PESHAWAR: The absence of referral system has been causing disruption of patients’ treatment requiring tertiary care services as people with routine ailments continue to visit medical teaching institutions (MTIs) in Peshawar.

“We have more than 1,500 beds in the hospital which remain occupied throughout the year for the simple reason that patients are coming from remote districts to Peshawar despite availability of senior doctors and facilities in their areas,” the director of one of the Peshawar-based MTIs told Dawn.

He said that about 80 per cent patients visiting MTIs could be treated in district headquarters hospitals. He said that a proper referral system was need of the hour as increasing beds in MTIs was not a solution.

“Our hospitals are meant to provide services to the people, who require tertiary care treatment but most of the patients coming here suffer from minor health issues that are easily manageable in their native hospitals,” he said.

Experts term proper referral system need of the hour

Officials in health department said that government had planned to pioneer referral system at two hospitals in as many districts and extend it to other districts afterwards.

“We have more than 2,600 health facilities across the province and more than 60,000 employees including doctors, nurses, paramedics and support staff whereas the number of MTIs is 10,” they said. However, they said, 70 per cent of the patients preferred to seek treatment in MTIs which deprived serious and chronic patients of the specialised treatment they required.

The medical director of another MTI echoed the same complaints. “We cannot refuse patients despite the fact that most of them can be cured in their local hospitals. As a result, we have to refer the chronically-ill patients to other MTIs for non-availability of beds and in many cases, those patients shuttle among MTIs for want of beds,” he said.

He said that there were about 4,500 beds in three MTIs in Peshawar that were more than enough for serious patients if they put in place a proper referral system. The situation with regard to neonates and children was extremely worrisome as MTIs had to admit three patients on a single bed that caused infections, he said.

The lone Burn and Plastic Surgery Centre is required to handle patients with more burn injuries that are not manageable in the district headquarters hospitals but one cannot find empty bed because patients from all over the province are being shifted to the centre for treatment.

“In many districts we have developed burn wards, which are being run by our trained plastic surgeons. They can refer critical patients here and treat the normal ones locally. But people continue to bypass their own hospitals and transport their patients to Peshawar even with minor injuries,” a plastic surgeon told this scribe.

He said that besides doctors they were imparting training to nurses and paramedics from different districts to improve management of burn cases at district level but patients’ flow to the centre continued to rise.

Officials at health secretariat told Dawn that government was developing district headquarters hospitals to lessen load on tertiary care hospitals in Peshawar. “We have started work to develop referral system as well. Without a referral system, upgradation of non-MTIs at district level will not make any difference,” they said.

They said that health department wanted to devise a mechanism under which patients with moderate illnesses were admitted and treated in local hospitals and those requiring specialised services were sent to MTIs through proper channel.

Published in Dawn, March 17th, 2025