Introduction

A healthy population is a prerequisite for socio-economic development. The health status is not satisfactory in Gwadar district. Common prevalence of malaria, ARI, gastrointestinal and vaccine preventable diseases indicate lack of preventive measures and an inefficient primary health care system. This situation is particularly true for women. On the one hand the female population is culturally deprived to move freely outside their house and always need some male member of the family to accompany them. On the other hand, women-exclusive health facilities are very few and there is severe shortage of female health staff, either medical or paramedical. Presently the Mother & Child Health Care Centre at Kallag, one out of 3 such centres in Gwadar district, is non-functional due to unavailability of electricity. Malnutrition among women is a common phenomenon in Pakistan. This not only results in their poor health, leading to low-birth weight babies, but also increases the burden on secondary health care facilities. According to the Gwadar District Headquarters Hospital data, there were more female outdoor patients (31,026) in 1996 as compared to the males (25,404). There were 2,600 indoor patients in 1996. However indoor data provided by the Gwadar District Headquarters Hospital seems unrealistic. Hospital bed occupancy rate exceeds 100 percent most of the times.

Health System

In the district, health services are provided at two levels. At primary level, 17 basic health units (BHU), 22 dispensaries, and 3 mother and child health care centres (MCHC) are established throughout the district, while 3 rural health centres (RHC) and one district headquarters hospital at Gwadar provide secondary level health care. Primary health care includes prevention of diseases through community health programs, cure of minor diseases, and provision of emergency medical services. Secondary health care includes provision of specialised health services to cure major ailments. Indoor patient facility is available at the District Headquarters Hospital with a capacity of 34 beds. However, according to the Medical Superintendent, DHQH, only 10 beds are used for the patients and the remaining are VIP beds, used occasionally. According to his statement patients do not like to stay in the hospital and in the evening they move to their houses.

Amongst the primary health care facilities, only 3 rural health centres and 3 basic health units have the availability of medical professionals; in the other units paramedical staff provides health services to people. Female medical staff is either not available or not willing to serve in the rural areas. There is not a single Lady Medical Officer working in the whole district. This results in unavailability of health services to female population of Gwadar district. Laboratory and X-rays services are available at the rural health centres only. Only two of the RHCs, Pasni (2) and Ormara (1), have ambulances on road. Two ambulances of RHC Jiwani and BHU Pishukan are off the road.

The District Headquarters Hospital, Gwadar provides specialised health services in surgery, ENT, and dentistry. Posts of specialists in Obstetrics and Gynaecology, Medicine, Ophthalmology, Pathology, Paediatrics, and Anaesthesia are lying vacant. A nominal fee is charged from patients for outdoor, indoor, X-ray, and laboratory services. Only one rupee is charged for OPD slip while indoor admission fee is rupees 5. Ambulance service is available at the rate of 2 rupees per kilometre plus fuel charges while a fixed amount of 20 rupees is charged for each X-ray, laboratory test, electrocardiogram (ECG), and dental surgery. Fee is being levied since September 1995 and all the income goes straight to the government account.

Apart from government run facilities, health services are being provided by private medical practitioners also. There are around 20 private clinics in the district and one private medical centre at Gwadar which is equipped with X-rays, ultra sonography, and clinical laboratory facilities. Even surgical operations are performed at the private clinics. Hakeems (traditional healers) seem to have a good practice here as there are 3 of them in Gwadar and 2 in Pasni while a few other may be in other towns.

Major Disease Incidence

In Gwadar district, disease pattern changes with the climatic change. In summer, malaria is the most prevalent disease along with gastrointestinal diseases. Absence of a sewerage system and improper garbage disposal results in swamps and marshy areas which not only provides mosquitoes an ample chance to grow but also contaminates drinking water. Diarrhoea and dysentery are common gastrointestinal diseases. In winter malaria is replaced with acute respiratory infections including bronchitis, sore throat, and pneumonia (specially in children). Apart from these diseases urinary tract infections are also common. A few cases of AIDS have also been detected. Major paediatric diseases are acute respiratory infections (ARI) and diarrhoea.

Regular and Special Health Services

Regular health services include the Expanded Program of Immunisation (EPI). The EPI is a major preventive health care programme to control or eradicate six communicable diseases, i.e. TB, polio, diphtheria, tetanus, pertussis and measles. In 1996, the coverage of EPI for infants was 82.2 percent at the average, while for the children under 2 years of age it was 1.6 percent. About 30 percent of the pregnant women in Gwadar district were vaccinated against tetanus in the year 1996. The vaccination among women of child bearing age in Gwadar district was negligible. There are 8 EPI static centres in Gwadar (2), Pasni, Ormara (2), Nalaint, Kappar, and Pishukan. The EPI has 2 jeeps and 5 motorcycles, to provide mobile services in the far flung areas, out of which one jeep is off the road.

Special health services in Gwadar district include school health services and the Prime Minister's Program for Family Planning and Basic Health. The school health service is not functional because the post of medical officer is vacant. The Prime Minister's Program for Family Planning and Basic Health was started in 1995. Under this program local women with a minimum qualification of middle pass are employed as Lady Health Workers for a fixed remuneration of 1200 rupees per month. They have been trained for three months and are supposed to collect health statistics of the area, register births and deaths, impart health education, and treat minor ailments like headache, common cold, and flu. They also refer children and pregnant women to the EPI centres for immunisation. Till December 1996, a total of 61 Lady Health Workers had been recruited in Gwadar district against 115 vacancies (to be filled in three phases). In Gwadar 25, in Pasni 21, and in Ormara 15 Lady Health Workers are working. World Food Program (WFP) has supplied vegetable oil to be distributed amongst pregnant women of the district. The house of the Lady Health Worker is named as "health house". Apart from trained and traditional birth attendants, these health workers help the pregnant women, provide them advice, and refer them to hospital in case of any gynaecological or obstetrics complication.

Under the Malaria Eradication Program, anti-malarial spray is arranged once in a year. This program has 7 workers to take blood samples of suspected malaria patients and to advise them, if found positive, standard anti-malarial remedy is given.

Administration of Health Services

In Gwadar district, a District Health Officer is responsible for primary health care and related facilities like rural health centres, basic health units, dispensaries, TB clinics, and mother child health care centres. He is also responsible for EPI, school health service, Prime Minister's Program for Family Planning and Basic Health, and Malaria Eradication Program. Secondary health care is provided at the District Headquarters Hospital located at Gwadar. A Medical Superintendent is responsible for proper functioning of the District Headquarters Hospital. At present one dental surgeon, one general surgeon, one ENT doctor, and 5 medical officers are posted at this hospital. Support staff includes 33 paramedics.

GO/NGO/private, etc. involvement in Health Development

Although federal government is providing support to special health services like the EPI and the Prime Minister's Program for Family Planning and Basic Health in the district, the provincial government is a major actor in the provision of health services to the people of Gwadar district. Private sector's involvement is limited to a few private clinics and medical stores.

Conclusion and major Development Issues

The health status of the people is poor in the district. The EPI coverage is reportedly quite unsatisfactory and needs immediate action. Awareness raising about family planning and right of access to health facilities is crucial to overcome the health problems. Awareness raising about women's health issues is equally important to make health facilities accessible to women and children. Myths and taboos concerning health and family planning affect, rather threaten the lives of the women and their children.

Health statistics are not available at the district level. Although the Health Management Information System (HMIS) has been initiated in the district, making it functionally effective needs a lot of efforts at all levels. Furthermore, stationery and accessories to run this system efficiently are not being supplied regularly.

Gwadar district is facing a problem in finding female medical staff. There are very few local females trained for health services and even if they are available, the socio-cultural environment inhibits them from rendering such services. The consequence is that women in particular do not have adequate access to health services. The whole district is without a single Lady Medical Officer.

A new dental unit has been provided to the District Headquarters Hospital for about a year. But many of the specialists are either not appointed here or do not like to serve here.

Number of Government Health Facilities