Where’s the fire: Health department rushes to rescue its facilities

Hospitals and health centres handed over to the private sector are in trouble

KARACHI: The government continued with its policy of public-private partnership in the health and education sectors in the year 2017. However, many viewed this strategy firstly as an indirect admission of the government's failure to manage and deliver the two essential and basic services; secondly as its efforts to absolve the state of its constitutional obligations and responsibilities of providing these services to its citizens; and thirdly to pursue this policy under political expediencies to favour and oblige some individuals or groups to whom these health and educational institutions are being handed over.
Whatever the reasons behind the government's strategy, the policy of public-private partnership has not succeeded in bringing about relief to public at large and the government’s solution to all its problems — public-private partnership — has failed to achieve its goal and uplift the health sector in Sindh.

According to reports, the state and performance of health facilities handed over to the private sector have seriously deteriorated, indicating the failure of the public-private mode of operation. The provincial health department has sprung into action following reports of poor functioning of these hospitals.

The statistics

In its initial investigation, it sent inquiry teams to the Sindh Government Children Hospital, Government Ibrahim Hyderi Hospital and 34 primary health centres in the city. In addition to Karachi, the government has handed control of over 1,165 primary health centres in rural Sindh under the People’s Primary Health Initiative. One hundred and four rural health centres have been handed over to a non-governmental organisation named Integrated Health Services. Health and Nutrition Development Services (HANDS) will operate the Sindh Government Ibrahim Hyderi Hospital and 34 primary health centres.



The Sindh Government Children’s Hospital at Nagan Chowrangi will be managed by a Khyber-Pakhtunkhwa based NGO named Pakistan Poverty Alleviation Fund (PPAF) whereas all public health facilities located in Thatta and Sujawal districts will be handed over to the Medical Emergency Resilience Foundation (MERF). Similarly, control of the Badin Civil Hospital was transferred to the Indus Hospital. The government-run ambulance services in Thatta and Sujawal have also been transferred to the Aman Foundation under the public-private partnership scheme. Likewise, a Thatta hospital built using funds from the Iranian government has been handed over to a Karachi-based doctor.

A senior official in the health department told Express News on the condition of anonymity that the government has initiated an inquiry following patient complaints at the Sindh Government Children’s Hospital at Nagan Chowrangi. Before the transfer of managerial control, the hospital used to run on an annual budget of Rs100 million, which included salaries of hospital staff. The hospital was transferred to the PPAF on the request of a senior leader of the Pakistan Peoples Party, after which the budget soared to Rs440 million.

The findings of the initial inquiry revealed that the new management of the hospital made 54 unnecessary appointments of officers on exorbitant monthly salaries. Similarly, the performance of the Ibrahim Hyderi Hospital and primary health centres under the management of HANDS has also deteriorated.

In its inquiry report for the hospital, the health department has pointed out problems such as unavailability of drinking water for patients, use of substandard medicines and absenteeism of doctors.

Sindh's health department has taken serious notice of the lacklustre performance of NGOs given control of provincial health facilities.



All the hospitals and health facilities were handed over to the private sector organisations after receiving the go-ahead from the Public-Private Partnership Board headed by the chief minister.

Gulshan-e-Iqbal hospital

The operational status of a large public hospital built at a cost of Rs1.6 billion in Karachi's Gulshan-e-Iqbal has been changed. The hospital, originally designed as an all-purpose general hospital, will now operate only as an orthopaedic centre. The 400-bed hospital originally had departments for all medical specialties, including gynaecology. However, the government was lured into converting the hospital into an orthopaedic centre by a retired professor of Jinnah Postgraduate Medical Centre (JPMC).

The government agreed to handover charge of the hospital to the retired professor and also approved the renaming of the hospital to the Sindh Institute of Traumatology, Orthopaedic and Rehabilitation during a cabinet meeting.

The hospital was constructed in eight years but a large part of its premises, including the parking lot, still awaits completion.

According to sources, the hospital was handed over the retired executive director of JPMC, Professor Anees Bhatti, on a political basis. As director of the hospital, Professor Bhatti had unduly reserved the special ward of the hospital for important leaders of the Pakistan Peoples Party. Hospital supplies amounting to Rs80 million were also purchased and stored in the store of Karachi's health director but due to a change in the operational status, the Institute decided to buy its supplies from scratch.



The hospital, a three-storey complex, is built over an area of 4,000 square-yards. It is meant to run independently under the supervision of its governing body.

Ibrahim Hyderi Hospital

A three-member health department team visited the 120-bed Ibrahim Hyderi Hospital on October 28, 2017 to evaluate its performance. The hospital is currently being run by HANDS and was handed over in November 2016.

The hospital has reportedly been using substandard medicines and there is no food provision for patients. Like many other public hospitals, patients do not have access to clean water. The hospital has a yearly allocation of Rs76 million from the health department of which Rs18.5 million was released for this quarter.

The hospital records had listed the number of patient admissions as 35, however, the team observed only two patients. A gynaecologist reportedly performed just one surgery during the past eight years, as revealed in the report submitted by the health department's monitoring team.

Upon inquiry, the hospital administration said the patients had been discharged.  However, the NGO failed to provide treatment records for the missing patients.

Reports have also come in that pregnant women are being asked to go to JPMC for their deliveries. There is no water at the hospital, even in the bathrooms. The NGO procures only one water tanker a week, which is why patients are often turned away and referred to JPMC.

The team also found that the hospital does not even have stationery to help maintain patient records.

Sources said that fake patient admissions were being documented to please top officers.



The hospital has 54 doctors on its payroll, however, a majority did not report for their duties. Most of the 16 female doctors remained absent throughout the year.

Another matter of concern was the absence of a qualified pathologist at the hospital's laboratory. The laboratory is being run under the supervision of a technician.

The monitoring team also visited another hospital handed over to HANDS in Memon Goth. The 50-bed hospital was also reportedly facing a shortage of medicine and food for patients. Some of the medicine being used was found to be of the poorest standards.

The NGO is also in charge of the administration of 34 health centres in Malir, all owned by the Sindh government. However, the performance of such centres is also questionable.

Govt hospital Thatta

The monitoring team also visited the Sindh Government Hospital in Thatta. The hospital is being run by MERF and it is in a similar state to the other hospitals being run under public-private partnership.

Its emergency ward has barely any medicine and, like many hospitals of its kind, there are no provisions for patients’ food.