SANGHAR: Like the rest of Sindh, Sanghar district is facing a chronic crisis of public healthcare infrastructure. Last week, local media reported an accident from Sanghar city’s suburb Sultankot in which two men died, while one person, Usman, got seriously injured. The injured injured were shifted to Sanghar’s Civil Hospital, the district’s only tertiary care facility, on private transportation since there is no public sector ambulance service. As Liaquat, father of the one of those injured, got the news, he rushed to the hospital. On the way, he also met an accident and was brought to the same hospital for treatment. However, hospital authorities denied treatment, saying that they lacked facilities. Authorities referred both patients to neighboring Shaheed Benazirabad District hospital which is 65 kilometers away. They asked attendants to shift both patients on their own conveyance because ambulance was also not available. It took hours for the attendants to arrange private transport. Meanwhile, some of the people present on the occasion staged a protest against the health department, district health officer and district and civil hospital administration. Later, both Liaquat and Usman were shifted to Benazirabad’s hospital. From Benazirabad, Liaquat was again transferred to Karachi where he died succumbing to injuries. Usman is said to be in critical condition. Few steps away from the emergency ward where Liaquat and Usman were struggling for life, there stood an ambulance owned by the hospital. But the ambulance was said to be ‘not in a working condition’. For locals, the district hospital has become only a referral point where majority of cases are sent to other districts like Shaheed Benazirabad, Mirpurkhas, Hyderabad and Karachi. The situation is worse for children and women patients. “Millions of rupees are spent on this hospital from our tax money. But in the end if every second case is referred then what is use of resources spent?” asks Amir Rajpoot, an area social worker. Dr Shafqat Illahi Yousfani, who is working as acting civil surgeon, while acknowledging the issue of referrals, linked the issue with shortage of medical staff. “Medical cases are referred to other cities because in those cities there are specialists, consultants and professors available. Why would we refer the cases had we have specialists?” he maintains. Dr Sikander Mandhro, a leader of ruling Pakistan People’s Party who held the portfolio of Sindh Health Minister until last month when he was elected as senator, defended referrals system. “If a case of emergency is coming should we allow him or her to die and not refer them to a district with better facilities? It happens all over the world, even in western countries. Tens of thousands of patients visit our healthcare system on daily basis. Among them, if some cases are referred then there is nothing wrong,” he says. Sindh is the largest gas producing province of Pakistan, which contributes more than 70 percent natural gas of the total production. Sanghar district is home to major oil and gas fields. It is among the country’s top cotton producing districts (55 per cent to the foreign exchange earnings of Pakistan come through cotton and cotton products). According to Zohaib Mushtaq, Deputy Commissioner Sanghar, production-wise district’s share in country’s oil and gas production is six percent. “Sanghar district receives Rs.150 million annually in terms of oil and gas royalty. But that is peanuts when compared to the scale of problems faced by the district,” Mushtaq says. In 2013, Supreme Court was informed by the Ministry of Petroleum and Natural Resources (MPNR) that the total sum of royalty payable by E&P Companies, (companies involved in the exploration and production of oil and natural gas) was more than Rs.160 billion in respect of crude oil and more than Rs.293 billion in respect of gas extracted from the various districts in the country. The Supreme Court ordered relevant authorities to ensure the collection, monitoring and optimal utilization of social welfare funds. The court also directed local governments of the districts concerned to conduct public hearings once every six months to involve the public in expenditure of social welfare funds. Sanghar DC claims that administration was conducting regular public hearing in compliance of court’s orders. However, Anwar Nizamani, a co-petitioner in the 2013 petition, dismisses the claim. “Had district administration spend the royalty on social welfare, things would have been very different on the ground. Money is going in the pockets of administration and local representatives with collusion,” he opined. With the population of 2.057 million, Sanghar Civil Hospital is district’s only tertiary care hospital with 1,500-2,000 patients in OPD (Out Patient Department) daily. Annual budget of the hospital in terms of medicines provided to patients is Rs.12 million. On paper, the hospital is district’s biggest health facility catering to Achhro Thar desert, Chotiari, Khipro, Tando Mitha Khan, Sinjhoro, and Jhol areas. Often patients are brought from neighboring Khairpur district as well. But hospital’s dysfunctional, outdated and understaffed healthcare system poses a grave threat to the public health. For instance, the Civil Hospital has no civil Surgeon for last four months. There are around 84 posts of medical officers out of which 50 remain vacant. Similarly, out of 18 posts of specialists’, 15 lie vacant. These are in the fields of pediatrics, gynecology, orthopedics, and oncology. “Due to vacant posts, cardiac, ENT, and chest wards have been closed for last many years,” Dr Shafqat Illahi Yousfani, who is working as acting civil surgeon, told this scribe. “Also, the orthopedic ward is being run without any specialist doctor,” he said. Similarly, there is no gynecologist in the district hospital. The maternity ward has women medical officers (WMO) and offers OPD services in the morning shift only. According to official record, on average there are 6,000 monthly delivery cases in the district, out of which only 100 cases are dealt at the Civil Hospital. Lutaf Ali Memon, district manager People’s Primary Healthcare Initiative (PPHI) – a public private partnership programme – working to reduce maternal and newborn mortality, claims that his organisation deals with 1,500 delivery cases in Sanghar every month. “Take the case of Basic Healthcare Unit (BHU) Maqsoodo Rind in Shahdadpur sub-district that is run by PPHI. It deals with 200 deliveries from neighborhoods in a month which is far better than Civil Hospital’s performance. Actually, this is the responsibility of BHUs, Rural Health Centres (RHC) and district civil hospital, but the burden has been shifted to PPHI, forcing us to stretch our mandatory duty timings from 6-hours a day to round the clock,” Memon added. Hospital administration refers the remaining delivery cases to city’s private clinics or to neighboring districts – a money minting exercise with collusion of area doctors, he blamed. Lack of medical staff has also reduced the admission capacity where out of total bed strength of 208, half cannot be used. In October last year, Civil Hospital made Haemodialysis Department functional after a gap of seven years. It was closed after 2011 massive rains, when hospital authorities claimed that machines malfunctioned due to flooding in the hospital. The department could only be operational after it got dialysis machines units with donations. The department has hired two private technicians whose salaries are paid through donations. A team is constituted under doctors and social workers, who collect donation money from philanthropists to provide free of cost dialysis treatment and run other related affairs. There is a pamphlet issued by Civil Surgeon Sanghar appealing well-off families for donations to contribute in the social work. It says that treatment is only possible if philanthropists don’t stop contributions. “There is no support from the government in running the department. If donation fall short of expenditures, then we borrow medicines from companies,” Dr Hadi Buksh, the in charge of the Haemodialysis Department says. The civil surgeon opines that limited budget was one of the main reasons for poor healthcare services. “We are dealing around 2,000 patients per day in OPD. So, we are spending Rs.4 to Rs.5 per patient. What commendable services can we provide in this limited budget?” he asked. The Health Department, for the ongoing financial year, was allocated Rs.100 billion – the second highest after education. CM Sindh Murad Ali Shah also imposed health emergency in the province. According to government’s ‘Health Profile of Sindh 2016’ document, the bed capacity in the district is 566. Out of this, 186 beds are in private healthcare facilities and 208 beds are sanctioned in district civil hospital. According to data, for 2,168 populations, there is one hospital bed in the district. National average is a bed for every 500 persons. Also, for every 3,001 people, there is a doctor in the district. This is far less than the national average of a doctor for every 1,282 persons. Similarly, in Sanghar, for 33,672 people there is a nurse. However, the national average a nurse is for 2,631 persons. Dr Shagufta Abid, the District Health Officer (DHO) who has retained the top position since PPP’s 2008 government, says, “criticism of health facilities is politically motivated. There is no reality in it. Whatever funds are available are spend transparently and that makes our performance evident.” Sanghar is the hometown of two former prime ministers Muhammad Khan Junejo and Raja Pervaiz Ashraf, and former chief minister Jam Sadiq Ali and various federal and provincial ministers and advisors. In the past, Sanghar was a stronghold of Pakistan Muslim League (Functional) that held key political and administrative positions in the district. Pakistan People’s Party Chairperson Bilawal Bhutto Zardari, during last week’s visit to the Khipro area of Sanghar, blamed PML-F for deteriorating conditions of infrastructure in the district including health for last 50 years. However, Bilawal himself took a decade to take notice of the situation as he announced construction of new hospital of international standard in the district. But he didn’t mention the timeline of construction. The PPP chairperson’s promise comes during election season. At present in power corridors, PPP represents Sanghar in majority. Out of six seats in Sindh Assembly, three belong to PPP, whereas out of three National Assembly seats, two belong to the PPP. Also, the district council chairman, the highest local government representative, belongs to the PPP as well. Senator Mandhero says expecting ‘overnight’ change is not the right approach. “We cannot close all other government departments and upgrade only the healthcare system. The system improves gradually, and is improving with time. Our demands and expectations are high but resources are limited,” he said. But recently, local media reported that from 2008-9 to 2016-17, PPP’s government allocated Rs.1,354 billions for development budget in the province. Of this, it could not spend Rs. 445 billion, thus the amount lapsed. Similarly, for the current financial year, during the first nine months till March 17, 2018, only 14 percent of the health department’s development budget was spent. Mandhero links district’s shortage of doctors with overall shortage in the province. “Recently Sindh government hired some doctors so there is an improvement,” he says. But DHO Shagufta negates this while saying that she wrote various times to the health department for the fulfillment of vacant senior posts, but nothing was done. Locals demand that the government should at least make the cardiac ward and other facilities functional, as in the recent past many people died of cardiac diseases or road accidents. Published in Daily Times, April 14th 2018.