Rural-urban divide
THE inferno resulting from the oil spill at Ahmedpur Sharqia in south Punjab in June this year resulted in more than 200 deaths. The nearest burns centre was 150 kilometres away — and it had the capacity to treat only 10 patients, while the number of burns victims was much higher.
Another incident took place on Feb 16 this year when a suicide blast inside the shrine of Lal Shahbaz Qalander in Sehwan, Sindh, killed 90 persons while over 300 were reported to have been injured.
In Sehwan, to save the lives of the wounded, visitors to the shrine and other citizens on their own took them to the Taluka Hospital Sehwan — where there was no functional burns ward or trauma centre. When some among the wounded were taken to the Liaquat Medical University in Jamshoro, they encountered the same situation. With the exception of Karachi, there are no reasonable tertiary-care hospitals in Sindh. It must be noted that Balochistan also depends on Karachi for tertiary healthcare.
These incidents have raised several questions — the ones that top the list pertain to the absence or lack of health facilities in suburban areas and semi-rural cities across the country. Most tertiary-care hospitals with a burns ward, trauma centre, cardio and dialysis facilities, etc exist only in the main cities of the country, ie Karachi, Lahore, Islamabad and Peshawar.
It is time to prioritise the needs of the smaller cities.
Over the last several years, while researching education and health facilities in Pakistan’s second- and third-tier cities, I felt that these places are ignored not only by governments and wealthy individuals who can make a difference but also by international aid agencies; in fact, local philanthropy programmes also tend to ignore them.
On the contrary, not only do hospitals and educational institutions located in urban centres such as Karachi, Lahore, Peshawar and Islamabad receive ample support from the federal and respective provincial governments, but NGOs, individual donors, international agencies also generously fund them — which is fine if some support is also extended to the rural areas.
The principal reason behind rural to urban migration is the neglect of rural areas in most parts of the country. The influx of people moving to the bigger cities in recent decades has mainly been due to the lack or absence of income-generating activities, health and education facilities in the rural areas.
Keeping in view the population influx and pollution, water and sewerage problems in the bigger cities, it is high time we prioritised the smaller cities by supporting and financially strengthening all institutions especially those in the health and education sectors by investing in them in spite of their uninspiring appearance.
An improvement in the condition of government-run hospitals is possible as the example of two teaching hospitals in Peshawar shows.
One can appreciate the initiative taken by the KP government to curtail bureaucratic delays and undercut the influence of vested groups by passing the Medical Teaching Institutions Act in 2015. This law has given autonomy to the top government-owned health institutions in KP. They work under a board of governors, whose members are selected by a search and nomination council. The members of the council are retired individuals; they have good contacts nationally and internationally, and they come from various walks of life. They are also known for their philanthropy.
The two teaching hospitals that I visited last month appeared to have the same facilities that one sees at the most expensive private hospitals in Karachi. But these hospitals charge a fee of Rs20. The MTI Act 2015 has allowed them to hire the best people and offer them competitive salaries, which has discouraged private practice. They can hire and fire people based on their performance and purchase the required machinery and other items as and when needed. Earlier, I was told, even if the staff required a syringe, the matter had to go through a thicket of red tape. Sometimes they ended up with medical items that were not needed; most of the time, they did not get even that which was badly needed.
There was a similar situation when it came to hiring. They depended on the process of the schedule of new expenditure, and it took years to employ people. Now they have hired a director facilities, who is responsible for housekeeping, repair, maintenance etc.
Other provincial governments can follow KP’s example and allow hospitals and other institutions to independently do what they are supposed to do. Investing in the health and education of people in suburban districts is as much the need of the hour, as is giving autonomy to institutions after constituting the best board of directors to get the best people at the best possible pay and perks, without letting biases creep in.
The writer is a social development professional.
Twitter: @AnitaLakyary
Published in Dawn, August 8th, 2017