Health services are of great importance for the women in the country. A vast majority of our women have a very miserable and poor health condition. They have to work for the whole family and bring up the children. If good health care is not provided to them, their health will deteriorate, the death rate at time of deliveries will increase along with infant mortality.

The health services present in the district in 1995 are shown in the accompanying table. The total population in district Killa Abdullah in 1995 was estimated to be 272,221. The first health service indicator, population per doctor, indicates that it was 9,074 which shows that the district is very poor in terms of availability of doctors. Similarly the population per hospital bed ratio, was 3,403. Looking at other indicators given in the chart, we find that indeed government facilities in the district are quite inadequate. The private facilities are also insufficient e.g. there are 14 private clinics, the number of Hakeem is 50, while the number of medical stores was found to be 27. According to health sector sources there are nearly 50 quacks.

Normally, two types of health facilities are available in a district, curative and preventive. As far as prevention is concerned, vaccination of mothers and children up to the age of 5 years through immunisation coverage, according to the health authorities, is around 32% in Killa Abdullah.

The infant mortality rate is very high in the area. This is due to contagious diseases, unhygienic conditions, illiteracy, lack of health education etc. The maternity death rate is also very high. Though statistics are not available, these are the facts of life observed in the district.

Civil Hospital Chaman

There are two civil hospitals, one for male and on for female patients. In the civil hospitals about 27 thousand patients were treated. In 1995, through the centres mentioned in the table, about 294,000 patients were treated. The data limitations do not allow portraying the exact cost per patient; the vital data for the cost of medicines distributed in the district are not available. A rough estimate can be made by adding the total expenditure incurred by DHO and MS of the district on the provision of health services excluding medicine, and that comes to Rs. 85 per patient per contact. The civil hospital gets Rs.20,000 quarterly for medicine. The cost of medicine per patient comes to Rs.3.

As far as family planning services are concerned, these are being provided in all the health centers and also in the civil hospital. Reliable data on all kinds of health statistics is hardly available.

Major disease incidence

As far as the gender specific diseases are concerned, the women experience acute respiratory diseases, anaemia, skin infection, renal disease, worms infections whereas men are plagued by diarrhoea/dysentery, fever including malaria, jaundice and worms infestation.

There are a number of special health services which are provided by provincial and federal government to improve or facilitate health programmes.

The Primary Health Care Programme is initiated by provincial government under Prime Minister’s Health Programme. They are strengthened through the involvement of international donors e.g W.F.P, UNICEF and WHO. The objective is to provide health services to the community at an affordable rate. This programme caters for the needs of mother and child care, providing them with nutritious food e.g. milk, ghee. Also it provides information regarding family planning and subsidises family planning medicine and contraceptives. Under the Prime Minister Primary Heath Care Programme, prevention and control of infectious diseases, immunisation and provision of essential drugs is also available. It also provides health education, treatment of common illness and provides awareness about the treatment of common diseases and sanitation

Another example is the Traditional Birth Attendant (TBA) programme. In the rural sector, middle aged women traditionally work as birth attendants. In the recent past they used to work without any formal training. But now most of them are trained by the Health Department. They are paid by the Health Department as well as by those who get their services at home.

Legend: - no involvement

x minor involvement

xx substantial involvement

xxx major involvement

Health facilities are provided mostly by the provincial government, in some cases international donors also help. Health facilities are provided through the interaction of various health units. Most of them are established by the provincial government. There are private clinics, among them homeopathic clinics, Hakeems and local medical practitioners. The society gets health care through all those units shown in the chart (see 7.2.5)

The conclusions that emerge are:

1. There are only two hospitals for a population of more than 272,000. There is one doctor for over 9,000 persons and there is one bed for 3,403 persons. These health facilities on per capita basis are very poor.
2. The health status of women vis a vis males is very poor. Further, a woman on average gives birth to six children during her life, consequently she faces more health problems than men.
3. The nutritional status of women is far lower than men’s (also one of the important reasons of their poor health).
4. The number of diseases could be reduced, provided awareness and safe drinking water are made available through piped water schemes.
5. It was also observed that technical persons were not available at their seats. This indicates that administration is not effective.
6. International donors have helped to create a sense of awareness about better hygienic and sanitary condition among the masses. Now people are more receptive to immunisation programmes.

 Issues

 The main issues are:

1. The health facilities/buildings are not in proportion to the area and the population
2. The health sector is not well organised.
3. There is lack of facilities for the patients and residential facilities for the doctors, particularly for lady doctors are inadequate.
4. Non availability and unwillingness of lady doctors to work in remote areas.
5. Statistical information system pertaining to health problems is based on estimated figures. Therefore, evaluation and monitoring of the system is difficult.