Health services are inadequate to meet the health requirements in the district. The number of health care facilities is limited and unevenly distributed, especially for women and children. Provision of services is concentrated in urban areas and severely ignoring the rural areas. The emphasis is on curative more than on preventive measures. Water-borne diseases are common. The health care facilities also lack provision of clean water and sanitation. The working conditions are not good, human resources are limited. Shortage of medicine and supplies are a common phenomenon. Financial constraints add to the weak capacity.

Health care for women is severely inadequate. Lack of female doctors and workers, who are unwilling to work in rural areas, add to the health problems of the women in the district. Social en cultural constraints make that women do not want to go to visit male medical practitioners. In Barkhan, maternal and infant mortality rates and fertility rates is relatively high. The concept of family planning is hardly promoted.

There is only one hospital with 10 beds in the district, with three doctors. Other staff are 10 paramedicals, 2 nurses and supporting staff. There are 12 dispensaries, 5 BHUs and 2 MCH centres in Barkhan.⁶³ There is only one Lady Medical Officer, who is posted in the hospital. There is only one male doctor, though there are eleven sanctioned post.

There are two private clinics, one at Barkhan and the other at Rakhni. However, some medical stores appear to practise medicine as well. There are 5 family welfare centres at Barkhan, Kochu, Narkot, Rakhni, and Rarkan and three family planning village based centres at Barkhan, Eshani and Rarkan. These welfare and village centres are run by the Population Welfare Department. There is no homeopathic clinic, nor a hakim.

Source: HMIS, 1997

In the peripheral areas the health system is functioning with dispensaries, Basic Health Units and Mother and Child Health Centres and mobile units. Immunisation work is carried out by the mobile team. Barkhan has a District Hospital (see also 7.2.1).

The health indicators show that the number of indoor patients was 289 during the month of September 1996 and the out door patients were 813 during the same period at Barkhan hospital.

It is very difficult to assess the cost per patient annually or daily as the inclusion of overhead cost and depreciation make it difficult to estimate it properly. However, the prima facie costs are 10 to 20 rupees per patient.

The health structure does not provide a proper registration system for mortality, fertility, or birth and death rates. Therefore no records are available to get information on these issues at district level.

The major diseases as reported by the district health officer are malaria, typhoid, tuberculosis, dysentery and eczema. A primitive mode of living, illiteracy and unhygienic conditions are the causes of many at these diseases. Major diseases among children are malaria, enteric fever, diarrhoea, dysentery and tuberculosis.

Special health services provided in the district is the Primary Health Care Programme carried out by the provincial government under the Prime Minister Health Programme. Under this programme health services are provided to the community at charges they can afford. It fulfils some needs of mother and child care providing nutritious food like milk or ghee. It also provides information regarding family planning and subsidies family planning medicine. Other special health services include traditional birth attending. Under this programme traditional birth attendants are trained by the Health Department to work in rural areas. Another form of special health services provided in the district is the Essential Drugs Programme in which drug control officers test the quality of drugs.

The District Health Officer (DHO) is overall responsible for health services provided in the district. the DHO is supported by doctors, paramedical staff, technicians and other supporting staffs. The Medical Superintendent (MS) is in charge of the district hospital.

Legend: - no involvement

 In district Barkhan the health services provided by the Government are insufficient and inadequate. The contribution of the private sector is negligible in the district. Far flung areas are deprived of health facilities. The health institutions are severely deficient in trained personnel and medicine and supplies.

Women’s health problems are more acute, due to lack of female doctors. Social and cultural constraints do not allow women to consult male doctors. This situation is a major threat to women’s health.

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