Healthcare in ruin

Adnan Adil
The News,Thursday, May 29, 2014
From Print Edition


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More than 150 years old, the 2300-bed Mayo Hospital in Lahore is a microcosm in which one can see
most of what is wrong with public healthcare in the Punjab province a dilapidated building,
overcrowded wards, new quarters under construction for almost a decade, shortage of specialist
doctors and unavailability of medicines to ordinary patients.

Punjabs public healthcare could not be in worse condition except shutting the entire system. The
administration seems to only make tall claims about the public healthcare system while doing little on
the ground.

During the last six years the healthcare system has been the biggest victim of insensitive policies.
During the ongoing fiscal year 2013-14, a sum of Rs17 billion was allocated for the development of
health and family planning, but during the first ten months the actual spending was merely Rs5.2
billion. Obviously, hardly a couple of more billions can be spent in the remaining two months of the
fiscal year, taking the total expenditure to one-third of the original.

This trend is in line with past practices. During the preceding three years 2010-2013 spending on
Punjabs health sectors development has been less than half of the original budgetary allocations
Rs23.8 billion against an allocation of Rs48 billion.

The entire focus of the provincial government is on civil works, especially roads. Last year, funds from
education and health sectors were diverted to build the metro bus track in Lahore at the cost of Rs30
billion. Further, this project has many supplementary projects as well.

This year, more than Rs10 billion has been spent on flyovers in the way of the metro bus. The
provincial government is now building a Rs40 billion metro bus project in Rawalpindi where roads were
widened just a few years ago. The provision of a few hundred public buses could resolve the transport
issue in the city.

Against this, the government-run hospitals in the province have been starved of even small funds.
Lahores General Hospital is the largest centre of neurological treatment. The government could not
provide it a tube-well and a water-filtration plant which the hospital arranged from a donation by a
philanthropist.

Lahores premier Dental Hospital is in such a mess that more than half of its dental chairs are broken.
The hospital has only eight 20-year old autoclave machines to sterilise equipment for the treatment of
nearly one thousand patients a day.

The majority of patients are denied scans on the excuse of shortage of x-ray films.

Since the public health system in rural areas and small cities is inadequate, non-functional and in
worse shape than what it is in a big city like Lahore, people from far-flung areas throng to the centres
of tertiary care in big cities for treatment.

Lahores Mayo Hospital deals with more than one emergency patient every one minute 2,000 people
are brought to the emergency ward and 3,000 for outdoor consultation every day. Even in such a
situation, half a dozen positions of senior doctors are lying vacant for the last six years.

Half of the hospitals 2,300 beds are out of order. Mattresses are in a terrible condition; 19 ECG
machines are out of order, the lithotripsy machine is in need of repair for the last two years; and in
more than 12 wards oxygen ventilators are not available.

A surgical tower, meant to provide 350 beds and later revised to 532, has been under construction at
Mayo Hospital for the last eight years. It was to be completed in three years. More than 70 percent of
the work has been completed but the remaining portion is incomplete for want of funds.

Similarly, the 200-bed first burn unit at Jinnah Hospital Lahore has not been made functional though
its building was built years ago. There is only a small 12-bed burn unit working at Mayo Hospital for
the entire province with a population of ten million. This unit too does not have a single trained doctor
or paramedic staff for treating burns. In contrast, the provincial government spent Rs2 billion on the
youth festival in Lahore this year. Funds are available for fun not for healthcare.

Similarly, the Cardiology Institute in Wazirabad has not been made functional for want of funds for
the last more than five years. Multans cardiology hospital is in still worse condition with only one
surgeon available and several posts lying vacant.

Lack of facilities in the rest of Punjab has resulted in overburdening Lahores Punjab Institute of
Cardiology, which gives a waiting period of one year for heart surgery and several months for
angiography. Poor patients visit the hospital several times a year but are refused treatment. The
hospitals emergency ward consists of 50 beds out of which 25 have been set up on stretchers and
other patients are treated on wheelchairs.

According to recent findings of the provinces Institute of Public Health about the drinking available in
Lahore, water was found to be contaminated in 21 public hospitals including teaching hospitals. It
found sewage in the drinking water in certain samples.

The impact of slashing the health budget to one-third of the original is that thousands of posts of
doctors, nurses and paramedic staff are lying vacant all over the province. Around 4,000 vacancies of
mostly senior doctors in the province have not been filled for years.

Thousands of posts of nursing staff are lying vacant while thousands of others are working on contract
basis. The government does not have funds to regularise 2,800 nurses. The provincial government
had chucked out 250 junior doctors earlier recruited on ad-hoc basis but was prevented by the Lahore
High Court.

More than 70 percent of the people in the province are forced to turn to private facilities despite the
fact that more than 50 percent of the population lives below the poverty line. There are 60,000 private
hospitals in Punjab compared to 325 public hospitals.

The high cost of treatment at private hospitals and clinics has further impoverished the poor. Even
those who are diagnosed or admitted to the government hospitals have to buy medicines and material
used in surgery from the open market.

Neglect of public healthcare is reflected in the immunisation campaigns as well. Although Punjab has
not reported any polio case, it remains at high risk. A month ago the World Health Organisation got a
third-party survey conducted in Lahore to check the availability of polio virus and found it in two
samples from certain localities.

The WHO pointed out that the citys 73 union councils are at high risk of polio. Punjab needed two
million OPV vaccine doses against which it had only 400,000 doses. One can usually see four children
lying on each single bed at Childrens Hospital in Lahore.

The above-mentioned lament of the public healthcare in Lahore is just a birds eye view of the
situation. Foreign donors can also make the government a little more accountable in its responsibility
in providing some basic healthcare facilities to the public.