The common prevalence of acute respiratory infections (ARI), gastrointestinal diseases, infectious hepatitis and malaria indicates lack of preventive measures and an inefficient primary health care system in Kohlu district. The situation is even worse for women than for men. Most of the women are malnourished. The women are culturally deprived of free movement outside their house and always need some male member of the family to accompany them. In case of pregnancy, usually the people do not bring their female patients to the hospital and take the Lady Health Visitor or Dai to their homes. Sometimes this practice proves fatal and results in maternal as well as neonatal death. The women-exclusive health facilities are almost non-existent and there is severe shortage of female health care staff, medical and paramedical. This not only results in poor health of females, but also increases the burden on secondary health care facilities. There is only one hospital in the entire district, i.e. District Headquarters Hospital (DHQH) where no specialist is posted, ambulances are non-functional and inadequate supply of medicines is a common complaint. There is only one Lady Medical Officer in the whole of Kohlu district. In such conditions, health status of the people cannot be satisfactory.

Only primary and secondary level health services are available in Kohlu district. At present one District Headquarters Hospital (DHQH), 19 Basic Health Units (BHU), 32 Civil Dispensaries, 4 health auxiliaries, 2 Mother and Child Healthcare Centres (MCHC), one mobile dispensary, and one TB Clinic are working throughout the district. Primary health care includes prevention of diseases through community health programmes, cure of minor diseases and provision of emergency medical services, while secondary health care includes provision of specialised health services to cure major ailments at the District Headquarters Hospital. At present, indoor patient facility is available only at the District Headquarters Hospital at Kohlu with a capacity of 32 beds.

The District Headquarters Hospital is without any specialised medical professional despite the fact that there are 8 sanctioned posts of surgeon, physician, ophthalmologist, paediatrician, pathologist, anaesthetist, gynaecologist and ENT specialist. Dental surgeon is also not posted at the DHQ Hospital. Only one Lady Medical Officer and two Medical Officers – against the sanctioned strength of 5 – are posted at the DHQ Hospital. Nursing care is not available. Although X-ray and pathological laboratory facility has been provided in the hospital, due to shortage of the materials, the patients have to go to the sole private X-ray centre and pathological laboratory. Two ambulances have been provided but are non-functional. The bed occupancy ratio is hundred percent. In 1996, a total of 13,003 patients visited the out-patient department of the DHQ Hospital. The medicines are provided by the Medical Stores Department at provincial level without paying any heed to the actual needs of the hospital. Only one rupee is charged for an OPD slip while the indoor admission fee is rupees 5. 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.

There are 4 private clinics, all in Kohlu town. However these clinics are being run by the doctors already employed in government health facilities in the district. The medical stores are a few and are run by paramedics who also prescribe medicine to the patients.

In Kohlu, the disease pattern changes with the seasons. In summer, malaria is the most prevalent disease together with gastrointestinal diseases. Absence of sewerage systems and improper garbage disposal results in swamps and marshy areas which not only provides mosquitoes ample opportunity to grow, but also contaminates drinking water. Diarrhoea and dysentery are common gastrointestinal diseases. In winter, acute respiratory infections including bronchitis, sore throat and pneumonia (specially in children) are very common. Apart from these diseases, pulmonary tuberculosis and urinary tract infections are also reported, though not common. Major paediatric diseases are acute respiratory infections (ARI) and diarrhoea. Most of the female patients come with gynaecological complications and malnutrition.

Special health services in Kohlu include the Expanded Programme of Immunisation (EPI) and the Prime Minister’s Programme for Primary Health Care and Family Planning. Under the EPI two vehicles have been provided for door to door vaccination. A total of 22 vaccinators have been employed for this purpose. However EPI coverage is not satisfactory.

The Prime Minister’s Programme for Primary Health Care and Family Planning was started in 1995. Under this programme local females with minimal qualification, middle school graduates, are employed as Lady Health Workers for a fixed remuneration of rupees 1200 per month. They are provided three months of training and they are supposed to collect health statistics on 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. The house of the Lady Health Worker is called "health house". These health workers help pregnant women, give them advice and refer them to the gynaecologist – who is not available in Kohlu district – in case of any gynaecological or obstetrics complication. To date (December 1997), 24 Lady Health Workers have been recruited under this programme.

In Kohlu, a District Health Officer is responsible for primary health care and related facilities like Basic Health Units, Civil Dispensaries, Health Auxiliaries, mobile dispensary, and Mother and Child Healthcare Centres. He is also responsible for EPI and the Prime Minister’s Programme for Primary Health Care and Family Planning. A Medical Superintendent is responsible for running the District Headquarters Hospital.

Although the federal government is providing support to special health services like EPI and the Prime Minister’s Programme for Primary Health Care and Family Planning in the district, the provincial government is the major actor in the provision of health care services to the people of Kohlu. The private sector’s involvement is limited to the clinics, X-ray centre, pathological laboratory and medical stores.

The provision of health care services is not satisfactory in Kohlu district. The EPI coverage is low and needs more attention. 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 much improvement. Furthermore, stationery and accessories to run the system efficiently are not being supplied regularly.

The district is facing problems in finding female medical staff. There are very few local female paramedics. Only one Lady Medical Officer is quite insufficient for providing healthcare to more than 50,000 females. The consequence is inadequate health services for half of the total population.

To date, specialised health services are not available to the patients due to non-availability of specialists at the DHQ Hospital. Adequate supply of medicines and laboratory and X-ray materials is of utmost importance.