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HIV cases in Larkana put a question mark on Sindh’s healthcare system

Updated May 05, 2019

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So far, 128 persons have been tested positive for HIV in Larkana. — Reuters/File
So far, 128 persons have been tested positive for HIV in Larkana. — Reuters/File

HYDERABAD: The recent surge in detection of HIV-positive cases in just one taluka of Larkana district has painted a bleak picture of the existing healthcare system in Sindh, where a number of bodies exist to fight HIV and other diseases but the situation has turned alarming.

Larkana is considered to be the political capital of the ruling Pakistan Peoples Party (PPP) and increasing number of such ailments indeed reflects poorly as far as its tall claims of good governance are concerned. This situation calls for a thorough audit of the healthcare system and related aspects.

The conditions at the primary and secondary level of health facilities are enough to make one worry.

Just a couple of years ago, close to 100 people, out of 13,600 measles patients, died in seven districts of upper Sindh after the Expanded Programme of Immunisation (EPI) had failed to achieve required vaccination coverage.

Editorial: Without immediate and proper attention, the HIV emergence can develop into full-blown cases of AIDS

Also, quackery apparently is the leading cause behind the current outbreak of HIV-positive cases in Larkana, as quacks reused syringes for patients.

So far, 128 persons have been tested positive for HIV in Larkana

If community screening is carried out elsewhere, as carried out in villages of Hyderabad district (140 HIV-positive cases since last year) by Peoples Primary Healthcare Initiative (PPHI), it would end up in more HIV cases.

Sindh Health Minister Dr Azra Pechuho in her recent policy statement in the Sindh Assembly had said that “screening everyone” for HIV in the province was difficult.

She disclosed that Hyderabad district was another high-risk area for HIV/AIDS in Sindh. Initially, Sindh’s AIDS Control Programme manager Dr Sikandar Memon had claimed 10,000 HIV cases were there in Sindh.

Police probe under way

In Larkana, a doctor, who himself tested positive for HIV during screening, has been arrested. He was accused by the Larkana deputy commissioner “of infecting 15 children” but health services director general Dr Masood Solangi disputed the DC’s statement and termed the doctor “insane”.

A case has been registered against the said doctor, but there is no explanation whether the 15 children were infected by him. Till May 3, 128 persons, out of 3,483, tested positive for HIV in Larkana, showing that the disease remains prevalent while health authorities are in a state of denial.

In response to a request of DIG Larkana Irfan Ali Baloch names of three senior professors — two from Dow University and one from the Sindh Institute of Urology and Transplantation (SIUT) — have been notified to assist the police in a probe against the held doctor.

The DIG, however, rejected the claim that the arrested doctor was “insane”. “We have found him normal,” he told Dawn.

Bodies like the Sindh Blood Transfusion Authority (SBTA), Sindh Healthcare Commission (SHCC) and the AIDS Control Programme apparently work in isolation. “We need to expand the scope of screening to other districts,” an SBTA official said.

The Sindh Health Care Commission (SHCC) is a relatively new set-up that became functional only last year. It has prepared a roadmap as to how to ban quackery besides improving quality healthcare in public and private sectors. It got 41 clinics sealed and issued notices to 100 for questionable practices in Larkana.

“In the last 70 years we have not been able to have the data of healthcare. We have planned geo-mapping of public and private healthcare establishments in Sindh through a questionnaire. Its trial run will begin in Karachi by mid-May,” said SHCC chief Dr Minhaj Qidwai.

He added: “There is a ‘rent-seeking behaviour’ among doctors in Sindh. The tendency among doctors to outsource their premises to dispensers results in increasing quackery. We will be having doctors’ registration re-verified with the Pakistan Medical and Dental Council.”

The SBTA’s task is to curb unsafe blood transfusion through unregistered blood banks. However, over the last several years it failed to make its presence felt effectively until it was headed by Dr Zahid Ansari. The authority had even declined to run German-funded blood centres in Sindh.

Now, it has got Dr Dur-e-Naz Jamal as its new head. She visited Larkana against the backdrop of HIV-positive cases and got some unregulated facilities closed.

The AIDS Control Programme has not been able to reduce HIV burden and it is not sharing correct statistics of the disease that may otherwise enable government to combat AIDS, lest it attains epidemic proportions in other parts of Sindh, too.

Govt outsources 53pc health facilities

According to one estimate, the Sindh health department has outsourced around 53 per cent of its health facilities. The PPHI owns around 90pc (1,135) of the basic health units (BHUs). Substantial number of rural health centres (RHCs) and taluka hospitals are outsourced. The health department practically deals with tertiary level, district headquarters hospitals and dispensaries.

Reports said that the World Health Organisation (WHO)-recommended kits for blood screening were not used even at the privatised health facilities.

“No third-party evaluation is done in respect of the BHUs so far run by the PPHI to see what qualitative change it had brought about. More facilities are privatised to other entities. The government paid Rs21 billion in three years to the PPHI. Why we are bent upon privatising our health infrastructure?” asked Pakistan Medical Association (PMA) general secretary Pir Manzoor.

The government has even outsourced one of four German-funded Regional Blood Centres (RBC) of Jamshoro to a private party. It was despite the fact that the Liaquat University of Medical and Health Sciences (LUMHS) had requested the Sindh government to hand the facility to it for safe blood supplies. But the government declined the offer.

The very RBC provides blood (packed cells) to a patient for Rs2,800-3,000, which is around 400pc more compared to the LUMHS’s current cost of Rs700 for the same blood.

Under the German funding, four RBCs were to be set up in Sukkur, Jamshoro, Benazirabad and Karachi. Out of Rs1.77bn funding, Sindh got a share of Rs637 million. Other provincial governments were running it in public sector universities.

“I think soon the Sindh health department will exist only on paper because we will have nothing to look after,” quipped a senior health source.

He said that while services were being privatised, the much-talked about change in the delivery of qualitative healthcare still remained a distant dream.

Published in Dawn, May 5th, 2019