HYDERABAD: One of the major reasons behind recurrence of newborn deaths in Tharparkar is the failure of dispensaries and basic health units to provide adequate treatment to the ailing mothers and their babies, compelling them to rush to Mithi civil hospital, and thereby stretching its already scarce resources to the limit.

According to official statistics, about 70 per cent government dispensaries in the desert region are either partly functional or without having an ‘approved schedule of new establishments (SNEs)’.

In bureaucratic jargon, a government establishment or infrastructure without an SNE will have no budget, no staff, no furniture and other facilities necessary for running it, thus seriously crippling its capacity to function.

Such establishments are run often on ad hoc basis by sending there some staff posted somewhere else and arranging material enough to make it run.

In Tharparkar, 26 posts of doctors, 25 of them BS-19, are still lying vacant, inquiries by Dawn showed on Wednesday.

The arid region is again in the eyes of media because of newborns’ death which have risen to 13 to date, according to Tharparkar’s District Health Officer (DHO) Dr Arjun Kumar who attributed the deaths to birth asphyxia, underweight, premature labour, diarrhoea and pneumonia.

Sources in health department said that Tharparkar health facilities were under dual management of the People’s Primary Healthcare Initiative (PPHI) and the provincial health department.

The PPHI caters to needs of 21 per cent of Thar area through 49 facilities, 31 basic health units (BHUs) and 18 dispensaries, whose budgets are with PPHI, while the health department manages six rural health centres (RHCs), four taluka hospitals and Mithi civil hospital.

Thus, out of total 256 health facilities, 49 are under PPHI and 30 under the health department which makes 79 in all with approved SNEs. But, a staggering 177 facilities or 69 per cent of the total are yet to have SNEs for which health authorities offer various explanations.

According to break-up shared by DHO, Tharparkar has, in all, 207 dispensaries and 30 of them have approved SNEs for medicines, equipment and human resource.

“Besides, 31 BHUs and 18 dispensaries are with PPHI with approved SNEs. Of the 177, 85 were established last year whose staff has been appointed but their budget for medicine is yet to be allocated,” he said.

He claimed that 92 of the facilities under the health department were being run with medicines received in aid. “I seriously doubt if these facilities are fully functional,” said a source in the health department.

If the six RHCs, dispensaries and taluka hospitals been working satisfactorily, the entire burden of newborns would not have landed at Mithi civil hospital, he said.

Secretary Health Saeed Ahmed Mangnejo gives a different explanation. He said that furniture of 85 dispensaries had been made available and staff — appointed last year — would draw their first salary now whereas tenders for medicines supply would be floated soon.

“It will take some time. I don’t have exact numbers but there are also some dispensaries which health department has opened on experimental basis,” he said.

He said that these dispensaries were opened in all districts including Thar over community’s demand, hence by the time they received their infrastructure they would keep working experimentally.

Except for 85 new ones, he admitted, there could be a large number of such experimental dispensaries in Tharparkar.

“The dispensaries and BHUs that the health department has handed over to PPHI are fully functional,” he said.

Most deaths of newborns, as confirmed by authorities right form health secretary to director general of health services and down to the DHO of Tharparkar, are reported at Mithi civil hospital.

In view of these figures, a safe assumption can be made that since dispensaries are not functional, the parents eventually rush to Mithi as a last resort.

Tharparkar has been a victim of official neglect for decades. Figures about doctors’ availability indicate that 64 doctors were appointed on contract basis in 2014 for two years in BS-17/18, who included chest specialists, paediatricians, anaesthetists, gynaecologists.

“Unfortunately, doctors are unwilling to work in Thar because they cannot earn much from private practice there,” said Senator Taj Hyder. “That’s why we appointed 60 Thar-domiciled doctors on contract basis with comparatively lucrative salary package equivalent to their counterparts in BS-18,” he said.

Hyder, Sindh PPP general secretary, has been looking after relief operation in the desert for two years. “Now their contracts are nearing an end and we are pondering over whether to renew them or regularise their services. If we regularise them then they will have a cut in their salary to be equal to a BS-17 doctor,” he said.

He disclosed that the government had ensured that the 60 doctors had Thar address in their identity cards and submitted a bond in this regard as well.

Trend of babies’ deaths

About 350 deaths of newborns because of malnutrition were reported in Mithi hospital last year.

Perhaps, the PPHI has not taken the trouble to analyse whether the malnourished newborns were from the areas falling under the BHUs and dispensaries it managed as Mirpurkhas regional director Riaz Rahujo insisted that no death was reported last year or this year at any of PPHI’s facility.

DG of Sindh health services, Dr Hassan Murad Shah, said: “The situation is not that alarming. Sporadic cases of diarrhoea are reported. There is in fact no outbreak of diarrhoea. Infant mortality rate in Thar is lesser than other areas and mostly one day to three day old babies have died”.

Mr Rahujo conceded that PPHI must see whether last year’s or latest deaths among newborns were from the areas under its cover.

“There is a possibility that in some cases parents might have directly reported the district hospital but no such case had been referred from our facility,” he said.

He considered trend of early marriages amid lacking birth spacing as main culprit behind newborns’ deaths. “We deal with cases in which an underage woman is at lactating stage while having a two month pregnancy at the same time,” he said.

Published in Dawn, January 7th, 2016