HEALTH CARE

DELIVERY IN
KARACHI, AN
UNACHIEVED TARGET
FOR GOVERNMENT
Dr. Abeer Ajaz , MBBS , Student
Bahria University Karachi Campus

ABSTRACT

Healthcare delivery system is an

arrangement that serves best to any
country’s population with effective, efficient
and fair
distributions of resources, and funds
through organized infrastructure to thrive
well. Better health improves country’s labor
force and ultimately raises human welfare
and economic stability. This healthy labor
force and productive human capital
resources with healthcare facilities by the
government for its people. Globally, health
sectors
varies from country to country and it
depends on how much expenditures on
health is been effectively utilized. In
majority
of the developing countries, private
healthcare sectors, donor, and out of pocket
expenditures are the primary contributors
in health care services that may raise
human capital and economic growth of the
country. Whereas, public health sectors
 remains underprivileged due to structural
fragmentation, lack of resources, and
functional inabilities.

METHODOLOGY:
Literature review of articles published in
scientific journals. Observational study with
life time experience .

IDENTIFICATION OF POOR HEALTH CARE

DELIVERANCE IN KARACHI BIG
GOVERNMENT TERTIARY CARE
HOSPITAL:
Health care deliverance is not merely a
business but it is considered as a basic right of
society and a responsibility of Government.
Hence taking a step to allow this goal’s
achievement, Government of Karachi has
established only 3 tertiary health care hospitals
in a population 15 million (1,5 crore) population
belonging to mostly middle-class level and
lower-class level which is equivalent to salt in
the sea.
Health care delivery systems range from almost
free
provision of healthcare like the National Health
Service in
UK, to systems that are financed through a mix
of public
and private contributions; like most European
countries ; ( Suhail 2008). Abbasi Shaheed
Hospital is one of the tertiary care hospitals,
has been operated in the center of city Karachi
since 1974. Initially, in first twenty years, it met
the standards of health care but gradually its
performance started declining like other
Government hospitals already had been in
operation. In 1991, it became a teaching
hospital for students enrolled in Karachi
Medical and Dental College and slowly affiliated
with CPSP for post-graduation fellowship but
never became successful in providing up to the
mark clinical training to the distinctive students
of Karachi Medical & Dental College fellows of
College of Physicians and Surgeons Pakistan.
ASH commitment towards public also started
declining and never showed a satisfactory
attitude towards the civilian of Karachi, mostly
middle and Lower classes.
THE ROOT CAUSES BEHIND THE FAILURE
OF HEALTH CARE DELIVERY SYSTEM OF
ASH:
There are a million causes participating from
top to bottom but the main causes lead to
failure of Health care system of ASH are briefed
out one by one:
a) INSUFFICIENCY OF FUNDS:
We all are known with the fact that nothing
is possible without money the Government
Health Care System is purely dependent on
the funds made available from the
Government and concerned authorities
Public sector is mainly financed
through external or overseas funding. It
contributes only 23% of
total expenditure on health. In contrast,
private sector contributes
77% of health expenditure. It means that
total 3to 4% of GNP is
spend on health, with 2 to 3% of GNP is
spend on private
healthcare sectors;(Shaista 2014) .There
had always been insufficient funds from the
start. Due to insufficiency of funds, public is
 not given standardized care, proper
accommodation, appropriate techniques,
sufficient OT instruments and modern
facilities. People from low socio-economic
classes have to contribute their money to
get their procedures done. Even the
Hospital management merely become a
name of Health delivery system, not
fulfilling its responsibilities. When managing
bodies address this issue to the City
Government, the Government blame the
reason of insufficiency of funds to the
Provincial Government and the Provincial
Government to the Federal Government
but the issue never gets resolved. The
Government always gave a deaf year to this
serious matter.
b) CORRUPTION:
Out of the 144 interviewees 98 (68%) gave
their opinions and comments about the
influence of
the political context on health policy All
respondents on federal level expressed
opinions. On district level about two third of
the interviewees gave their opinions. Remark-
able is the low number of civil servants and
managers on provincial level, who answered
on
this issue. The role of the political context is
clearly recognized by most respondents;(M.M
Khan 2007). The second major reason behind
is Corruption. ASH had been a center of
various MQM suspicious activities. There
always had been a political influence on the
management of Hospital. There had been
limited number of Ventilators and bed
availability. Under these circumstances of⁶
scarcity to public, ventilator and beds are
booked and reserved for political influential
personalities, neglecting the Local public, who
are the main claimants of the Health care. In
case of any casualty, the ventilators and beds
are fully occupied by political people, and the
remaining are left for people. This is basically
an indicator of jungle’s rule. The other aspect
of corruption is being operated in terms of
funding. When funds are announced by the
government, a major part goes to the hands
of the politics personnel, then to managing
bodies, a small share to the salaries of
doctors and nurses and nothing is left for the
well-being of society.

c) INEFFICIENT MANAGEMENT:
During 1990's, many activists came together
again to make up most of the emerging
challenges of Global health and tackle the
most intransigent ones such as poverty and
inequity. A People Health Assembly held in
Bangladesh in 2000, a step taken to attain
the aim written in WHO constitution : “ the
enjoyment of highest attainable standards
of health is the fundamental right of every
human being “;(WHO 2005).
Any system whether a private health care
system or a Government Health care
system need perfect management. Lacking
in skills of management leaves a disastrous
impact. The system of management in ASH
is very poor. There is no proper
accountability and merit criteria of how
important positions are designed and
fulfilled. The important positions are
occupied by influential people, burying the
merit criteria underground. Seats are
announced but only to make public fool.
Hence unskilled persons are playing with
the lives of people on the slogan of Health.
They are only there to engulf as much share
of the public as they can. Those who are
honest but lack in skills ultimately show no
contribution towards public and society
well-being. They have no sense of managing
funds, managing hospital staff and
managing Hospital maintenance. The dumb
off garbage is far cleaner than ASH stairs
and corridors. This is how they provide
health and hygiene to the people,
contributing to the spread of diseases
rather to fight against diseases. Hence, The
healthy policy cannot take place without
support
of political administration. Pakistan has
centralized
health system in which all major health
decisions and
power is under control of Federal
government. Due to
this centralization, provincial government
has only
right to implement policy in their own
provinces.
There is no participation of stakeholder,
community
and individual groups in formulation of
heath policies
and health planning. As a result of this,
communication gap is found between
federal,
provincial and district levels. Moreover,
there is lack
of implementation, duplication of resources
and
many programs have no outcome. Although
government acknowledges in National
Health Policy
2001 that good governance is the basic key
to achieve
quality of care but in real practice,
government is not
providing opportunities for good
governance;(Zohra 2016).
THE REAL ASSETS OF HOSPITAL:
After the failure of Government and
Management, how this name ASH survived.
This hospital has been survived by the
participation of most enthusiastic doctors,
residents and para-medical staff. They are
those heroes who make contribution of
money from their pockets and never leave
their patient empty-handed. They conduct
all emergencies, casualties in this so-called
hospital, that always remain unequipped,
from their pockets. These are the doctors
who are working in this harsh environment
where unavailability of water is a routine.
Surgeons purchase gallons of water and
then wash for surgery. They all are stuck up
for their salaries for two, two years and
when they protest for their rights, they are
labelled as “greedy”. Not only providing
health to the patients they simultaneously
conduct teaching and training session of the
students, house-officers and residents.
Hospital never arm them with good
instruments and equipment, still they carry
out all operations, procedures and
casualties with full expertise and patients.
How could Government and managing
bodies leave them unarmed to fight for
health? This is seriously insane!
REAL LIFE EXAMPLE:
This incident happened when I was working
as a house officer at Abbasi Shaheed
Hospital . It was a night of Feb , 2017. A
young female rushed into Gynaecology Unit
2 labor room with bleeding. She was in a
state of shock. Her EmLSCS was planned but
the attendants were not willing to bring the
operation’s necessary requirements ( which
were never present in Abbasi Shaheed
Stock ). Then all the doctors from Gynae
unit 2 and other units contributed money
and brought all necessary tools needed. She
was taken to OT and the mother and baby
were survived. Upon hearing the news that
she was a baby girl, her attendants left the
baby there and had taken the mother with
them. The doctors performed out of their
ways, but the greedy family didn’t
anticipate at all.

NEGLIGENCE OF MANAGEMENT:
Health care delivery in Pakistan on the
other hand, is the worst of both worlds; not
only the health care delivery is
predominantly private there
are no watchdog bodies, agencies or audit
commissions to
monitor the quality of health care delivered
to the patient;(Suhail 2008).
How could the managing body and
Government be so harsh and insensitive
that they are playing their evil plans on the
grounds where health is being provided.
They are only sitting to misuse their
managerial position. They have no sense of
public health at all. The government pay no
attention and the concerned authorities
satisfice with the situation because their
pockets are kept warmed. If this could have
done outside Pakistan, they are charged
with NEGLIGENCE ACT, CRIMINAL ACT and
other MISUSE OF POSITION ACT.
If the population is distributed in 03 halves
for 03 major hospitals Jinnah, Civil and
Abbasi , so they must be playing with the
blood of 05 million people.

AREAS OF IMPROVEMENT:
For the provision of efficient and timely
healthcare to
everyone, the policy makers will need to
understand the
needs of the people and their ability to pay
for the
healthcare. Various methods of financing
can be
used for our population. Social health
insurance and
community health insurance are some of
the options
which can be applied to the segments of
the population
who are able to pay for their health. For
those who are
unable to access the healthcare, due to
their meager
incomes, safety needs be provided so that
they can also
avail healthcare without losing their sources
of
livelihoods. The universal coverage can be
achieved in
a manner that all of the users pay according
to their
ability to pay;(Jamil 2008). So, coming
towards the end of case study how could
we organize and manage this. First of all,
we must shake the Government authorities
to provide the appropriate funds or if not,
then to shut the hospital off. Terminate all
the corrupted holdings of managerial
positions and replace the positions by
skilled and educated persons. Take help of
the NGOs and other funding organization to
run the hospital affairs. This is such a
massive tertiary hospital everyone could
feel pride to take charge in their hand, and
a responsibility of 5 million people of
Karachi.

EXTRACT OF STUDY:
The purpose of sharing this study is
highlighting the unavailability of
Government sector hospitals in
Karachi. Those present, are working
far below standards. Hence its an
appeal to the Government to kindly
look into the matter and understand
the fact that nothing is important
 more than health and education. If
you fail to provide standard health
and education, then how tall and
magnificent infrastructure you build,
you in yourself remain a failure.

REFERENCES:
 Comparison and analysis of health
care delivery
system: Pakistan versus China
1ST JUNE 2014, SHAISTA TAUFIQ,
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 SUHAIL ANWAR (2008) HEALTH CARE
DELIVERY IN KARACHI. THE WORST OF
BOTH WORLDS; 14(1),1-2.
AHMED
 AHMED J & SHAIKH B.T (2008) AN ALL
TIME LOW BUDGET FOR HEALTH CARE
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PHYSICIANS AND SURGEONS; 9(1),390.
 M.M KHAN & HEUVET (2007), THE
IMPACT OF POLITICAL CONTEXT UPON
THE HEALTH POLICY OF PAKISTAN ;
39(1),73-74.
 SUHAIL ANWAR (2008) HEALTH CARE
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 GLOBAL HEALTH WATCH 2005-2006,AN
ALTERNATIVE WORLD HEALTH REPORT;
10(3),1.
 ZOHRA KURJI,ZOHRA SHAHEEN
PREMANI & YASMIN MITHANI,
ANALYSIS OF HEALTH CARE SYSTEM OF
PAKISTAN, LESSON LEARNT AND
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