WHILE the efficacy of the Sindh government’s inaugural event for the Sindh Development Forum remains to be determined, it is high time that the provincial government revaluate its commitment to ongoing projects, particularly in the health sector.

Despite a jump of 26 per cent in budgetary allocation for health — from Rs79.88 billion to Rs100.32bn — for the current fiscal year, Sindh’s population continues to ail.

According to the Sindh Multiple Indicator Cluster Survey (MICS) of 2014, the sole recent one available, infant and under-five mortality rates were 82 and 104 deaths per 1,000 live births, respectively.

This represents an alarming rise from the Demographic and Health Survey (DHS) of 2012 where the infant and under-five mortality rates were 74 and 89 deaths per 1,000 live births.

Sindh Bureau of Statistics officials tell Dawn that the next MICS was due for 2018. It is hoped that health indicators reflect positively on the huge sums of investment under the government’s Public-Private Partnership (PPP) programme launched after the Sindh Public-Private Partnership Act of 2010.

Outsourcing government hospitals to the private sector has resulted in better service delivery, but some officials believe not all is well in these dealings

Designed to enhance health service delivery by contracting out various health facilities to the private sector, the PPP programme became operational in 2016.

These partnerships have resulted in better service delivery. Before Indus Hospital, a partner in the initiative, Civil Hospital Badin had an outpatient department of 200, which swelled to 1,000 per day after being contracted out, according to a newspaper report.

Under Medical Emergency Resilience Foundation’s (MERF) management, one District Headquarters Hospital, four Tehsil Headquarters Hospitals, and eight Rural Health Centres in Thatta and Sajawal began running twenty-four seven, with the overall OPD attendance swelling to 105,457 in February.

Integrated Health Service (IHS) effectuated numerous technological reforms to improve staff attendance, from developing apps to monitor compliance to providing bonuses for achieving targets. With their efforts, OPD attendance jumped from 887,633 in 2016 to 1,563,357 in 2017.

Poverty Eradication Initiative’s (PEI) — another organisation part of the PPP — upgradation of Children Hospital North Karachi culminated in around 2,000 patients visiting the hospital per day as compared to 150 in 2016, and admissions rose to 120 patients daily from the one to three patients before contracting out.

Regrettably, the PPP initiative also facilitated underhand dealings, sources say.

According to the Request for Proposal documents seen by this writer, the districts selected for the PPP pilot were Thatta, Tando Mohammad Khan, Sajawal, Tharparkar, Hyderabad, Larkana and Benazirabad, besides Lyari Town, Saddar Town, Gadap Town, and Korangi Town in Karachi.

However, Civil Hospital Badin — whose Rs500 million contract was awarded to Indus Hospital — was never included in the procurement process, a former government official says.

However, to a query about documentary evidence of the agreement, Indus Hospital CEO Dr Abdul Bari Khan responds: “Yes, we have the relevant documents. The agreement isn’t possible without them.”

Another questionable dealing was of the contract (originally awarded to Merlin International) sublet to MERF, which had only registered with the Securities and Exchange Commission of Pakistan (SECP) in 2015. This contradicted the eligibility criteria of five years’ relevant history listed in the Expression of Interest.

“In 2015, Merlin decided to close operations in Pakistan. We decided to carry on the legacy and work of Merlin. So, an organisation was registered with the SECP under the name of MERF. We approached the Sindh government to see if they were interested in the same people, the same managerial procedures to let us continue. After due process, they agreed,” explains MERF Director Operations Sayed Ghalib of the merger.

Murkiness also shrouds the government’s dealing with the IHS — another partner in the PPP programme — as reportedly all the districts offered were never part of the procurement. The Sindh government has also been tight-fisted about releasing necessary funds to their partners.

“Unfortunately, the government has not released any of the development funds so far, although we keep requesting for them. We are managing with the budget given to us, but we cannot construct new rooms; I am not satisfied with the state of the facilities,” says IHS Executive Director Dr Asim Mahmood.

“This year we were given around Rs473m, which was less than the allocated budget of Rs480m last year. Our request was for Rs600m. We do as much as possible from our operational budget, but it is not enough at all,” adds Mr Ghalib.

Shahid Yusaf, programmes director at PEI, however, says, “The government budget was around Rs400m. We still haven’t exhausted the budget for the first year; there have been significant savings in trying to do things smartly.”

A reliable source also contends that independent financial and technical audits of these organisations were still pending, a claim that the organisations refute, barring PEI which says the government has yet to confirm its auditor.

“It’s not possible that organisations haven’t had audits if that’s part of the agreement. If someone has told you that, then it’s wrong information,” says a health department official.

Published in Dawn, The Business and Finance Weekly, March 26th, 2018