The Punjab govt seems to have come up with a novel way of providing free health care at the local level… Apparently, its a big success so far…
Just goes to show, that with the right motivation and will, a lot can be accomplished through very little… Now all we need to do is to expand this to the other provinces!
Help is now within reach
Basic healthcare services can easily improve quality of life for the poor who live miles from towns and cities, reveals Rina Saeed Khan
We all know about “ghost” schools in Pakistan — but have you ever heard of “ghost” basic health units (BHUs)? These are usually dilapidated buildings, located in every union council of the country, which are supposed to be functioning as mini-medical centres. It is a sad and familiar story — the doctors hired by the government hardly show up, the medicines rarely arrive and the community health workers are nonexistent.
People living in these districts often have no choice but to trek to nearby towns or cities to get access to health care. This is expensive and time consuming, and hence the poorest of the poor in rural Pakistan never make it to a hospital. Chronic ill health dramatically reduces the quality of life.
But there is always hope — and in the past couple of years, there has been a quiet, yet dramatic, turnaround in basic healthcare services provided by the government in the province of Punjab.
It is estimated that 1.5 million women and children living in 12 districts of Punjab who never had access to health care are now being treated free of charge by female doctors. More than 20 million living in these 12 districts (out of a total of 35 in Punjab) now have free of cost medical assistance in their own hometowns and villages.
This is the result of a project pioneered by the National Rural Support Programme (NRSP) in Lodhran from 1999-2003. This happened when the management of three BHUs was handed over to the NRSP. The first thing they did was to raise the salary of the doctor from Rs12,000 to Rs25,000 for working at the three BHUs. This increase in salary gave the doctor a greater incentive to work properly and not shirk from his duties as was happening in most BHUs. The Lodhran model was soon followed in the district of Rahim Yar Khan, when 104 BHUs were transferred to the NGO.
“At first we were uncomfortable with the idea,” recalls Farooq Haroon of the PRSP. “Most BHUs were in bad shape. These are the zila nazim’s responsibility but most are just not interested in making sure that they are run properly. And somehow the local people don’t bring up the issue and demand that something be done about it.”
At the time, the PRSP was engaged in organising communities and giving out micro-credit, so this programme was out of their range of activities. However, they decided to sign the agreement. The challenge was to effectively deliver health care services through the BHUs with the same staff, while remaining within the district budget. Strict monitoring took place to ensure staff presence at the BHUs and a continuous supply of medicines was maintained.
The project proved to be a success and within six months it was obvious that much can be achieved by ensuring staff presence and the availability of medicines. The Chief Minister’s Initiative for Primary Healthcare was thus launched and its extension was approved to any other district in the province which opted for it.
The government of the Punjab undertook to bear the cost of a Programme Support Unit based in Lahore and District Support Units in each of the districts which opted for the programme. Soon, aside from RYK, 11 other districts had signed up for the programme — Chakwal, Vehari, Lahore, Faisalabad, Sahiwal, Kasur, Mianwali, Toba Tek Singh, Hafizabad, Lodhran and Pakpattan.
The PRSP is currently managing 1050 health units and these BHUs now offer community health programmes, female health programmes, pregnancy tests, blood sugar level tests, anti snake venom, sterilised stitching and first aid. They hold monthly review meetings and the emphasis is on preventive health care.
The BHU located near Jallo Park outside Lahore is one such well-equipped BHU and the emphasis here is on vaccination, mother/child healthcare, and creating awareness about safe drinking water, nutrition and sanitation. Rashida Bibi, who has three children and lives in a nearby village, had to go all the way to Lahore for medical care before this BHU was revamped by the PRSP. “I visit the lady doctor all the time – this is a big help. My children are healthier now.”
The lady doctor, Dr Rukhsana, gets paid a handsome salary of Rs37,000 a month for her work and she is quite happy commuting to the BHU from Lahore. According to her, “I get a good pay package. This helps because then we can take an interest in the work.”
Dr Rukhsana covers three BHUs in the district and says that the most common health complaints are skin infections and gynaecological problems. She is so busy, that some days she sees almost 250 patients!
Dr Rukhana is helped by another male doctor who also looks after the administration of the BHU and 34 lady health workers in Jallo Pind who recruit patients. These lady health workers act as “ambassadors of health” in the local community by advocating healthcare. They receive a government salary and are trained by a master trainer. A lady health supervisor looks after their activities. There is also a midwife, Jamila Bibi, who has been trained properly and is also a government employee. Strict monitoring of the BHU is conducted by the district support unit.
The Jallo Pind BHU is now owned by the community, which has seen the difference that it has made in their lives. A local committee oversees the management of the BHU and intervened when a water cooler had to be installed or when a wall broke down. The BHU even organises medical camps in the area and has helped bonded labour working in the union council.
The programme has been so successful that the President and the Prime Minister have asked for it to be used throughout the country. This requires political will and vision by all those involved — if that is forthcoming then there is no reason why millions of Pakistanis cannot be provided with free basic health care. A healthier population would mean a more prosperous country for all of us, regardless of our income and background.
how much all of this costed?