Sindh healthcare system a ticking time-bomb

Province lacks capacity to deal with large-scale health emergencies

KARACHI: When it comes to providing healthcare, Sindh is suffering from a serious shortage of facilities for its ever-growing population, data compiled by the provincial health department has revealed.

Not only is the ratio of citizens to health professionals and hospitals an extremely wide one, the province’s health authorities also lack standard operating procedures to cope with emergencies. More alarmingly, however, is the number of beds in government hospitals in Sindh, which is more or less the same as 20 years ago, even though the health department’s budget has increased year upon year.



According to a report compiled by the Sindh Healthcare Commission, available with The Express Tribune, the province has 41,082 beds in 7,651 health facilities - ranging from major government-run hospitals and institutes to private tertiary care hospitals - against a population of roughly 47.89 million. This means that province has only one hospital bed for nearly 1,200 people, which is less than half of the global hospital beds to people ratio ascertained by the World Health Organisation (WHO).



And although the figure compares favourably to the one for the entire country - there is in Pakistan on average only one hospital bed for 5,000 people according to WHO data - the report reveals that most of the health facilities and consequently hospital beds are concentrated in Karachi.

Of Sindh’s 7,651 medical facilities, as many as 1,770 or 23% are located in the six districts of Karachi alone. But the contrast between Karachi and the rest of the province grows starker when the numbers of beds is considered: a staggering 16,482 or roughly 40% of the over 41,000 beds in Sindh belong to health facilities located in Karachi.

Sindh health department data also revealed that the number of doctors and paramedics working under it is 15,000 and 30,000 respectively. This means that the provincial government has only three doctors and six paramedics working for every 10,000 residents in the province.

To provide some context, the total number of registered doctors in the country is 143,000, according to Pakistan Medical and Dental Council (PMDC) records, and the total number of nurses and midwives registered with the Pakistan Nursing Council is 35,000 and 29,000 respectively.

When taking Pakistan’s approximately 200 million-strong population into account, this translates to roughly seven doctors, two nurses and one midwife for every 10,000 citizens. WHO data provides a more optimistic picture - roughly 12 doctors and 4 nurses and midwives for every 10,000 citizens - the actual situation might be much more dismal if anecdotal accounts from various health professionals are believed. According to them, as much as half of Pakistan’s doctors have moved abroad for better opportunities and this is not counting the roughly 30% of registered lady doctors, who they suggest are out of practice.

“Given the country’s population, which continues to grow, the number of doctors, nurses, paramedical staff and beds is shockingly inadequate,” said Jinnah Sindh Medical University Vice-Chancellor and former PMDC member Professor Tariq Rafi.

“Pakistan has a total of 170 medical and dental colleges, counting both government-run and private institutes, and they produce 15,000 graduates every year,” he said. “But around half of them move to various other countries, like the United States, United Kingdom, Saudi Arabia and other European or Middle Eastern countries as soon as they are registered as doctors.”

Referring to a WHO report, Dr Qaiser Sajjad of the Pakistan Medical Association pointed out that the optimum doctor-to-patient ratio is one physician for every 600 people or roughly 17 doctors for every 10,000 people.

“However, the health sector of our country is in a deplorable state,” he said. “Take Karachi, we need at least 500 ventilators in this city but the total number of ventilators in both public and private hospitals here is just 100.”



Health facilities in Sindh are also grossly inadequate when it comes to coping up with catastrophes and natural calamities. According to sources, the province does not have adequate infrastructure, doctors, nurses or beds to tackle large-scale emergencies.

For instance, there is only one burn injuries centre in the entire province that is located in Dr Ruth Pfau Civil Hospital Karachi and only has 40 beds. Consequently, there is an immense rush at the facility almost constantly as burns victims jostle to get treatment.

Pakistan also reports the highest infant mortality rate among developing countries - 72 out every 1,000 infants - due to a lack of basic and primary healthcare facilities. In Sindh, the responsibility for developing health infrastructure rests with the Peoples Primary Healthcare Initiative (PPHI). But despite receiving generous funds directly from the Sindh government, dozens of infants and children continue to perish in many parts of the province, particularly Thar, under PPHI’s watch.

Published in The Express Tribune, July 18^th, 2019.