INTRODUCTION

The role of BHUs in treating common diseases among local population cannot be ignored. BHUs
are the first level care facilities to provide healthcare to local communities. Pakistan having population of
more than 200 million people has extensive network of BHUs. Pakistan is a nation that has made progress
towards economic development but is struggling towards sustainable development.
Most of these BHUs have not been fully utilized with average number of only 10 to 20 patient reporting
per day due to reasons like administrative, infrastructure problems, non-availability of medicine, problems
with attitudes of health professionals and inaccessible locations. Health system now focuses on their
primary health services through clinical and financial aspects to get better results and in turn whole health
system becomes sustainable. For provision of high quality of primary health care services there is a dire
need to develop methods for quality assessment and monitoring system.Physical structure of these
centers should incorporate availability of all required equipment and continuous supply of drugs to meet
needs of population. In addition to this, availability of staff and their behavior is also important to
strengthen the role of these facilities in the provision of health services.
China has made large investments in health by upgrading its primary health care level by making it
more affordable, accessible and according to the needs of people. Patient’s experience at a health facility
is a major determinant of trust and satisfaction with services provided. Countries having strong primary
health care systems have reduced morbidity, increased longevity of people and increased equity in health
outcomes.

This study is aimed to assess the service provisions of Basic health units of Bannu district. This
will improve our understanding about the service provision in these facilities and will alert the
governmental agencies about the deficiencies identified.

MATERIAL AND METHODS

Sample Size and Criteria for Selection
A cross-sectional descriptive study was carried out to assess the quality of 05 BHUs out of total 35 BHUs of
district Bannu, BHUs were selected through convenient sampling techniques in the outskirts of Bannu. The unit of study
was individual irrespective of age and sex of the respondent. Looking to the aim of the study and available resources ,
only 20 individuals were randomly selected from each BHU. In this way a total of 100 subjects were selected from 05
BHUs.. Though the sample size may or may not be enough to represent the whole district, but it can indicate the actual
position of utilization of healthcare at BHUs in Bannu.

Data Collection
A simple questionnaire form was used to collect information regarding the utilization and availability of healthcare at the
Basic Health Unit . Before interviewing, the individuals were briefed about each question in the form. Keeping in view the
education level of the respondents, the questions, originally framed in English, were asked in local language i.e. Pushto.
Emphasis was laid to get information in a friendly atmosphere and in privacy, so that the respondent may not feel
embarrassed and hesitate answering in the presence of others. The data was collected during a period of three months.
A thorough analysis of BHUs was done in three domains which were staff attitude, availability of essential drugs , and
facilities available at these health centers. Likert scale was used to assess these domains and questionnaires were filled
by patients or their attendants.

Data Analysis
The collected data was analyzed using computer software (Ms Excel). The percentages of answers of each question
were determined and presented in tables.

RESULTS
Availability of clean water
Regarding availability of water, 75% of the patients said that clean drinking water was
available during their stay at health unit, while 50% of patients said that there was no electricity at
BHU during their visit. The number of patients per day was calculated (during working hours from 8
am to 2 pm) after consulting the respondents and by taking record of medical registers and average
number of patients was 15 to 20 per day.

Extent of Satisfaction/Dissatisfaction with Existing Health Facilities

The subjects were also asked about their satisfaction on the overall health facilities as presented in Table 1 . Out of 100
respondents in the project area, 65 (65%) expressed their dissatisfaction on the health services. They complained about
the shortage of good quality medicines in the Basic Health Unit of their villages. Moreover, they complained about the
unavailability of the qualified doctors in these health centers. Since there is also scarcity of transport service in the night
time, so in case of emergency it becomes very difficult for them to reach the general hospitals of the city on time.
Therefore, the respondents need 24 hours service in B.H.U’s, or at least 24 hours emergency service that will meet the
requirements of the villagers in case of emergency.

Timely appointment

Regarding the staff, results were mostly positive with 90% of respondents claiming that their appointment was on time
and claiming that the staff was cordial and welcoming as present in table 2.

Communication with the staff

The respondents raised concerns over the communication and behavior of
Health staff at BHU. 50% of respondents claimed that the behavior of staff was very poor and 50% claimed that the
behavior of staff was good, cordial and welcoming( table 3). The analysis of narratives of respondents shows that the
unfriendly attitude and behavior of BHU staff caused negative feelings among those interviewed.

Availability of Free Medicine

When asked about availability of medicine , 75% claimed that they did not receive any medicine ( table 4 ). They
reported that the incomplete and unavailability of free medicine is a main factor that pushes them to go for private care.

Respondents raised complains in the following words;

 “ The medicines are only given at the beginning of the month. If I need medical care in the later days of the month,
the medicine is not available. The staff say that the current supply of medicine is not sufficient.” ( female respondent ,age

35 )

“ I can not afford to go to a private clinic, so I rely on healthcare in BHU. Therefore, I have to wait until the start of

last month.” ( Male respondent, age 28) The respondents further disclosed that the medicine given was of low quality.

Accessibility of BHU
When asked about accessibility of BHU, 65% of respondents claimed that BHU was accessible to them and 35% raised
their concerns about the inconvenient location of BHU ( table 5) . Due to long distances from home to BHU and lack of
transport , the use of BHU services are hindered , particularly by the women. The women face accessibility problems due
to lack of transportation facilities. Moreover, their access to BHU becomes more problematic because their
unaccompanied travel to health facilities is not seen as honorable in local society.

Use of Family Planning Services

As can be seen in Table 6 , as a whole 65 (65%) respondents in the project area reported to have practiced family
planning methods and have visited the BHU for family planning services as against 35 (35%) respondents who did not
practice family planning methods. The different contraceptive methods found to use by the respondents were injections,
condoms, and oral pills.

Attitude towards Expanded Programme on Immunization (EPI)

EPI is working against six communicable diseases namely Tuberculosis,
Poliomyelitis, Diphtheria, Whooping cough, Neonatal Tetanus and Measles. The services of EPI is available free of cost in
almost every health centers of the country. The response and attitude of the villagers reported by the sample
respondents was very encouraging, which can be seen in Table7.

Lack of laboratory and diagnostic services

At BHU level, it is mandatory to provide laboratory services. However, unavailability of diagnostic tests for chronic
disease such as diabetes, TB and widal were not available. Out of 5 only one BHU provides laboratory services.
Tab1: Response towards health facilities in the project area

BHUs Satisfied
Yes %age No %age
Bizen Khel 0 0% 20 100%
Jando Khel 5 25% 15 75%
Azim Kila 12 60% 8 40
Khalifa Gul Nawaz 13 65% 7 35
Nizam Bazar 5 25% 15 7
__________________________________________________________________________
Project Area 35 35% 65 65%
 Tab2. Response
towards wait time
BHUs Wait Time
Short %age Long %age
Bizen Khel 18 90% 2 10%
Jhando Khel 17 85% 3 15%
Azim Kila 19 95% 1 5%
Khalifa Gul Nawaz 19 95% 1 5%
Nizam Bazar 17 85% 3 3%
_____________________________________________________________________________
Project area 90 90% 10 10%

Tab3. Communication with

the staff
BHUs Communication
. Good %age Very poor %age
Bizen khel 12 60% 8 40%
Jhando Khel 10 50% 10 50%
Azim Kila 8 40% 12 60%
Khalifa Gulnawaz 10 50% 10 50%
Nizam Bazar 10 50% 10 50%
_______________________________________________________________
Project area 50 50% 50 50%
Tab4. Availability of
medicine
BHUs Availability of medicine

Yes %age No %age

Bizen khel 8 40% 12 60%
Jhando Khel 4 20% 16 80%
Azim Kila 2 10% 18 90%
Khalifa Gulnawaz 5 25% 15 75%
Nizam Bazar 10 50% 10 50%
_________________________________________________________________
Project area 25 25% 75 75%
Tab5. Accessibility of BHU

BHU Accessibility

Yes %age No %age

Bizen khel 15 75% 5 25%
Jhando Khel 12 60% 4 20%
Azim Kila 18 90% 2 10%
Khalifa Gulnawaz 10 50% 10 50%
Nizam Bazar 10 50% 10 50%
__________________________________________________________________
Project area 65 65% 35 35%

Tab6. Family planning

services
BHU Services availed
Yes %age No %age
Bizen khel 12 60% 8 40%
Jhando Khel 10 50% 10 50%
Azim Kila 10 50% 10 50%
Khalifa Gulnawaz 18 90% 2 10%
Nizam Bazar 15 75% 5 25%
_____________________________________________________________________
Project area 65 65% 35 35%
. . . . . .