LAHORE: In order to improve health facilities for the man in the street, the Punjab government will “outsource” the rural health centres (RHCs) and basic health units (BHUs) of the six low-performing districts in the province.

The idea had been derived from the ‘Khyber Pakhtunkhwa Model’ where the government had taken this initiative by exploring other options to reform the primary and secondary levels such as district hospital autonomy and contracting out facilities including district headquarters hospitals, tehsil headquarters hospitals, RHCs and BHUs, an official told Dawn on the request of anonymity.

The KP in its report ‘Health Sector Strategy 2010-17’ had indicated this option and later materialised this scheme by giving key responsibilities to the district coordination officers, NGOs and EDOs of health.

Idea stems from KP health reform model

The Punjab government has decided to take the initiative in phases and initially identified the RHCs and BHUs of low-performing districts including Nankana Sahib, Bahawalnagar, Narowal and Mandi Bahauddin. It would extend the scope to the THQs and then to the DHQs.

The health secretary told Dawn on Wednesday that the government would invite bidding from the interested firms to outsource the RHCs and BHUs of the six selected districts. He said according to the agreement, the government would transfer the annual budget of the “outsourced” health facilities to the account of the qualified firm which would distribute it among the respective staff.

He said the firm would be bound to retain the government staff of the health facilities and on finding the poor performance of any staff, the authorities would transfer him/her to the hospital other than that manned by the firm. However, it would be entitled to hire new medics and other staff on its own terms and conditions and salary package in order to make the government health facilities fully functional. There would be a third-party evaluation to ensure service delivery, he said.

The health secretary said that under the agreement the public property including land, equipment and other infrastructure of the health facilities would belong to the government. A cluster of the identified facilities would be formed according to the geographical perspective, for example, a RHC would be attached to some 20 BHUs nearby to facilitate the local residents at their doorsteps.

A BHU is located in a union council and serves a catchment population of up to 25,000 people and provides all health care services along with integral services that include basic medical and surgical care, malaria and TB control. The qualified firms would ensure maximum services under the agreement which would be extendable on the basis of the performance.

Similarly, each RHC serves a catchment of population of up to 100,000 people. It provides promotive, preventive, curative, diagnostics and referral services along with in-patient services besides clinical, logistical and managerial support to the BHUs, LHWs, mother and child health centres and dispensaries that fall within its geographical limits. The RHCs also provide medico-legal, basic surgical, dental and ambulance services.

Answering a question, the health secretary said the staff including doctors, nurses and paramedics of the outsourced health facilities would enjoy all the privileges like service rules and promotions. He said this new scheme was being launched after some other initiatives to make the primary level health facilities fully functional proved futile despite huge spending.

In a handout issued on Wednesday, Adviser to Chief Minister on Health Khwaja Salman Rafique said the government would not hesitate to outsource the BHUs to ensure provision of health facilities at the doorsteps of the people. He said the government’s responsibility was to provide budget, make policies and ensure implementation.

Published in Dawn, May 14th, 2015

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