During one of my visits to Sindh, I was perturbed to see the health care situation of the districts. I talked with district health and nutrition managers, visited basic health units and sat with local communities and came to a conclusion that the plague of corruption, political pressure and lack of accountability has spread deep into the governing body of the province.
The political monopoly of leading parties in Sindh has done little to fix health crises of the province. The province lags behind the rest of the country in health indicators in spite of increased budget allocation of 26% in 2017-18 over last year’s allocation. However, the district health situation still presents a grim picture. The improvements though present are so small and unnoticeable that they can barely help to elevate health standing of the province. The district health representatives as well as the health care providers share endless rants about obstacles in service delivery. The obstacles that include corruption, political interest, lack of human resource and irregularities in purchase of medicines and vaccines.
The budget allocated Rs 2.4bn for the Lady Health Worker (LHW) Programme, with the deployment of more than 2,100 LHWs. The Sindh Immunization Support Program was allocated Rs 8.09bn while Rs 690.14 million was allocated for strengthening and expanding the Extended Programme for Immunisation [1]. The district level data indicates that a vast area is still uncovered due to which one LHW has to cover the population of 2-3 union councils. Therefore, a substantial portion of population remains unaware about health promotion, routine immunization and vaccination. Continued irregularity in salaries has curbed the enthusiasm of extension workers. The role of LHWs in informed decision regarding health and nutrition of family is influential but the capacity building and field monitoring of LHWs need serious review as there is lack of uniformity in messages promoted by LHWs (I met some LHWs in Nausheroferoz who emphasised the benefits of giving goat milk to a new born rather than mothers feed).
Shortage and unequal distribution of trained staff and doctors at primary and tertiary health care facilities is another factor that restricts service delivery. This shortage is caused by unavailability of educated and trained human resource as well as preference for working in major cities.
Accountability lacks at district level primarily due to political affiliations and peer pressure. The district authorities are well aware about false reports of extension workers and monitoring visits and misquoted coverage figures of routine programmes. Still they are more inclined towards keeping pace with politically affluent and less bothered to bring transparency and accountability in to the system.
The province faces constant threat of health emergency due to food deficiency. Malnutrition in Sindh is still strong despite of all aids, grants, accelerated action plan and community outreach programmes. The province faces acute nutritional deficiency in districts of Tharparkar, Umerkot, Badin, Sanghar and Jaccobabad. The situation is not good in other districts as well and needs urgent and sustainable treatment.
According to the National Nutrition Survey (2011), Sindh has the prevalence of wasting at 19%, underweight at 40% and stunting at 26% [2]. The Multi Indicator Cluster Survey (2014) for Sindh found out that 72% of households were food insecure [3].
Poverty, frequent births, early marriages, anaemic mothers and poor food choices are some of the reasons for alarming rise in malnutrition and stunting in the region. High nutritional diet does not appear frequently on food tables of middle to low income households - the daily-wagers group. Health is not a priority and nutritional deficiency among women and children is seldom taken seriously and goes unnoticed until it becomes chronic. It is vital to promote food sufficiency through kitchen gardening and educate communities about benefits of foods that are high in iron and other micro nutrients (the most common food items were found to be biscuits, tea and potatoes).
The Sindh Government with assistance from the World Bank conceived a multi-sectoral project to combat stunting and malnutrition in the province. The project brought various departments like health, agriculture, livestock and fisheries, planning and development, population, welfare, education etc. under the umbrella of an ‘accelerated action plan’ to ultimately improve nutrition at the core. An allocation of Rs 1bn per year was fixed through the development fund. The project aimed to target districts where the stunting rates are above 30%. A provincial stunting task force has been constituted for strategic guidance and policy direction and commitments have been made but the progress on these is still awaited. The future of Sindh Health care Commission also seems uncertain despite four years since the bill was passed.
A party that has been governing the province for the last decade, maintains a large vote bank, and claims Sindh as its center of power, one wonders why it has failed to uplift its health sector. The province is in dire need of a health system that strengthens the health synergies and caters to the entire population, however it seems that its favourite leadership has not still realised the core problems that threaten its people. It is high time that it place nutrition at the forefront of their party agenda and bring accountability and transparency in public health system and health workforce.
Links:
1.
http://fdsindh.gov.pk/site/userfiles/Budget%202017-18/BUDGET%20SPEECH%202017-18/BUDGET%20SPEECH%20ENGLISH%202017-18.pdf
