A healthy population is a prerequisite for socio-economic development. The health status is not satisfactory in Kech. Common prevalence of malaria, ARI, and gastrointestinal diseases indicate a lack of preventive measures and an inefficient primary health care system. This situation worsens more for girls and women than for men. On the one hand the female population is culturally deprived of free movement outside their houses and consequently they always need some male member of the family to accompany them. On the other hand, women-exclusive health facilities are hardly available and there is severe shortage of female health staff, either medical or paramedical. Presently, 2 out of 4 Mother Child Health Care Centres in Kech are non-functional due to non-sanctioning of female health staff. Malnutrition of women is a cultural phenomenon in Pakistan. This not only results in poor health of women but also increases the burden on secondary health care facilities. According to the district headquarters hospital data, the average number of patients is 7,000 per month. Women constitute the majority of the patients but this situation seems reverse in case of indoor patients. Hospital bed occupancy rate exceeds 100 percent most of the times.

In the district, health services are provided at two levels. At primary level, 5 rural health centres, 24 basic health units (BHU), one sub health centre (SHC), 40 dispensaries, and 4 mother child health care centres (MCHC) are established throughout the district while one district headquarters hospital at Turbat provides 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 at the district headquarters hospital. Moreover, indoor patient facility is available at the district headquarters hospital with a capacity of 64 beds.

Only some of the primary health care facilities have availability of a medical professional; otherwise 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, except in the district headquarters hospital. This results in unavailability of health services to the female population of Kech district. Laboratory and X-rays services are available at 3 and 4 rural health centres respectively.

The district headquarters hospital at Turbat provides specialised health service in paediatrics, surgery, ophthalmology, cardiology, obstetrics and gynaecology, dermatology, ENT, pathology and dentistry. 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 rupees 20 is charged for X-ray, laboratory test, electrocardiogram (ECG), and dental surgery. These fees are 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 25 private clinics out of which 3 are medical centres equipped with X-rays, ultra sonography, and clinical laboratory facilities. Even surgical operations are also possible at the private clinics. There are 10 hakeems (traditional healers) practising in Kech district.

In Kech disease pattern changes with the climatic change. In summer, malaria is the most prevalent disease along with gastrointestinal diseases. Absence of 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, pulmonary tuberculosis and urinary tract infections are also common. Major paediatric diseases are acute respiratory infections (ARI) and diarrhoea.

In 1996 the coverage of the Expanded Program of Immunisation (EPI for infants was 48.4 percent at the average while for the children under 2 years of age it was 8.2 percent. About one fourth (26.3%) of the pregnant women in Kech district were vaccinated against tetanus in the year 1996.

Special health services in Kech include Leprosy Control Centre, School Health Services, and the Prime Minister’s Program for Family Planning and Basic Health. The School Health Service is not functional due to lack of funds and lack of appropriate planning for physicians’ visits to schools. The leprosy control centre is also not functional due to unavailability of the staff.

The Prime Minister’s Program for Family Planning and Basic Health 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 rupees 1200 per month. They have been trained for three months, after which they 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 145 Lady Health Workers had been recruited in Kech. World Food Program (WFP) has also supplied vegetable oil to be distributed amongst pregnant women through this program. The house of the Lady Health Worker is named as health house. Apart from 66 trained birth attendants, these health workers help pregnant women, provide them advice, and refer them to the hospital in case of any gynaecological or obstetrics complication.

In Kech, a District Health Officer is responsible for primary health care and related facilities like basic health units, dispensaries, 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 leprosy control centre. Secondary health care is provided at the district headquarters hospital located at Turbat. A Medical Superintendent is responsible for proper functioning of the district headquarters hospital. At present one dental surgeon, one general surgeon, one paediatrician, one ophthalmologist, one gynaecologist, one dermatologist, one cardiologist, one pathologist, one ENT specialist, one anaesthetist, 5 medical officers and one lady medical officer are posted at this hospital.

Although the 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 the major actor in the provision of health services to the people of Kech. Private sector’s involvement is limited to private clinics and medical stores.

The health status is poor in the district. The incidence rate of diarrhoea, ARI and malaria is reportedly high. The EPI coverage is quite unsatisfactory and needs immediate action. Health statistics are not available at district level. Although the Health Management Information System (HMIS) has been initiated in the district, its performance requires a lot of improvement. Furthermore, stationery and accessories to run this system efficiently are not being supplied regularly.

The district is facing problems in finding female medical staff. There are very few local women trained for health services. Even if they are available, the socio-cultural set up inhibits them from rendering such services. The consequence is inadequate health services for the women, i.e. for half of the total population. This results in high maternal mortality and high infant mortality. The morbidity and life expectancy of women and the poor nutritional status of mother and child are major issues of concern in the health sector, needing immediate efforts of both government and private sector.

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