Dereliction of duty

The quality of public health services in Pakistan falls short of the mark everywhere. Underfunded and poorly managed throughout, they are a textbook example of how not to care for an impoverished and already unhealthy population. Much of the evidence of this remains anecdotal, based upon the experience and observations of users and inquisitive journalists. Empirical evidence, as in appropriately researched and sourced, is rare. Among the worst public health services were reputed to be those of Khyber-Pakhtunkhwa (K-P) and now the K-P government has provided hard data on its own failings in the public health sector. At one level, this is encouraging, as the newly set up Independent Monitoring Unit (IMU) provides a hitherto unavailable transparency in a notoriously opaque area. At another level, the IMU report is profoundly depressing, exposing as it does, levels of incompetence, corruption and bad management that are not easily or quickly fixable given their depth and breadth.

The IMU’s purpose was to oversee the quality of service delivery at 1,600 state-owned and managed health centres across the province, staffed by 63,000 provincial employees. Most health centres in Peshawar are understaffed — a slightly surprising finding — underequipped and in a dilapidated condition. At least one is being used “for immoral purposes” and as a venue for privately organised social events. Where they are present at all, power generators are broken or lack the fuel to run them. Mattani Civil Hospital is actually overstaffed — but many staffers fail to show up for their duties. The list of deficiencies at every level goes on and on. Listing the faults in the system objectively is just the start of the process of fixing them. The K-P government now has a ‘to do’ schedule that it needs to address on a priority basis if it is to begin to provide the most basic health care to the citizenry. Allowing this report to gather dust serves nobody except those under whom such an essential service fell into neglect. Reversing this dereliction of duty is going to require political steadfastness and courage. We await results.

Published in The Express Tribune, August 10^th,  2015.

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