KARACHI, Aug 27: Sindh ranks lowest in public sector healthcare facilities use among the provinces as only 22 per cent of its population uses these facilities as compared to 29pc in Pakistan, thus 78pc people here use private practitioners against 71pc elsewhere in the country, it emerged here on Tuesday.

Karachi, the country’s largest city and provincial capital, has the lowest ratio of using public sector health facilities, according to a situation analysis report for health sector strategy of Sindh conducted last year by a team of consultants headed by Dr Shehla Zaidi.Sindh has the highest concentration of private health providers in the country where private sector utilisation rates are high in both urban and rural areas “even amongst the poor although for differing reasons”.

The report said the rural areas had well-designed district health systems but they were functioning poorly while urban areas had an almost “non-existent primary and secondary health care tier” with reliance on the few tertiary hospitals that in turn get utilised beyond capacity.

The report said Tharparkar, Sanghar and Khairpur districts had higher public sector utilisation rates with Karachi, Hyderabad and Kashmore showing the lowest.

The report said 69pc of rural Sindh utilised private health facilities while the urban parts had a whopping 86pc reliance on it. Among the three districts with lowest public health utilisation, Karachi ebbs the most with just 6.5pc population. Kashmore’s 13pc and Hyderabad’s 14pc population relied on the facility proffered by the government.

People in Thar utilised the government facilities most who aggregate 60pc; followed by Sanghar (48pc) and Khairpur (38pc).

The report said though the public sector had a considerable infrastructure of basic health units (BHUs) and rural health centres (RHCs) and preventive health programmes, the population mainly used the private sector for both promotive services such as maternal and child care, as well as illness episodes in adults.

“Private sector provision has overtaken traditional providers in provision of prenatal care across Sindh and in provision of both antenatal care and delivery care in urban areas. The private sector is also provider for child care illness in 76pc of the cases and for health consultation across all age groups in 78pc of the cases.

“A similar pattern is seen in other South Asian countries. However, the UN and donor strategies have tended to exclusively focus on public sector provision over the years,” said the report. It said teaching hospitals across Sindh as well as tertiary hospitals in urban centres were however heavily utilised providing the main source of functional and subsidised inpatient care.

In antenatal care 27pc people in Sindh use public sector facilities as compared to the 30pc national ratio. Here, the share of rural Sindh is 32pc and it is 24pc in urban centres. As compared to nationwide 51pc, 57pc people in Sindh use private sector for antenatal care comprising 47pc in rural parts and 66pc in urban centres. The rest use traditional care providers.

In birth care, Sindh is at par with national ratio of 12pc people using government facilities with 8pc in rural and 18pc in urban areas. Some 35pc population of Sindh, as compared to national ratio of 29pc, uses the private sector, which includes 19pc in rural and 57pc in urban areas.

Some 59pc of Pakistanis prefer birth care at home. However, some 53pc deliveries in Sindh are performed at home; 73pc in rural and 25pc in urban areas. Discussing reasons for the least usage of public health facilities, the report cited a previous survey saying the client perception of inferior quality of care and non-availability of drugs were the most commonly cited reasons for low use of public sector health facilities.

Another reason cited in the report was the high ‘hidden costs’ of free public sector services with out-of-pocket expenditure on drugs, diagnostics and supplies commonly borne by patients availing of government facilities. The report said the increased private sector cooption into health strategies was needed but at the same time it urged necessary caution.

“The private sector is a mixed group comprising of both qualified and non-qualified providers. Poor consumer knowledge and lack of regulation government has resulted in flourishing of quackery. Besides, quality of certified providers also varies widely with Sindh having some of the most developed private institutions and qualified practitioners while many others do not have standard treatment protocols and over-prescription of drugs and diagnostics due to a combination of lack of continuing medical education, patient demand and un-curtailed interaction with industry,” it said.