.. by Islamuddin
For the past few years the people of Pakistan are being given awareness about their constitutional rights to free quality education, health care and sustainable development. However the level of performance of pro-change forces, like the PTI, leaves much to be desired. Marginal improvements in some sectors did take place in KP during the last 5 years but much more could have been achieved had there been genuine commitment, expertise and leadership. Bhutto?s charisma could not sustain PPP for long and so would the charisma of Imran Khan. The party has to perform and institutionalize itself with clean and competent leadership to inherit the charisma. Without transferring individual charisma to institutions, sustainable development is impossible, as is borne out from the experience of Malaysia, where 80 year old Mahatir had to step in to save the system that he had so painstakingly put in place, which was now in danger from government corruption.
A case study of Chitral would be in order to gunge the level of corruption and misgovernance that need to be corrected. Millions if not billions have gone down the drain in the name of development but no heads have so far rolled and the culture of impunity still reigns supreme. While it is true that more has been done by NGOs, especially AKDN, to improve the quality of life of the people but the resultant growth of parasitic mindset, jobbery and culture of impunity, owing to the lack of transparency and accountability, have largely mired the gains. About the development projects funded by the government, the less said the better. Not more than 40% of these funds have filtered down to benefit the people with the bulk having been pocketed by sponsors, their favourite contractors and relevant government officials. By way of example we can refer to some recent projects in my own area. Apart from minor ghost projects to benefit party loyalist, few on ground projects billed as mega in the local context, either could not be operationalized or sustained due to substandard construction. These include roads, power houses and drinking water projects.
In the education sector the situation is no better either. Instead of strengthening existing primary school system, informal schools have been established with one teacher and room. Jobbery rather than the cause of education appears to be driving this initiative. It would have been in the fitness of things(cost effective too)to reinforce formal primary school system by increasing number of teachers and provision of facilities rather than adding up to the burden. It is universally recognized that without improving primary education, higher education cannot be improved. On the one hand the government promises universal literacy but on the other puts age limits for admissions to different levels.The establishment of Chitral University is a dream come true but despite lapse of years, this university is housed in a temporary building and forced to offer courses in anticipation of HEC approval. It is hoped that students passing out do not meet the fate that others in similar situations have faced elsewhere for no fault of their own. The subjects being offered also leave much to be desired. Modern and emerging disciplines must be included in its programs.
Commercialism, which is the bane of private sector education, is slowly creeping into the government sector. Community based colleges, charging nominal fee, are nor only made to pay handsome contributions to the universities that they are affiliated with but also pay heavy amounts to regulators annually and in return get no services at all. This is a disincentive to quality, affordable, not- for- profit and self help community based initiatives Our suggestions that community based colleges should not be equated with private colleges having pure commercial considerations, have fallen on deaf years and so has our suggestion (that I made as Chairman PTI District Education Monitoring Committee) to designate Chitral as mountain area for the purpose of vacations. Unlike hilly areas, the mountain areas of Chitral have pleasant summers and harsh winters. We do not need summer or spring vacations; instead we need long winter vacations (December to February). This would spare us the cost of fuel, influenza and abstentions in classes.
The situation in the health sector is even worse. According to media reports, people with moderate health issues are referred to Peshawar because there are no specialists or facilities in the DHQ hospital. In average 50 patients are referred to Peshawar every week and those who cannot make it to Peshawar due to financial constraints go back home to wait for the miracle that religions have made them to believe. At least three Tehsil hospitals in Mastuj, Torkhow and Lotkuh have been outsourced to AKHSP, which has renovated them with the help of donors and also got ISO certification, the cost of which have to be borne by the poor communities. The constitution of Pakistan promises free health care, which is available in other more affluent areas of Chitral, including DHQ hospital but ironically the remote regions stand deprived and have to pay for these services which only the rich can access and the poor are left with no option except to self medicate, visit chemists, quacks or wait for the inevitable. When there is 100% poverty around Patient Welfare Fund or Baitul Mal can be used discriminatorily and the only way out is free treatment.
After increasing public demand, high ups of the Health Department and AKHSP recently visited these partnership hospitals. The Health Department officials were impressed with hospital hygiene, quality of medicines and equipment which they confessed that cannot sustain and therefore these hospitals should remain with the current management. Hopefully the government would subsidize cost of health care in these hospitals in the same way that it has done for other government hospitals, e.g entry fee would be reduced to Rs.10 and not Rs.150/ that is being charged at present and which keeps patients away.
At least three specialists for Gynecologist,Physician and Surgeon may be provided along with one Medical Officer each for dentistry, female and male patients. ISO certification will have no meaning for a patient if he/she cannot access the facility. It would amount to advising people to eat cake if they do not have flour for bread. It was this mindset that triggered French Revolution. It is not the job of an NGO to provide ISO certified services with donor support in a region where people make subsistence living i.e living from hand to mouth, with leadership that hides facts and stage manages monitoring or inspection visits to project ?all is well? mantra, in which they are so good. One will hope that the above referred high profile visit will lead to free health care in the partnership hospitals, failing which our social fault lines would be taxed having negative consequences for our social fabric. .. Islamuddin, Garm Chashma, Chitral 25 Dec 2018
Chitral : Majority of the employees of the Aga Khan Health Services Pakistan AKHSP Chitral continued their protest sit in for the third consecutive day. The employees were protesting the plans of the management to terminate services of employees without giving them due benefits, the employees said talking to this correspondent. Most of the employees were women working in different health centers.??Dr Zafar Ahmad, the head of Community Health and Government Relations, talking to this correspondent from Islamabad on phone said that they were closing seven health centers in Chitral. He said the AKHS had already informed the employees that the centers having very low patient visits would be shut but the staff went on a strike.
The AKHSP senior management has issued the following press handout on the matter:-
Aga Khan Health Service, Pakistan Recalibration
The Aga Khan Health Services (AKHS) is one of the agencies of the Aga Khan Development Network (AKDN) that supports activities in health in Pakistan and several countries around the world. Together, AKDN health activities reach 5 million people annually globally and over 2.2 million per year in Pakistan. The agencies also work closely on planning health delivery improvements in Pakistan, training and resource development.
In recent years, emerging health care needs, a rapid increase in additional and alternative health care providers, a rise in innovative techniques and the need for greater access to other healthcare facilities has required AKHS to develop a more effective delivery model.
In order to increase efficiency and serve growing needs of its patients, AKHS is recalibrating its health service delivery to ensure that it can remain independent and self-sustainable. A cornerstone of this approach is to ensure partnerships with national and local governments and other health service providers ? both within AKDN, such as the Aga Khan University, and outside AKDN, such as government health facilities — to ensure improved health services in the long term.
In some cases, the recalibration will mean that certain health functions will be built on an effective hub and spoke model. The AKHS,P Service Model will feature:
Hubs: The Gilgit Medical Centre and the Booni Medical Centre, which will consist of 46 and 37 bed secondary health care units, respectively, with ?core? specialised services in paediatrics, obstetrics/gynaecology, internal medicine and surgery, as well as other specialised services in e.g. orthopaedics, ophthalmology, psychiatry etc., that are reflective of local needs. The Gilgit and Booni Medical Centres are connected with the ?super-hub? at the Aga Khan University Hospital in Karachi for e-health services. The two Medical Centres serve as the referral units for the Compehensive Health Centres (CHCs) and play an active role in supervision and capacity building of the CHCs? staff, including via outreach and e-health.
Sub-hubs: The six CHCs (7-18 beds) are to be staffed by generalist rural family medicine physicians trained to diagnose and treat a large variety of common diseases, e.g., obstetric complications, emergency surgeries and stabilisation of severe medical and paediatric conditions. CHCs are the referral units for the BHCs, and CHC staff also provide outreach clinics in BHCs.
Spokes: Staffed with Lady Health Visitors (LHVs) and Community Health Nurses (CHNs), the Basic Health Centres (BHCs) offer health promotion and disease prevention services, including screening for non- communicable diseases (NCDs). There are advanced discussions with AKU?s School of Nursing and Midwifery (AKU-SONAM) to start modular upgrading courses for the LHVs, as well as primary health care services with a focus on reproductive, maternal (including normal deliveries), and child health. The BHCs are the link between the formal health system and the community; and these will be linked via mobile health (m-health) services.
The recalibration is essential to improve efficiency so that AKHS, a non-profit organization, can continue to provide affordable healthcare to the community. The new model will ensure both quality and affordability.
.. Gul Hamaad Farooqi, 23 Jan 2018