The existing health system is inadequate to meet the health requirements of the people in the district. The health structure is not only limited but also unevenly distributed. This problem is more acute for women and children, specially in rural areas, as the services are mostly concentrated in urban areas. Presently the emphasis is on curative measures, while the need for preventive is great. There is a lack of sanitation and potable water. Other areas like environmental health, nutrition, family planning and education are not adequate or in line with the needs of the people.

Working conditions are not good in the health facilities; human resources are limited. The physical infrastructure being provided is insufficient. There are shortages of medicines and supplies. Financial constraints add to all these problems.

The problems of health facilities for women are even more acute and severe. Female doctors and other staff are unwilling to work, this multiplies the problems related to women’s health. The social and cultural impediments are a barrier for women to go for treatment to a male practitioner.

The staff of Loralai Hospital comprises 10 specialists, 6 medical officers, 2 lady doctors, 2 dental surgeons, one pharmacist, 5 nurses, one male nurse, 36 paramedics and 27 other supporting staff, for details see annex (13). At Duki Hospital there are 3 doctors, two male and one female. There are 32 male and 3 female paramedics and various other support staff.

In addition, there are 2 RHCs, 27 BHUs, 62 civil dispensaries and 5 MCH centres⁶³. The number of staff engaged in these centres are 4 medical officers and two lady doctors working in RHCs. The number of male paramedics is 26, with 3 females paramedics. The total number of beds in these RHCs is 20. Five medical officers are working in the BHUs, with 135 male and 45 female paramedics.

Ten medical officers are posted in the dispensaries, with 216 male and 71 female paramedics. The number of male and female paramedics is 18 in MCH centres, 9 male and 9 female.

There is also public health field staff in the district. One male doctor with 2 paramedics are engaged in the school health unit. Some 16 paramedics work in various functions the public health field. There are 58 private clinics in the district, Besides there are 8 EPI centres, 11 Hakeems and 3 Homeopathic clinics.

There are no hospitals in the rural areas. However, health services are being provided through dispensaries, basic health units, mother and child health centres and mobile units. The immunisation programme is carried out through mobile teams.

The total number of patients reported by the District Health Officer for 1991-92 was 525,300, increasing to 909,000 in the year 1995-96. The allocation made during the same period for medicine was Rs.1,460,280 for 1991-92 and Rs.3,898,740 for 1995-96. The per-patient expenditure on medicine was Rs.2.77 in 1991-92 and Rs.4.28 in 1995-96.⁶⁴

The number of patients reported by the Medical Superintendent of Loralai Hospital was 22,572 for 1991-92, which increased to 27,786 in 1995-96⁶⁵. Due to overhead and other charges it is difficult to estimate the exact cost per patient as most of the combined costs are not easily allocated.

The health structure has no proper system for registration of mortality, fertility, crude birth and death rates. Therefore no proper records are available at the district level. However some information is available at hospital level.

The major diseases reported are:

1) Upper and lower Respiratory tract infection.

2) Gastro Enteritis and Admeric Dysentery.

3) Anaemia/Gastritis.

4) Tuberculosis.

Major diseases among children between the age of 0 - 5 years are:

1) Dirriaoe.

2) Upper and lower respiratory tract infection.

3. 3)Malnutrition (Protein energy malnutrition).
4. 4)Malaria.

The Special Health Services provided in the district are the Primary Health Care Programme by the provincial government under the Prime Minister Health Programme. Under the programme, health services are provided to the community at an affordable rate. It caters to the need for mother and child care, by providing nutritious food like milk and ghee. It also provides information regarding family planning and subsidizes family planning medicine and contraceptives.

 Other special health services include Traditional Birth Attendance (T.B.A). Under this programme traditional birth attendants are trained by the Health Department to work in rural areas.

 The Essential Drug Programme (EDP) is another form of special health service provided in the district. It ensures the quality of drug testing by a drug control officer. Under the programme the drug control officer visits the local medical stores and checks the quality of the drugs.

 The District Health Officer (DHO) is the overall in-charge of health services provided in the district. He is supported by doctors, paramedics, technicians and other support staff.

 The Medical Superintendent (MS) works as the in-charge of a hospital and is supported by doctors, nurses, paramedics and support staff.

x minor involvement

xx substantial involvement

xxx major involvement

The contribution of the private sector in health care is very small and negligible in the district, while the public health services are insufficient and inadequate. The remote areas are deprived of health facilities. Even the established health institutions face severe shortages in trained personnel, medicine and supplies.

 The health structure is not only limited but also unevenly distributed. In rural areas especially women and children are deprived of these services, as the services are mostly concentrated in urban areas. Female doctors and supporting staff are not willing to work in rural areas. Social, culrtural values do not allow women to go for medical treatment to male practioners, which aggravates their problems related to health.

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