Almost half of the 80 Basic Health Units (BHUs) monitored in April 2011 by FAFEN did not have specially-trained staff to treat TB patients. There was also a noticeable shortage of staff to run disease control programmes currently being implemented by the Health Ministry. These include the Malaria Control Programme (MCP) and the Control of Diarrhoeal Diseases (CDD) programme. FAFEN, an NGO, visited 80 BHUs units across Pakistan during April 2011 – 33 BHUs in 22 districts of Punjab, 25 in 18 districts of Khyber Pakhtunkhwa, 15 in 11 districts of Sindh and seven in 11 districts of Balochistan. “With the exception of facilities monitored in Punjab, where 73 percent BHUs had TB staff, at least 60 percent BHUs lacked TB staff in all other regions. Similarly, 39 percent of the monitored BHUs nationwide did not have staff to run the CDD programme and 35 percent did not have staff to run MCP,” FAFEN said in a statement on Monday. In Balochistan, 57 percent of the monitored BHUs did not have staff to offer basic vaccination facilities under the Expanded Programme on Immunisation (EPI). This is especially worrying since many serious diseases are covered under the EPI.
However, in all other regions, at least 90 percent of the facilities in each had the required staff. The monitored BHUs also showed lacks in maternity care. Forty six percent of the monitored facilities did not have the standard minimum two maternity beds at the premises. In addition, labour rooms were missing in 40 percent of the monitored BHUs and 20 percent lacked delivery kits. Female staff was present to attend to patients in 86 percent of the BHUs monitored, however, 57 percent in Balochistan lacked the facility. With regard to essential equipment, more than half of the monitored BHUs nationwide did not have a working oxygen tent, 31 percent did not have sterilizers and 17 percent lacked syringe cutters.
Moreover, 69 percent lacked wheelchairs and half did not have stretchers. Lacks in these areas were also noted in BHUs monitored in April 2010, and negligible improvements were observed during the current monitoring. All these are very basic items that all health facilities should have. The lack of wheelchairs and stretchers means that there is no provision for moving patients into the BHU, even if they are injured or otherwise incapable of walking. Similarly, administering injections to patients is part of routine work for BHU staff, and the absence of syringe cutters is reflective of lack of concern with regard to reuse of syringes, which often leads to transmission of diseases.
General facilities for patients were also lacking in April 2011, as 36 percent lacked arrangements for clean drinking water for patients and over a quarter of the monitored BHUs lacked washrooms with running water for patients. Similarly, a properly shaded waiting area for patients was missing in 21 percent of the monitored BHUs. On a positive note, the numbers of BHUs with clean drinking water and washrooms with running water for patients increased by seven and nine percentage points respectively in 2011, compared to the data gathered in April 2010.