A healthy population is a prerequisite for socio-economic development. The health status is not satisfactory in Panjgur. Common prevalence of malaria, ARI and gastrointestinal diseases indicates a lack of preventive measures and an inefficient primary health care system. This is primarily true for 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 hardly available and there is a severe shortage of female health staff, either medical or paramedical. Presently, 3 out of 4 Mother and Child Health Care Centres in Panjgur are non-functional due to unavailability of female health staff. Malnutrition of women is a cultural phenomenon in Pakistan. This not only results in their poor health but also increases the burden on secondary health care facilities. According to the District Headquarters Hospital data, the number of patients has approximately doubled to a total of 58,101 in 1995 as compared with the figures for 1994, i.e., 26,470. Females constitute a 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. This hospital is providing health services to patients from Iran as well, as the border is only 54 kilometres from Chitkan town.

In the district, health services are provided at two levels. At primary level, 11 Basic Health Units (BHU), 3 sub health centres, 15 dispensaries and 4 Mother and Child Health Care Centres (MCHC) are established throughout the district, while the district headquarters hospital at Chitkan provides secondary level health care. One Rural Health Centre, a primary health care facility, is under construction at Parome. 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 42 beds.

Amongst the primary health care facilities, some units have the availability of a medical professional; in the other facilities paramedical staff provides health services to people. Female medical staff is either not available or not willing to serve in the rural areas. This results in unavailability of health services to female population of Panjgur.

The District Headquarters Hospital at Chitkan provides specialised health service in paediatrics, surgery, and dentistry. Nominal fees are charged from patients for outdoor, indoor X-ray, and laboratory services. Only one rupee is charged for OPD slip while indoor admission fee is 5 rupees. Ambulance service is available at the rate of 2 rupees per kilometre plus fuel charges while a fixed amount of 20 rupees is charged for each of X-ray, laboratory test, electrocardiogram (ECG) and dental surgery. Fees are being levied since September 1995; 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 8 private clinics and two medical centres equipped with X-rays, ultra sonography and clinical laboratory facilities, all of them mainly ran by government doctors. Even surgical operations are also performed at the private clinics. One or two hakeems (traditional healers) also practice in Panjgur but only for a few months a year.

In Panjgur disease pattern changes with the climatic change. In summer, malaria is the most prevalent disease along with gastrointestinal diseases. Absence of a 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. Incidence of cholera is common in Bonistan where every year tens of people get affected from this disease. 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.

Special health services in Panjgur include the Leprosy Control Centre, the school health services, and the Prime Minister’s Program for Family Planning and Basic Health. In 1996, coverage of the Expanded Program of Immunisation (EPI) for infants was 55.4 percent at the average while for the children under 2 years of age it was 13.8 percent. About 15 percent of the pregnant women in Panjgur district were vaccinated against tetanus in the year 1996. The vaccination among women of child bearing age in Panjgur was negligible. EPI actually is not a special but a routine programme within the health service.

School health service is not functional due to lack of funds and to inappropriate planning for physician’s visit 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 was 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 and 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 141 Lady Health Workers had been recruited in Panjgur. World Food Program (WFP) has supplied vegetable oil to be distributed amongst pregnant women of the district through this program. The house of the Lady Health Worker is named as "health house". Apart from 120 trained birth attendants, these health workers help the pregnant women, provide them advice and refer them to the hospital in case of any gynaecological or obstetrics complication.

Both the Family Planning Association of Pakistan and the Population Welfare Department have their centres (one by each) at Chitkan to provide guidance and facilities regarding family planning. Although women are allowed to visit these centres, males still have a slightly negative attitude towards family planning. Condoms and pills are used more than the other methods. According to an estimate by the Population Welfare Officer, 70 percent of the population has awareness about family planning.

In Panjgur, a District Health Officer is responsible for primary health care and related facilities like basic health units, dispensaries, and mother and 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 Chitkan. A Medical Superintendent is responsible for proper functioning of the District Headquarters Hospital. At present one dental surgeon, one general surgeon, one child specialist, 5 medical officers and one lady medical officer are posted at this hospital. Support staff includes 4 nurses and 54 paramedics.

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

The health status is poor in the district. The EPI coverage is quite unsatisfactory and needs 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. No data on infant mortality rate (IMR), etc. are collected, neither instances of hepatitis, HIV/AIDS, etc. are adequately registered, which leaves the district with an enormous data gap on prevalent diseases. Furthermore, stationery and accessories to run this system efficiently are not being supplied regularly.

 The district is facing problem in finding female medical staff. There are very few local women trained for health services and even if they are available, the socio-cultural environment inhibits them from rendering such services. The consequence is that women are deprived from adequate health services.

 The only hospital in the district has no source of drinking water. An overhead water tank has been constructed in the hospital but it does not have its own water source. This situation not only deprives the patients of drinking water but also creates problems for cleanliness in the hospital. The flush system latrines constructed in the hospital are also non-functional due to unavailability of water.

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