due to lack of interest of the health department and thus, the objective of the intervention could not be achieved,” the report said.

In all specialties, an acute shortage of physicians and surgeons was observed. Twenty nine posts of MOs and women medical officers (WMOs) were found to be vacant. Similarly, one post of radiologist, three of consultants, four of senior women medical officers, two posts of gynecologists and two posts of additional principal women medical officers found vacant. “In the absence of such specialists’ posts how can a hospital be upgraded?” the report questioned.

Hence, it can be concluded that the objective to provide skilled human resource to cater for the need of better health services for DG Khan by upgrading its DHQ Hospital could not be achieved in letter and spirit that needs to be probed and the responsibility must be fixed, the report concluded.

Published in Dawn, May 6th, 2015

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