The health status is not satisfactory in Killa Saifullah. Common prevalence of malaria, ARI, tuberculosis and gastrointestinal diseases indicate a lack of preventive measures and an inefficient primary health care system. The picture is even worse for the women. On the one hand the female population is culturally deprived of free movement outside their house and consequently they always need some male member of the family to accompany them. On the other hand, women-exclusive health facilities are absolutely non-existent and there is a severe shortage of female health staff, either medical or paramedical. Malnutrition of females is a cultural phenomenon in Pakistan. This not only results in poor health of females but also increases the burden on secondary health care facilities. According to the District Headquarters Hospital data, in 1996 a total of 3,730 patients visited the outpatient facility of which a small majority (51.2%) was female. Similarly female patients constituted a considerable majority (64.2%) out of 330 indoor patients at the District Headquarters Hospital in 1986. However, it is noteworthy here that many patients are not registered in the hospital record as they do not pay prescription slip fee (a sort of registration fee).

In the district, health services are provided at two levels. At primary health care level, one Rural Health Centre (RHC), 11 Basic Health Units (BHU), 3 Sub Health Centres and 15 Civil Dispensaries are functional throughout the district. A District Headquarters Hospital at Killa Saifullah and a Civil Hospital at Muslim Bagh provide secondary level health care. Moreover, 5 Civil Dispensaries and 3 Basic Health Units are either under construction or not functional due to non-allocation of staff. 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, at the Civil Hospital in Muslim Bagh and at the Rural Health Centre in Badinai.

None of the primary health care facilities has sufficient medical professional and paramedical staff – like Medical Technician, Female Medical Technician, Lady Health Visitor and Dispenser – to provide health services to the people. In most cases, female medical staff is either not available or not willing to serve in the rural areas. This situation results in non-availability of adequate health services for the female population of Killa Saifullah district.

The District Headquarters Hospital at Killa Saifullah is supposed to provide specialised health service in paediatrics, surgery and dentistry but despite the existence of sanctioned posts none of the specialists is posted here. Nominal fees are charged from patients for outdoor, indoor, X-ray and laboratory services. Only one rupee is charged for an OPD slip while the indoor admission fee is rupees 5. An 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 each of X-ray and laboratory test. Fees are being levied since September 1995 and all the income goes straight to the provincial government’s accounts through the district treasury. At present, only 3 out of 5 ambulances are functional.

Apart from government run facilities, health services are being provided by private medical practitioners also. There are 10 private clinics and 3 clinical laboratories in Killa Saifullah and Muslim Bagh. Two hakeems (traditional healers) also practice in Muslim Bagh. Family planning centres are working at Killa Saifullah and Muslim Bagh.

In Killa Saifullah district the disease pattern changes with the climate. In summer, malaria is the most prevalent disease along with gastrointestinal diseases. Absence of sewerage systems and improper garbage disposal results in swamps and marshy areas which not only provide mosquitoes ample chance to grow but also contaminate 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). After malaria, pulmonary tuberculosis is the most common disease. Its infestation is attributed to the immigrants from Afghanistan. The majority of the immigrants is infected with tubercle bacteria (Mycobacterium tuberculi). Patients suffering from hepatitis and peptic ulcer are also common. Major paediatric diseases are acute respiratory infections (ARI) and diarrhoea. Most of the female patients have complaints of anaemia, amenorrhoea and dysmenorrhoea while tuberculosis is more prevalent in females than males.

Special health services in Killa Saifullah include the Expanded Program of Immunisation (EPI) and the Prime Minister’s Program for Family Planning and Primary Health Care. The PM’s Program was started in 1995. Under this program local females with a minimum qualification of middle pass are employed as Lady Health Workers for a fixed remuneration of rupees 1,200 per month. They are provided three months’ training and 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 motivate pregnant women and the parents for vaccination of their children. In phase I of the programme, 10 workers were recruited from Muslim Bagh area. In phase II, 17 workers were recruited from Muslim Bagh area, 5 from Killa Saifullah area and 9 from Kan Mehterzai area. In the phase III six workers from Muslim Bagh area and four from Killa Saifullah area were recruited to work as Lady Health Workers. In this way, till June 1997, a total of 51 Lady Health Workers have been recruited in Killa Saifullah district. The house of the Lady Health Worker is named "health house". Apart from 16 trained 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. The programme has provided one small van and 2 carry vehicles but these are not being adequately utilised for the programme.

In Killa Saifullah, a District Health Officer is responsible for primary health care and related facilities like Rural Health Centre, Sub Health Centre, Basic Health Units and Civil Dispensaries. He is also responsible for the Expanded Programme of Immunisation and the Prime Minister’s Program for Family Planning and Primary Health Care. Secondary health care is provided at the District Headquarters Hospital, Killa Saifullah and the Civil Hospital, Muslim Bagh. A Medical Superintendent is responsible for proper functioning of the District Headquarters Hospital while a Senior Medical Officer supervises the Civil Hospital. At present, the District Headquarters Hospital is facing severe crises regarding medical professionals. There are sanctioned posts of paediatrician and dental surgeon but not one is posted at the DHQ Hospital. Out of 4 sanctioned posts of Medical Officers one is being held by a Lady Medical Officer who is presently attached to the Sandeman Provincial Hospital, Quetta. Three other posts of Medical Officers are filled but 2 of them do not perform their duties in the hospital. Another Lady Medical Officer is appointed in the DHQ hospital but she has attached herself to the Civil Hospital in Muslim Bagh. This means there is not a single Lady Medical Officer in the District Headquarters Hospital. Only one Lady Health Visitor is present in the DHQ Hospital to attend the female patients. The situation at the Civil Hospital in Muslim Bagh is relatively better where 2 Medical Officers and 3 Lady Medical Officers are present to attend the patients.

Although federal government is providing support to special health services like the EPI and the Prime Minister’s Program for Family Planning and Primary Health Care in the district, the provincial government seems to be the major actor in the provision of health services to the people of Killa Saifullah. Private sector’s involvement is limited to private clinics, hakeems, clinical laboratories and medical stores.

The health status as well as the health service provision is poor in the district. The EPI coverage is quite unsatisfactory and requires immediate action. Health statistics are not available at the district level. Although the Health Management Information System (HMIS) has been initiated in the district, its performance requires a lot of improvement.

The district is facing 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 administrative lenience has resulted in inadequate health care provision in Killa Saifullah. The affairs of the District Headquarters Hospital needs immediate attention and amelioration.