PESHAWAR: The Khyber Pakhtunkhwa local government department has turned down a health department proposal to hand over the task of establishing and upgrading civil dispensaries and basic health units in the province to the district governments.

The proposal floated in Dec 2016 was supported by the planning and development as well as finance departments.

At the end of the last calendar year, the health department had a summary saying all primary healthcare facilities have been devolved to the district governments under the new local government system introduced under the PTI government.

It added that under the KP District Governments Rules of Business 2015, district governments would ensure the planning, development and operational interventions in health facilities and outlets in the district for upgradation and optimal usage of health facilities leading to the measurable improvement in primary and secondary healthcare.

Says district govts should ensure smooth delivery of services at the already devolved facilities

The summary said the establishment of new primary healthcare facilities was likely to create financial complications to cash-strapped province and that civil dispensaries and basic health units were not cost-effective and didn’t provide appropriate healthcare services.

The health department proposed that the establishment or upgradation of primary healthcare facilities (civil dispensaries and BHUs) from the provincial ADP funds be discouraged and that the district governments establish or upgrade those facilities on need basis in light of the devolution of primary health facilities to them under the new LG system.

Supporting the devolution of health facilities, the P&D department asked the health department to come up with a joint proposal in consultation with the LG and finance departments.

In its formal response, the LG department acknowledged that under the existing rules of business, upgradation of primary healthcare facilities was one of the district government’s functions.

It however pointed out that since their operationalisation in 2015, the local governments had been gradually and carefully adopting their functions enshrined in the district government rules of business.

The department said the current priority was that the district governments ensure smooth delivery of services in the existing devolved facilities including primary healthcare.

“For this purpose, they are required to allocate 10 per cent of the financial resources granted to them under the Provincial Finance Commission Award. The function of the establishment of new service delivery facilities, including those of primary healthcare, may be taken up in the long run by the district governments when they demonstrate the capacity to undertake this function,” it said.

The department also said that P&D guidelines 2015 for the district governments also warranted this approach.

“The Guideline No 91 specifically bars the district governments from establishing new education and health facilities and requires this function to be rested with the provincial government and therefore, the department doesn’t support the proposal,” it said.

However, the finance department, in its response, said the local government’s contentions that under the relevant laws and rules, the creation and abolition of posts on establishment of district offices and examinations of schedule of new expenditure and establishment of new facilities, having recurrent financial implications and creation of posts in all devolved sectors shall be within the purview of the provincial government, didn’t reflect the realities of the health sector.

“Given the realities described by the administrative department and the policy direction of the government, the finance department supports the proposal,” it said.

A health department official requesting anonymity told Dawn that the proposal was meant to make the district governments share some of the burden as under the laws, doing so was their responsibility.

“They (district governments) are getting funds but are doing nothing,” he said, adding that neither district nor tehsil nazims were concerned about the provisions of medicines or other facilities at their respective health facilities.

Published in Dawn, March 10th, 2017