Health Quetta

Introduction

Good health services are based upon certain indicators in the form of available medical facilities, preventive and curative measures. The health services present in the district during 1995/96 are shown in the accompanying table. The total population in district Quetta in 1995 was estimated at 676,941. The first health service indicator, population per doctor indicates that it was 1,864 which shows that the district situation is very poor in terms of availability of doctors. Similarly gauging from population per hospital bed criterion, we find that there is only one bed for 488 people. Looking at other indicators given in the chart, we find that indeed government facilities in the district are quite inadequate.

Looking at the other side of the picture we note that the private facilities are also insufficient – though they seem to be more than government facilities (e.g there are 30 private hospitals). The number of Hakeem is not less than 80, while the number of medical stores was found more than 1,000. According to informed sources, there are more than 200 quacks in Quetta city and in its surroundings. It is interesting to note that almost all the specialist doctors work part time in clinics at evening time. Additionally, a large number of doctors, who are not government employee, also provide their service to the population.

If we compare the health status of women in district Quetta to that of males, then we find that their health is poor. The females feed the children. She also provides food to the male members of the family and only then she feeds herself. The health status of migrant women is worst. There is no data available regarding the calorie intake of the females and males. However, the quality of food which is used by migrants (Afghan female refugees) is poor. Hakeem and eastern doctors are operating in the district. Due to low fees charged, people often visit them. A substantial number of homeopathic doctors is present in the district. Some quacks are also found sitting on the pavement.

 Most people are uneducated so they cannot differentiate between a good doctor and quack.

Health System

Normally two types of health facilities are available in the District, curative and preventive. As far as prevention is concerned, this includes vaccination of mothers and children up to the age of 5 years through immunisation coverage, which according to the Health Authorities is:

Children up to the age of 11 months were immunized for BCG, DPT and Measles in Quetta district, Their coverage was 97%, 66% and 60% respectively. For those children whose age was between 12 – 23 months the percentages were 23%, 15% and 24% respectively. Ante-natal vaccination is of two types: vaccination to pregnant women and, secondly, care of the pregnant mother. Pregnant women were given TT1 and TT2 for prevention (58% and 42% respectively). According to the district health authorities, the infant mortality rate is very high. This is due to non-hygienic conditions, illiteracy, lack of information etc. The maternity death rate is also high, through it is less as compared to rural districts.

There are 5 government hospitals working in the district. They provide treatment facilities to men and women. However, there is no separate government hospital for ladies. Moreover, there are hospitals run by various organizations for their staff members and their families, like Railway, WAPDA, Cantonment Board, Combined Military Hospital (CMH) etc. They also provide treatment facilities to general public. As mentioned before, there are at least 30 private hospitals in Quetta. The treatment cost of private hospitals is much higher than that of the government controlled hospitals. There is no data available to show the exact number of patients who visit the hospitals. However, according to the Medical Superintendent Civil Hospital Quetta, more than 5,000 patients daily visit the hospital for treatment. These patients include indoor and outdoor patients. According to the District Health Officer (DHO), the patients visiting RHCs, BHU, Dispensaries etc is annually more than 272,000. The absence of data makes it difficult to estimate the cost per patient, per contact. However, in the private sector the cost per patient per contract may range from at least Rs.100/= to Rs.3000/=, depending on the type of disease and on the type of specialist/doctor and the test recommend by him.

There is no data available regarding the private sector involvement in health activities to demonstrate the number of registered cases as a percentage of the total population. Some sketchy data is available which cannot be used to compute the percentage of the population visiting hospitals.

Two other types of facilities are available. The homeopathic way of treatment is popular among the masses due to the belief that this type of treatment has no side effects. Moreover, its medicines, are comparatively cheaper. People also visit Hakeems who treat them with traditional oriental herbs and shrubs.

As far as family planning services are concerned, they are being provided in all D.H.O offices and also in the civil hospital. There is a growing awareness and public approval

in favour of family planning. This may be due to the electronic media campaign and thedemonstration effect witnessed by the society. Due to this, in 1996 more than 1,700

women made use of family planning services. It is worth mentioning that patients from outside the district and even from Afghanistan visit Quetta for treatment. One reason is the proximity of Quetta to Afghanistan.

Major Disease Incidence

As far as gender specific diseases are concerned, the women suffer from acute respiratory diseases, anaemia, skin infection, renal disease and worm infection, whereas male are plagued by diarrhoea/dysentery, fever including malaria, jaundice and worms infestation.

Special Health Services

1. There is a number of special health services which are provided by provincial government to improve or facilitate health programmes. The Primary Health Care and Family Planning Programme is initiated by provincial government under the Prime Minister’s Health Programme. It is further cemented through the involvement of international donors e.g W.F.O, U.NH.C.R and W.H.O. The objective is to provide health services to the community at an affordable rate. This programme caters the needs of mother and child care, providing them with nutritious food e.g. milk & ghee. Also it provides information regarding family planning and subsidised family planning medicine and contraceptives. Under this Programme (P.H.C) prevention and control of infectious diseases, immunisation and provision of essential drugs is also available. It also provides health education, treatment of common illness and provides awareness about the treatment of common illness and sanitation

2. The Traditional Birth Attendant (T.B.A) Programme. In the rural sector, middle aged women traditionally work as birth attendants. In the recent past they used to work without any formal training. But now most of them are trained by the Health Department. They are paid by the Health Department as well as by those who receive their services.

Administration of Health Services

As an example the organizational chart of Quetta’s main hospital is given

Fatima Jinnah General and Chest Specialist Hospital

The main hospitals in the district are:

1: Sandeman Civil Hospital

2: Fatima Jinnah General & Chest Hospital

 3: Helper Eye Hospital

4: Police Line Hospital

5: Railway Hospital

6: Leprosy Hospital

GO/NGO/private, etc. involvement in Health Development

Health facilities are provided mostly by the provincial Government. International donors like Red Crescent, WHO, UNICEF and Alkhidmat also help in providing finance for eradication of certain diseases. Health facilities are provided through the interaction of different health units. Most of them are established by the provincial government. There are private clinics, homeopathic clinics, Hakeems and local medical practitioners. The society gets the health care through all the units shown in the table. Presently, a children’s hospital is being constructed with the help of the German government.

Conclusion and major Development Issues

Although Quetta district has the best health infrastructure in the province, much is left to be desired. Quality of services in government hospitals and other health care institutions is a cause of concern. There is an increasing role for the private sector, but this sector caters most probably for the more well to do sections of society. There are five government hospitals for a population of around 700,000. It has to be remarked here that Quetta hospitals in practice serve a much wide population. The health care system in the city has probably a catchment area

that crosses international boundaries and the hospitals are the top of the referral system for a considerable part of the province.

Major issues in the sector, some of them not discussed in this chapter, are:

• the physical condition of many of the health institutions
• the constraints for lady doctors to work in remote areas
• the inequality of availability and accessibility of health services between men and women, with women in a much disadvantaged position
• low level of intersectoral co-ordination among government institutions in health and health related fields
• low level of community involvement in health schemes.

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