The PML-N had promised in its 2013 manifesto that increased employment opportunities for qualified doctors would be provided by constructing more hospitals, and extending soft term loans on easy instalments for private practice.
Other than a slight improvement in health facilities, the Punjab government has done almost nothing to bring about comprehensive change. According to official figures, at least 284 Basic Health Units (BHU) are operating without doctors in only 13 districts of Punjab. Out of 1011 Basic health units, in the major districts of Pakistan’s largest province, around one-third are operating without a medical officer.
Around 72 per cent of BHUs in the district of Nankana Sahib are working without doctors. The area with 1.5 million people has 48 BHUs, but only 13 have doctors available, while 35 are just buildings in the name of BHUs.
There are 52 BHUs in Sargodha, one of the larger districts of the province, again, without doctors. There are a total of 27 BHUs in the district. According to certified information, 47 BHUs of Okara district have no doctors available, while in Jhelum, 27 are operating without doctors.
Health experts are of the opinion that BHUs are the first line of defence against epidemics and diseases. Medical officers in BHUs provide life-saving support to emergency patients in far-flung areas. However, the absence of trained doctors in the countryside sometimes proves fatal for the sick patients.
In the absence of physicians, people of rural areas are left at the mercy of quacks. These quacks further complicate the medical conditions of the patient by administering the wrong treatments.
According to the Economic Survey of Pakistan 2016, there were 5464 basic health units in the country. The state’s public health care system comprises of 1167 hospitals, 5695 dispensaries, 675 rural health centres, 733 mother and child health centres and allied medical professionals. The ratio of one doctor per 1038 person, one hospital bed for 1613 person and one dentist for 11513 persons shows apparent inadequacies, particularly in the case of dentists and hospital beds.
The tall claims regarding health sector improvements has been on the cards by the Punjab government for long. However, in the early months of 2017, the Pakistan Tehreek-e-Insaf, brought out a white paper to show the condition of the health sector in Punjab. According to the report, there was only one doctor for 2173 patients in Punjab
The report further elaborated that due to the flawed policies of the Punjab government, nearly 40 per cent of drugs sold in Punjab were spurious and substandard, and that illegal drugs and injections were readily available in medical stores. The report also revealed that the growth rate of diseases in Punjab was also escalating.
The condition of children’s hospitals is no better. Nearly eleven thousand children were on the waiting list for operation in Children Hospital Lahore. Even patients requiring immediate surgery were asked to wait for two months
Out of 2450 primary health care sectors in Punjab, over 50 per cent are non-functional.
In Punjab, every 115 out of 100,000 women die during delivery. In the financial year 2015-16, almost 24.50 billion Rupees were allocated for developmental projects in healthcare systems in Punjab, but the performance remained stagnant. Approximately 200 million Rupees were assigned for interior decoration and maintenance of public hospitals in Punjab, but no development could be seen.
Salman Rafique admitted that rural areas are facing a shortage of trained medical officers, but claimed that the provincial government was working to resolve the issue. Regarding their failure in providing doctors to rural areas when the government had promised to provide them employment opportunities, the minister said that funding issues were a major constraint for them.
“Doctors seek hard area allowance to work in remote parts of the province. This demands an elaborate budget which is not available,” Khawaja Salman Rafique said. However, he claimed that all the vacant posts of doctors would be filled soon under a project being implemented with the help of the Department for International Development (DFID), UK.
A senior doctor at the Punjab Healthcare Commission, who wishes to remain anonymous, told Truth Tracker that the government has been fooling people in the name of health reforms. He said that government hospitals were run by different private agencies and due to a lack of standard operating procedures, corruption is rife. He said that loans had been given to the doctors, but since they were not targeted loans, and no follow up was conducted, the exercise proved useless. He further added that the CM Punjab has no understanding of the health sector reform. “Shahbaz Sharif,” he said, “follows whatever he is told by the people around him, who are equally weak in knowledge pertaining to the health sector. The health sector is in bad shape, and the government is trying to hide behind big-ticket projects such as Kidney and liver centre, etc. Even these ventures will prove to be a failure in the long run.”
Mehmood ur Rasheed, Leader of opposition from PTI in Punjab Assembly, told Truth Tracker that thousands of vacancies for the doctors were open in Punjab. “The process of hiring doctors is so complicated,” said Rasheed, “that every year thousands of posts continue to remain vacant.” While talking about sending doctors to rural areas, Rasheed said that unless the government gave incentives to the doctors in terms of good salary, bonuses and a working environment in the Basic Health Units, no doctor would agree to serve in downtrodden areas.
“In Mayo hospital, which is considered to be one of the largest hospitals in Asia, the emergency can barely accommodate 200 patients at a time, whereas, the flow of the patients is somewhere around 2,500 per day. Not only that, beds are insufficient, as are the numbers of doctors,” Rasheed said.
Regarding the future, Rasheed said that if the existing trend of gender specification in the medical colleges is allowed to continue, where only 30 per cent boys are becoming doctors while the ratio of girls getting a medical education is 70 per cent, we will be short of physicians in the future. The pattern in Pakistan has been that 60 per cent of lady doctors in Pakistan do not practice after getting married. Those who do practice would never like to serve in rural areas, where even their male counterparts refuse to serve. “The government,” Rasheed said, “needs to come up with legislation which will evenly divide seats between men and women subscribing to become doctors.”
“Over the past 25 years, not a single big hospital has been built by the Punjab government,” Rasheed added.
Doctor Mehmood Shaukat, Professor at Allama Iqbal Medical College, said that the government had failed to provide enough doctors in the province. He said that because services and health facilities had not been increased in proportion to the rise in population, the induction of medical staff remained inadequate. “A hospital,” he said, “does not only need another bed. One more bed means more medical staff, more doctors, more machines, more medicines and more care.” Shaukat explained: “It is the responsibility of the government to create a useful space for the doctors and then hire them.” “Currently there are hundreds of doctors working in a single unit of some hospitals, but since there is no work, these doctors are getting salaries without providing services,” Shaukat said.
“Even to date, nearly 70 per cent of the budget of a single government hospital goes towards salaries, 18 to 19 per cent is spent on utilities, and the rest is left for development. We can imagine the kind of infrastructural development that can happen with the remaining amount,” he commented.
The government has failed to provide employment opportunities to doctors through the development of health sector.