Pakistan: The sad state of Punjab hospitals

There is a common perception, based on public experience, that while Pakistan boasts some of the best medical professionals, patients often times suffer from complications due to poor quality of care in hospital wards, even in intensive care units. A press report about the conditions in Punjab hospitals confirms that perception. It points out a number of factors that account for poor quality of medical care in the province. Using information gathered from the administration of 12 major tertiary care hospitals in the province, the report concludes that there is no critical care specialist available in any of the government-run institutions. The reason is obvious: even though such specialists occupy important positions in teaching hospitals, they prefer to spend more time in private clinics collecting large sums in fees and/or through partnership profits.

As per expert opinion, one out of every ten patients in emergency wards usually requires attention in an intensive care unit. But all the major hospitals in Punjab have just 250 ICU beds. And other conditions too are a lot less than satisfactory. For instance, the World Health Organisation recommends one nurse for each bed in an ICU. In the province's public and private hospitals one nurse looks after three or more patients. The list of problems goes on and on. The Dental Institutions Recognition and Accreditation Standard Regulations, 2012, says that "at least 15 ventilators should be available for a 500-bed hospital". The report narrates the story of one particularly patient in need of a ventilator support. The family had to travel all the way from Sahiwal to the provincial capital for help only to discover that a major government hospital could not provide the needed support for being fully occupied, and the one private medical centre that admitted the patient in its intensive care unit did not have a ventilator. The patient died without getting the required treatment, but with a huge bill to be paid.

The episode underscores two sordid realities in the largest and relatively affluent province: one that important rules and regulations are being openly violated right under the nose of a chief minister who likes to be seen taking a hands-on approach to health issues. Second, the provincial government does not have its priorities right. There is greater focus on flashy, attention getting projects than on improving the quality of health care for a maximum number possible. Also, the system suffers from different weaknesses that need to be addressed effectively. The present trend of appointing senior health department officials and hospital executives on the basis of political connections must come to an end, making merit the only criterion for selection. The right person should get the right job. Equally important, the accountably mechanism needs to be strengthened. Anyone flouting the accreditation standards and rules set by the Pakistan Medical and Dental Council must be held to account in a manner that serves as a deterrent for all concerned.