Lack of professionalism, an unhygienic environment, incompetence, mismanagement and poor public service delivery are some of the issues that characterise our public sector institutions, including hospitals. The case in point is the Children Hospital Larkana. A couple of days ago, I took my child to the hospital in question for his check-up. What I observed was quite disturbing.
First and foremost, the coronavirus SOPs prioritised by the provincial government were flagrantly violated by none other than the hospital staff and paramedics, as well as by patients and their attendees. The magnitude of mismanagement can be measured from the fact that three doctors were attending to the patients in a single room – and that, too, without partitioning. Many attendees accompanying their children were allowed at the same time. Some of the attendees were talking at the same time, in order to apprise the doctors about the ailments of their loved ones, creating a commotion in the consulting room. It thus pointed to not only an unprofessional working environment, but also an open violation of patient privacy: one of the core values of the patient care system institutionalised by the health department.
After having attended to my child, the doctor in attendance handed over a prescription suggesting Fenbrol and Augmentin syrup, which were to be given by the Government Pharmacy established in the hospital premises. The pharmacy staff gave the Fenbrol, the cheaper medicine. They refused Augmentin syrup, citing unavailability. I saw so many people facing the same: either the suggested medicine was partly given to them, generally the cheaper one, or else they were refused any medicines altogether, instead being asked to buy from the private medical store, located some yards away. Meanwhile, some people who had handed over their prescriptions with the reference of Mr. So and So were fully accommodated, leaving the less influential to fend for themselves in the hospital of the hometown of Bilawal Bhutto Zardari, whose PPP is in its third consecutive stint in power in the province.
I imagined that those fully facilitated must be politically influential or personally powerful in terms of relations. Once I started digging deeper into the matter, an employee on condition of anonymity disclosed that one of the many reasons behind this situation is that sometimes medicines are put aside: i.e. subtracted from the prescriptions of the ordinary people, in order to accommodate the influential ones when needed. Other reasons, I was told, include red tape in centralised procurement of medicines, as well as underhanded dealings when it comes to getting a budget passed from the finance department etc. – all causing an insufficient supply.
And who can deny the famously poor-quality food being served to the hospitalised and poor patients?
Needless to say, the vast majority visiting these healthcare centres is both poverty- and inflation-stricken. Asking them to purchase prescribed medicines from their purse is nothing but callousness. Thus, these healing spots are transformed into trouble-breeding grounds. Under such circumstances, the public make all-out efforts to opt for private medical centres, given how they run from pillar to post for every tiny procedure/treatment of their ailments, and that too from their own wallet.
The other day, a video of doctors in OPD Chandka Hospital Larkana went viral, in which one could see a group of doctors having refreshments inside a room, whereas patients in queues kept waiting for the messiahs outside. People from various sections of society have poured wrath on those involved, subsequently asking the relevant authorities to take notice and initiate disciplinary action so that none could dare doing the same in the future. This is the reason why we see people rushing to private clinics. As a result, the private clinic culture has mushroomed in every nook and corner of the province, not to mention throughout the rest of the country.
While the impoverished people visiting these hospitals are denied medication, government medicines are allegedly sold into open market by “black sheep,” while tampering with the stamps.
Their endless greed surfaced in June 2020; when the Police officials summoned few staff members of Larkana Chandka Hospital for an inquiry into their alleged role in selling the government medicine. The police, on a tip-off, conducted a raid at a house in Murad Wahan neighbourhood of Larkana and recovered government medicines worth Rs20 million from two private go-downs in the city, which had stamps of “Government of Sindh” and “not for sale” on them. This was followed by recovery of 26 cartoons from the graveyard. The criminals had seemingly thrown the stocks of medicines in the graveyard over the fear of being arrested. Dumping of medicines in the graveyard that were to be given to the sick suffering from various diseases, does demonstrate utter indifference directed against humanity by unscrupulous characters operating in health facilities. It goes without saying that instances such as this one are a result of rampant corruption and patronage extended to those who are corrupt to the core.
A meticulously written report recently published in Medical News titled “Sindh hospitals in deep crises due to shortage of life-saving drugs” shone light on the Sindh Health Department’s blatant professional poverty in terms of ensuring much-needed medicines in public-sector health facilities across Sindh. As a result, provincial government-run health facilities had been suffering from a severe scarcity of life-saving pharmaceuticals, and surgical disposal materials for the past six months.
“Doctors frequently ask patients in Sindh’s hospitals, such as Dr. Ruth Pfau Civil Hospital Karachi(CHS), Jinnah Post graduate Medical Centre (JPMC), Sindh Government Lyari Hospital, Sindh Government Hospital Liaquadabad, National Institute of Child Health (NICH), and others to buy medicinal products out of their own wallets. Life-saving medications and other supplies are in short supply in health facilities in Hyderabad, Larkana, Sukkur, Mirpurkhas, Shaheed Benazirabad and other towns. Besides, the Sindh Ombudsman’s damning report 2020, released in 2021 and subsequently submitted to Sindh Chief Minister Murad Ali Shah, exposed the empty claims of Pakistan Peoples Party and its Sindh Government with regard to offering free treatment to people. The Ombudsman’s report stated that even in emergency cases, patients are not provided free medicines. It stated that in2020, a total of 6,048 complaints were received, out of which 1,129 were taken up. It noted: “This is a general complaint that medicines are purchased from private medical stores. Even in emergency cases, attendants run from pillar to post to arrange medicines and blood.”
The police, on a tip-off, conducted a raid at a house in Murad Wahan neighbourhood of Larkana and recovered government medicines worth Rs20 million from two private go-downs in the city, which had stamps of “Government of Sindh” and “not for sale” on them
Old wine in a new bottle
Despite the Sindh Health Department’s experiment of running health facilities with public-private partnership not delivering desired results in every context, as is evident from taking back the administrative control of seven taluka headquarters hospitals and 104 rural health centres (RHS) from the Integrated Health Services (IHS), a healthcare group almost six months back. It signed an agreement with the Integrated Health Services in March 2015 with the Public Private Partnership Act 2010, under which these facilities were contracted to the IHS. Despite those health facilities given to Integrated Health Services (IHS), the shortage of medicines, staff and mismanagement was phenomenal in institutions handled by IHS. Given the persistent problems elaborated above, the Sindh Health Department ultimately made up its mind to back out of the contract in the middle. It thus suggested that setting up an institution to run another institution is an ad hoc approach.
Despite lackadaisical performance by public-private partenerships, a new forum called the People’s Primary Healthcare Initiative (PPHI) Sindh is a Public Private Partnership programme of the Government of Sindh. On the 2nd of February this year, in the first phase, the reins of eight health centres: three taluka headquarters hospitals of Arija, Dokri, Ratuder and rural health centre of Garello, Badeh, Bunguldero and Model Hospital of Garhi Khuda Bux Bhutto were given to PPPHI. Justifiably, the news of handing over headlines in local newspapers was following the failure of the health department and incompetence by Integrated Health Services: the health centres in question have been given to PPHI.
In 2018, the then Medical Superintendent (MS) Chandka College Hospital (CMCH) earned the indignation of relevant authorities after having dropped a bombshell on the overseeing authorities with regard to political interference in administrative matters, ultimately resulting in poor performance. Against this backdrop, the MS in question was unceremoniously removed from his post at the drop of a hat. It thus gave a strong message to the successor to be amenable to influence or be willing to face the music, i.e. the same consequences. Recently, an assistant professor in Corneology – also a consultant and the author of sixteen research papers with double FCPS – held a press conference and accused the Chandka Hospital authorities and HOD ophthalmology to have deprived her long-due elevation to the post of professor. She stated that both misogyny and male chauvinism were at play undermining her. It is disturbing to note that some one is facing such harassment when demanding their due right.
An ad hoc approach
To set an institution to run another institution is ad hoc-ism; neither has it helped fix the issues in question nor will it be fruitful in foreseeable future. Recently, the Prime Minister came under fire for having declared that giving far-flung hospitals to Public Private Partnerships was necessary as doctors were not willing to do their duty there. The unwillingness of those posted to do their duty and subsequent absenteeism is failure of the overseeing authorities concerned.
Why are they not terminated on charges of unprofessional conduct? Why is it that institutional action can’t be initiated against those falling short of their duties? The truth is that a political connection undermines the professionalism and accountability of those not doing their professional duty. When individuals are recruited while preferring political affiliations, nepotism and cronyism, then we get holy cows instead of professional performers. And, when we place pliant civil servants and dummies in decision-making centres, then institutional paralysis is sure. It has to be acknowledged that establishing a state-of-the-art health facility like the NIVCD in Sindh is a feather in the cap of the provincial government. However, the facility is for the treatment of heart diseases. The general hospitals in the province are calling for much-needed measures with regard to ensuring infrastructure, professionalism, availability of medicines, and accountability of those dishonest.
The health department concerned and provincial government presiding over pathetic performance in the province must sit down together in order to find a sustainable solution of the issues elaborated above. This would be in the larger interest of suffering population, who have no option but to choose public-sector hospitals. And here, the only way forward is the empowerment of employees and institutions alike.