Oversight Report. Health Department District Sanghar & Tando Allahyar

Transcription

1 Oversight Report Health Department District Sanghar & Tando Allahyar

2 June 2014 This report was made possible with support from the American people through the U.S. Agency for International Development (USAID). The contents is the responsibility of Sustainable Development Foundation (SDF) and do not necessarily reflect the opinion of USAID or the U.S. Government. II

3 Acknowledgements Sustainable Development Foundation (SDF) is implementing Citizen s Voice Project, in collaboration with USAID, under cycle 04, with thematic area Citizens Voice and Accountability for Youth Development. Main objective of the project is to aware youth about their health issues. We are very thankful of all members of Taluka and District Youth Councils in Sanghar and Tando Allahyar district, who are rendering their volunteer services to raise and advocate issues, related to youth at various levels for its resolution. We are grateful to CVP Team, for providing their continuous attention and kind feedback in finalization of this Report. We are also thankful of the health department officials of both districts who providing important data, which is a great support for us to understand the issues facing by the Youth. 1

4 List of Abbreviations SDF CVP USAID TYC DYC BHU THQ DHQ GD Sustainable Development Foundation Citizen`s Voice Project United State States Agency for International Development Taluka Youth Council District Youth Council Basic Health Unit Taluka Head Quarter District Head Quarter Government Dispensary 2

5 Table of Contents Title page i Disclaimer.. ii Acknowledgements... iii List of Abbreviation...iv Table of Contents......v Chapter 1: Introduction... Error! Bookmark not defined. 1.1 Background... Error! Bookmark not defined. 1.2 Project Description... 3 Chapter 2: Oversight Methodology... 4 Chapter 3: finding of the report... 8 Chapter 3: Major Health Problems... 8 Staff at Facilities Genral Observations...,,,,,,,,,,,,,,,,,,,,,,,,,... 6 Challangesand Recommendations... 6 Conclusion... 7 Picture Gallary... 8 Annexure

6 1. INTRODUCTION 1.1. Background Youth account for around 18% of world population. Developing world houses majority of youth population. Asia and Africa alone have62 and 17 percent of the world youth respectively. 1 As majority of world s youth lives in developing countries, they are faced with multitudes of problems such as social, economic and political problems. Figures reveal that around 40 percent of world youth are unemployed. 2 This could be because they come from areas which do not train them according to market needs of modern times. While importance of youth as future has been emphasized, no practical steps have been taken to train them to secure the future of young generation. In order for youth to be effective in future, they should be partners in present and should be provided with training and education meeting the present day market needs. Any one between 14 to 25 years is recognized as young globally. However, in Pakistan any one between 15 to 29 years is considered youth census shows that around 62 percent of the population falls under the age of 29, of which percent are counted youth (Labor Force Survey, 2009). 3 The net primary enrollment stands at 57 percent whereas percent of the youth are able to complete secondary education. 4 The literacy rate at the age of 10 stands 57 percent. As per UNDP s Youth Census, 32 percent of Pakistan youth is illiterate and 9.5 percent are unemployed. 5 Only 0.5 percent of youth goes to top universities which indicates that a great number of youth do not attain good education. As a result they are unable to get good job in the market. This shows that youth in Pakistan is facing problems similar in other developing countries. They lack social, economic, political civil and civil opportunities which could help them live a dignified life. There is also a positive aspect of huge number of youth population. It could be used for socioeconomic development to the extent that it could take Pakistan to new heights of development. For that to happen, Pakistan has to invest intensively in youth development. The youth development programs should focus on education, health and job creation. If this is done, Pakistan can achieve rapid progress. It is a documented fact that the countries that invested heavily in youth development achieved a quick and sustainable economic growth. However, failure in channeling the youth population in right direction will result in reversal of social benefits and economic development. A well-established relation between youth unemployment and violence can be seen ibid 2 see also

7 from the prevailing unrest and law and order situation in Balochistan, Khyber-Pakhtunkhwa and Sindh (mostly notably in Karachi and upper Sindh in tribal conflicts). Moreover, youth can become a catalyst of change in political culture of the country. Being largest section of the population, youth are also the largest number of eligible voters. Despite that, youth s participation in politics in general and elections in particular is marred with disillusionment. The disillusionment is result of poor governance which has failed to deliver, on one hand, and the education system which does not include the importance of politics and political participation. So if youth are activated and their potential is properly groomed and utilized, they can play their role in strengthening democratic culture and institutions in the country. However, such a role of youth can only be realized by investing heavily in youth development, particularly in education which should also focus on politics, not just economics. State of youth in Sindh is quite similar to rest of Pakistan. It would not be exaggeration to say that youth s conditions in Sindh are rather appalling as the state of governance in the province is second worst to Balochistan. Although there are no specific figures available, yet youth suicide has become common due to lack of employment and other issues in the province. There is widespread illiteracy, absentee teachers and ghost schools. There are three public universities covering higher education needs of 23 districts. This shows that achieving higher education is still a distant dream for majority of the youth in Sindh. As Pakistan has fallen on human development index to rank 145 th, Sindh has also fallen to 3 rd number in provincial ranking of HDI. While earlier SPSI reports ranked Sindh 2 nd after Punjab in HDI ranking of provinces. The Sindh government does not have any youth specific development policy. However, Government of Sindh along with Youth Affairs Department is running some youth specific program notably Benazir Bhutto Youth Development Program under the Chief Minister Secretariat. Even then, the initiatives taken by Sindh Government are not sufficient as majority of the youth in the province are living in poverty and are vulnerable to poor health and nutrition. Given this background, the project will target Sanghar and Tando Allahyar districts. Both these districts do not pose good picture of human development and opportunities for youth development are also scare. Majority of the population depend on agriculture and there is a dearth of other employment opportunities. Youth in both districts on one hand do not have avenues for social and education development and on the other hand are constrained by lack of employment opportunities. There are hardly any skill development centers which could train youths of the area in different vocations. As a result, there is an abundance of illiteracy and unemployment among youths in the targeted area. District Sanghar is mainly an agrarian district except large and small part of Taluka Khipro and Sanghar. Small industries like cotton factories, flour mills, rice mills, rice mills, oils mills, ice factories, match factories, juice factory and one sugar mills do exist in the district. There is widespread illiteracy.. Similarly, there is a shortage of health facilities in the district.. There is limited industrial base consisting of small and medium industries in the district. As a result there is widespread youth unemployment in Sanghar district. 5

8 Tando Allahyar also does not pose good picture in terms of economic development. Only 47 percent of the population is literate. Male and female literacy rate stands at 60 and 32 percent respectively. There is an acute shortage of education and health facilities.. Agriculture followed by small and medium sized industrial units are the main source of livelihood for the people of the area. Mehran Sugar Mill is the only largest industrial unit in the district. Although there is no specific figure available on youth unemployment, yet it can be concluded that there is widespread unemployment due to absence of strong industrial base in the district. In recent years, a number of youth organizations like Youth Parliamentarian and Progressive Youth Forum have emerged at national level but these organizations do not have representations from Sanghr and Tando Allahyar district. These organizations are actively working and have good strength in Punjab and Khyber Pakhtunkhwa province. Contrary to that, in Sindh there are a few youth organizations and most of them are located in Karachi and Hyderabad while there are few groups in Khairpur and Ghotki districts. British council s Active Citizens Program has reached some districts in Sindh but so far there are hardly any initiatives taken in the targeted districts to build youth s capacity and engage them in advocacy for the youth development. Moreover, there are groups of political parties, but their efforts are concentrated within the party support base. Similarly at provincial level, there have not been organized efforts to address youth s issues and their development needs. Given such a pitiable conditions of youth, the project addresses the following needs of youth in targeted districts: lack of independent youth organizations/groups in target districts for policy advocacy on youth development issues; lack of research on needs and issues of youth in Sindh and a framework of consolidated and mutually agreed charter of demand for youth development and; Lack of Linkages between youth groups, political parties, government departments and civil society in target districts. As project theme is issues of youth, it will focus on youth s health issues and increasing youth s role in oversight of public health institutions and their service delivery. 1.2 Project Description The overall long-term objective of the project is to enhance support for increasing opportunities for development of youth with specific focus on youth s health issues. The specific objectives that project focuses are: To form Taluka and District Youth Councils and train them in policy advocacy and oversight of public institutions; To raise awareness among youth about reproductive health, anti smoking laws and campaigns, preventive healthcare and the importance of physical fitness; To oversee the performance of district health departments and create linkages between district health departments and other relevant institutions, in order to improve provision of preventive healthcare education, reproductive health counseling and opportunities for sports / physical activity to youth, especially for girls; and To advocate for early finalization of Sindh Youth Policy this responds to concerns, ideas and suggestions made by youth groups. 6

9 Chapter 2: Oversight Methodology Project team has formed district youth council (DYC) at district level and Taluka Youth Councils (TYCs) in both districts. (DYC) have 12 members with equal men and women representation. Tando Allahyar district is divided into three taluks while Sanghar includes six talukas, so therefore two male and two female nominees from each Taluka of Tando Allahyar district represent their respective TYC in DYC while in district Sanghar one male and one female nominee of TYC represents their TYC in DYC. The oversight report is developed on the basis of information collated by the members of DYC on their direct observation and questioner, individual interviews of communities and health department officials. A detailed Questioner were developed before visits of health institutes, and all DYC members were oriented during trainings sessions of TYCs, and assigned task to meet the officials of Health Department and also meet with the communities in surroundings of health facilities. District Youth Council teams of District Sanghar and Tando Allahyar has visited the fallowing during the first round of oversight. During the month of May and June following Health institutes were visited randomly: S# Name of Facility UC Taluka District 1 Taluka Hospital Sinjhoro Sinjhoro Sanghar 2 Rural Health Center Jhole Sinjhoro Sanghar 3 Rural Health Center Chambar-i Chambar Tando Allahyar 4 BHU Piyaro Lund Piyaro Lund Jhando Mari Tando Allahyar 5 BHU/ MCHS RukanBuriro Kurkli Sinjhoro Sanghar 6 BHU Chak No 8 Khadwari Sanghar Sanghar 7 BHU Sanjar Chang Sanjar Chang Chambar Tando Allahyar 8 BHU Awadh Shah Sikanderabad Sanghar Sanghar 9 Government Dispensary, Chak No 41 Shah Sikanderabad Sanghar Sanghar 10 Government Dispensary, Shah Mardanabad Sinjhoro Sanghar Ghundan 7

10 Chapter 3: Findings of the report 3.1. Issues Highlighted In Targeted District Major Health Problem: According to the officials of the above mentioned facilities on the basis of the daily OPD, seasonal diseases are common in local area, like Malaria, Diarrhea, Skin diseases, TB and Breathing problem. About 35% of populations are suffering from hepatitis B and C. In UC Gujri and Shah Sikanderabad the cases of mal-nutrition and were observed and both female and children, the BHU officials told the reason of problem is early child marriage and lack of awareness about the benefits of family planning. Unavailability of safe drinking water and un-hygienic conditions causes the skin diseases and Diarrhea. About 70% youth are smoker and 30% uses Gutka and other supares. According to the observation of DYC members the drugs like Gutka, Mainpure and stuff like this is frequently available at shop and cabins in villages or cities, even children are can buy the prohibited aforementioned tobacco drugs. The local authorities do not take necessary legal action to stop sell of tobacco drugs. Quacks (Charlatan, Non-Qualified Doctors) are the issue of all over the area, due to lack of awareness people prepare quick more than the doctors available at government facilities, due that blood transmitted diseases spread in the area : Staff at facilities: According to the officials of THQ Hospital Sinjhoro, out of 33 sanctioned position of grade 17 and 18, 23 are vacant and just 10 are filled, and out of 63 positions of grade 1 to 16, 58 are filled and 5 is vacant, there is no gynecologist in this hospital. No single specialist doctor is appointed at THQ hospital. At BHU level positions of one male and one female medical officer, along with one vaccinator, one dispenser, one midwife and one supporting staff is filled, out of 10 facilities visited on one BHU Awadh, of UC Shah Sikanderabad was on leave despite the working day. 8

11 Targeted population for the facilities is as below: S# Name of Facility UC Population No OPD in May Taluka Hospital Sinjhoro Not shared 2 Rural Health Center Jhole Not shared Not shared 3 Rural Health Center Chambar-i Not shared 4 BHU Piyaro Lund Piyaro Lund BHU Sanjar Chang SanjarChamg BHU Chak No 8 Khadwari BHU Gujri Gujri BHU Awadh Shah Sikanderabad Government Dispensary, Chak No 41 Shah Sikanderabad Government Dispensary, Shah Mardanabad Ghundan S# Name of Facility UC Population No OPD in May Taluka Hospital Sinjhoro Not shared 2 Rural Health Center Jhole Not shared Not shared 3 BHU Wali Muhammad Jhole BHU/ MCHS RukanBuriro Kurkli BHU Chak No 8 Khadwari BHU/ MCHS Head Jamrao Shah Sikanderabad BHU Gujri Gujri BHU Awadh Shah Sikanderabad Government Dispensary, Chak No 41 Shah Sikanderabad Government Dispensary, Shah Mardanabad Ghundan 9

12 3.2 Facilities at Health Centers: All BHUs and Dispensary are in under of PPHI, where they provide all medicines of common health problems, and screening test facility of Sugar, Malaria, is available. In THQ hospital Sinjhoro 2 ward on 20 and at BHU Awadh 2 beds are available for indoor patients. BHU Chack no 8 and Awad have no electricity connection and water facility. Building of Government dispensary Chak no 41 is dangerously damaged. 3.3 General observations: The issue of Quacks (Charlatan, Non-Qualified Doctors) is a serious concern of all medical staff of government facilities, to attract more patient s Quacks (Charlatan, Non-Qualified Doctors) often misguides the people about the government facilities. This issue can be resolved if the presence of BHUs and dispensaries assured, and the timing of staff availability should be increased. There is no drug rehabilitation center in the area visited smoking ratio is 50% to 60% very high in both male and female of the rural area. Medical stores are selling medicines without the prescription of doctors this can cause serious health issues in communities. All officials reported that no elected representatives visited the health facilities sometimes DO (Health or district Manager PPHI comes to visit the BHUs or dispensaries Chapter 4. Challenges and Recommendation 4.1: Challenges During the visit of health institutes DYC members faced problem to collect proper data, because in government dispensaries staff were demanding the permission letter from DHO, and at BHU level staff said that for any kind of observation visit its necessary to have letter of district In charge of PPHI. In meeting with EDO, when this issues was highlighted DHO said that it is officials requirement as per the instructions of Secretary Health, and permission authority is regional director health only. 10

13 4.2 Recommendation Government should take following steps for increasing awareness of youth about their health issues and their satisfaction with public health officials and public health facilities: Medical staff in public hospitals should be appointed on merit. Like there should be qualified doctors, dispensers and other staff, rather than just medical practitioners. Provision of safe drinking water in all remote areas of both districts to avoid water borne diseases. Newspaper reports and DYC members have reported availability of a large number of hepatitis patients. So therefore government should ensure administration of vaccine to entire population in the targeted districts and make efforts for eradicating the causes of the spread of such a disease. Although complete figure not shared by the officials but they said that Hepatitis B and C in every 3 rd person. Presence of medical staff at government hospitals should be ensured. Absentee doctors and other medical staff should be treated according to rules and regulations. Timing of centers should be increased. As the official timing of government centers is 8:00 am to 2:00 pm, is not enough to serve the rural communities Youths awareness about health issues should be increased by launching public awareness campaigns through government hospitals, print and electronic media. Because people are not much aware of the health services provided by the government through PPHI Use of drug should be discouraged and law enforcement authorities should implement concerned laws strictly. This report depicts health service situation of Sanghar district only and no details / figures of oversight in Tando Allahyar is given. The oversight questionnaire covers important areas like monitoring by high officials, operation of health facility (cases referral, treatment of medico legal cases etc) but focus of this report in only on available facilities. Conclusion is missing 11

14 Conclusion: The first oversight has conducted by the members of the District Youth Councils of Sanghar as well as District Tando Allahyar. During the reporting period DYC Tando Allahyar has visited three health institutes, Rural Health Centre Chambar, BHU Sanjar Chang and BHU Piyaro Lund. DYC Sanghar has visited the one Taluka Head Quarter Hospital Sinjhoro, District Sanghar, Rural Health Centre Jhole, BHU Chak No. 8, BHU Gujri, BHU Awadh, Government Dispensary Chak No. 41 and Government Dispensary Ghudan. DYC team has observed personally, conduct meetings and interview with staff, patients and local community about the service. PPHI work is mostly observed effective and best than Health Department. Medicines have been provided by PPHI to all the patients but time period of the clinics under PPHI is till 2:00pm. Local community demand that time must be 5:00pm. It is observed after 2:00pm majority of the patients go to the untrained and un-qualified Quacks (Non Registered Medical practitioner), it is therefore they suffering in other diseases. Health Department as well as PHHI staff informed during the visit that majority of health institutions ie Government Dispensaries, Basic Health Units and Rural Health Centers that majority of the institutions are running without approval of the Sanctioned Numbers of Employees (SNEs). 40 to 50 percentage positions of the gazette officers are vacant in Taluka & District Head Quarter Hospitals. Hepatitis B and C disease is common among the local people Government officials told that there no facility of the screening of the Hepatitis B and C nor any diagnostic facilities at Primary level of Government Dispensaries, BHU or Rural Health Centers. Most backward areas of Sanghar like UC Shah Sikanderabad and Desert areas of District Sanghar are badly affected by malnutrition. Majority of the children and women are suffering in malnutrition. There is big gap of proper monitoring and management majority of the Doctors are absent in Government Hospitals of Health Department. The staff of some BHUs in remote and backward areas was observed absent due strict and effective monitoring of PPHI. 12

15 5. Picture Gallery: Formatted: Font: Gill Sans MT, Bold 13

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17 Annexure Questioner used to collect the information for oversight: PERFORMANCE INDICATORS TOOL FOR HEALTH INSTITUTIONS Rural Health Centers-RHC/Basic Health Units-BHU Observation month : Name of the visitor Contact # Taluka District Name of the Health Facility (Must): Address (Must): Name of Medical Superintendent /Incharge Date of Visit: (dd-mm-yyyy) Time of the visit: From to: Telephone No : UC No./ Name Tehsil/ Town/ Taluka S. No A. Facilities at Dispensary /MCH/BHU/ RHC Question Yes No A1. Physical Facilities 1 # of wards for in-door patients 2 # of beds are available for patients 3 # Of labor room. 4 # Of laboratory for tests. 5 # Of Medico-legal service. 6 # of functional ambulance service 7 # Of standby generator. 1 Surgery 2 Is women medical officer is appointed in BHU/RHC 3 Is ultra sound facilities are available in BHU/RHC 4 Is hospital have active community support group (CSG) 5 Are regular meetings of CSG conducted 6 Are EPI facilities are available at center 7 1 A proper road leads to the Dispensary DHQ/THQ 2 There is a boundary wall around 3 The building is in good condition. 4 Electricity connection. A3. General Facilities 15

18 5 # Of fans in wards. 6 Clean drinking water arrangements for patients. 7 # Of wash room [with running water] for patients. 8 sui gas connection 9 landline telephone connection 10 There is proper place/shade for waiting patients. 11 Medicines are available in the in-house pharmacy. 12 Cleanliness 13 There is a residential house for doctors in the premises 14 There are residential quarters for staff in the premises Health Facilities: Please add some essential health services B. Peoples Perception (Interview with 3 outdoor patients) Questions Patient 1 Patient 2 Patient 3 Yes No Yes No Yes No 1 Was doctors present on his/her duty? 2 Do you think doctor has given you enough time? 3 Was the behavior of doctor with you? 4 Did staff provide you all the required support and guidance? 5 Did you get free medicine from in-house pharmacy as per doctor s prescription? 6 Did anyone at Dispensary /BHU/RHC/THQ demand illegal money for providing services? D Visit of Elected Representative and Government Official during last 3 month. If Yes, Please provide the following information S. No. Designation Name 1 MNA 2 MPA 3 EDO/ Health 4 Any other Government official 5 Any other elected representative Date of the visit Purpose of the visit [What did s/ he do for the health facility] 16

19 E. The visitors should verify that following key staff is appointed in BHU/RHC or not: 1. Medical Officer (Male) 2. Women Medical officer 3. Health Technician 4. Dispenser 5. LHV 6. Vaccinator 7. Malaria technician 8. Watchman G. Referrals and medico legal services S. No Service Total number Information not available Information not shared 1 Number of serious patients referred to DHQ/Teaching hospitals in last calendar month 2 Number of medico legal cases treated in last calendar month Please add some questions for CSG Staff is completed in concern RHC/BHU? Higher management is providing proper required medicines and other equipments? What are the main three diseases among the youths of the area? Have any especial service or facility for youth facilitation about socio-sociological problems? Have any suggestion for youth health issues? Direct Observations and Comments of visitor/s: 17