Like the previous years, the health department has nothing to boast of in the outgoing year except gradual improvement in routine immunization coverage and introduction of central induction policy for PG trainees. Issues like protests by young doctors, nurses and paramedical staff, failed attempt of introducing central admission policy for private medical institutions, Congo and Diphtheria outbreak, reporting of Zika and Chikunguny virus, regular increase in prices of drugs, dysfunctional equipment and lack of medicines at hospitals largely dominated the headline.
Punjab’s Expanded Program on Immunization remained the bright spot in Punjab’s progress on health indicators in the year 2016.
The year was marred by confrontation between Young Doctors Association and the government on various issues. The protests were triggered over central induction policy, suspension of doctors and staff following manhandling of attendant of a patient at Mayo Hospital, restructuring in health department and rationalizion of pay structures. The theme surrounding the health department throughout the year was restructuring. By the fag end of the year, the department had two Health Ministers. Even though the department claims the bifurcation is aimed at more judicious resource distribution, the experts believe that this will result into lack of synergy, and fragmentation of human and material resource.
Punjab led Pakistan’s battle against polio eradication with a zero polio year, thus becoming the first province in the country to have completed the year without any polio case. Pakistan recorded a total of 19 cases with 08 each from Khyber Pakhtunkhwa and Sindh, 02 from FATA and 01 from Baloshistan.
Punjab has no polio case in 2016 so far (Pakistan total 19). Punjab reported two polio cases out of country total of 54 in 2015, one from Chakwal and the second from Rahim Yar Khan. In the year 2014, Punjab reported four cases out of country total of 306.
There were 10 positive environmental samples in Punjab in year 2016: Lahore 03, Rawalpindi 03, Faisalabad 02, Multan 01 and DG Khan 01.
One major milestone was that Punjab has been validated for Mother and Neo Natal Tetanus elimination by WHO and UNICEF in November 2016.
Introduction of Rota Virus Vaccine and DPT Booster dose in Routine Immunization was processed for 2017. Rota vaccine is the 10th vaccine to be included in Punjab EPI Program. Routine Immunization coverage increases from 64 per cent in December 2014 to 86 per cent in 2015 (Neilsen Survey 2016). The TRF reported 92 per cent coverage in 10 randomly selected districts in first quarter of 2016. As per PHS survey conducted in Oct 2016, the coverage of fully immunized children was 81.9%. The children receiving measles-1 dose were at 86%.
As per PHS survey, Punjab was able to reduce the urban and rural disparity in immunization coverage, with difference now just over 1 per cent.
After android-based application E-vaccs monitoring of staff, vaccinators attendance improved from 46 per cent in January 2015 to 97 per cent (June 2016) and Punjab was able to boost up its routine immunization to > 80 per cent in 2016.
Punjab organized a total of 15 polio campaigns which include 05 National Immunization Days (held across the province), 06 sub National Immunization Days (in selected high risk districts) and 04 Case Response campaigns (response to areas near positive samples).
The independent assessment (LQAS) conducted to measure the quality of campaigns in union councils recorded the pass per cent of 90% as stipulated in the targets set by National Emergency Action Plan for Polio Eradication 2016-17.
As per Neilsen Survey conducted with UK’s DFID support in the first quarter of the 2016, Punjab’s routine immunization (Penta 3) was recorded at 86 %.
Frequent YDA strikes and protests not only hampered service delivery at hospitals, these also caused traffic mess in major cities in general and in Lahore in particular in peak hours.
Manhandling of attendant of a patient by duty staff at Mayo Hospital initiated high level probe. Suspension of YDA Mayo Hospital chapter President Dr Shaharyar Niazi and transfer of a nurse triggered protests. After failure to get any attention even after suspension of OPD services at Mayo Hospital for three weeks, YDA come out of roads and staged a sit-in on The Mall. The protesting doctors, however, were forced to eat a humble pie due to weak moral grounds. The episode caused huge inconvenience to visiting patients and motorists on The Mall and adjoining roads.
Central Induction Policy for PG trainees initiated series of protests throughout the year. During the last month of the year, YDA boycotted OPD services across the province, causing huge inconvenience to the ailing humanity. The government, however, managed to keep OPDs open with the help of senior doctors under security cover. The YDA called off strike after getting assurance of doubling the number of slots for PG trainees.
The government failed to implement the centralized admission policy of Pakistan Medical and Dental Council for private medical colleges. More than 4,000 students applied to the University of Health Sciences online for admission to private institutions. But the powerful institutions stuck to the stance and admitted students at own, in most of the cases after getting huge amount in the name of donation. Only time will tell that whether the government will be able to implement PMDC policy next year or not.
Frequent incidents of increase in prices of drugs, both by the Drug Regulatory Authority of Pakistan (DRAP) and pharmaceutical companies at own, put additional burden on the pockets of ailing humanity. People at helm of affairs remained silent spectator while powerful mafia continued fleecing the hapless patients. What to say of facilities at BHUs, RHCs, DHQ/THQ Hospitals when shortage of equipment like ventilators and unavailability of medicines at tertiary care hospitals and specialized healthcare centres like Children’s Hospital is taking lives of patients.
Experts say that facilities at DHQ/THQ Hospitals, RHCs and BHUs and introduction of referral system are necessary for reducing burden on tertiary care hospitals. They suggest more local procurements and manufacturing to make medicines cost effective.
Punjab Institute of Nuro Sciences (PINS) in the premises of Lahore General Hospital, Surgical Tower Mayo Hospital and Wazirabad Institute of Cardiology still awaits completion even after years. The government plans to complete these projects along with first phase of Pakistan Kidney and Liver Institute in 2017.
The province saw the rare incident of reporting of a case of Zika fever, a condition caused by amoeba usually found in swimming pools. The hapless patients breathed his last at Services Hospital Lahore.
Crimean–Congo hemorrhagic Fever (CCHF) or Congo virus cases emerged Punjab. The deadly virus took many lives including healthcare providers. The scary virus affected a doctor at Victoria Hospital Bahawalpur. Fear of getting deadly disease through contact with tits on skin of animals caused people to take necessary precautions while going to makeshift markets for purchase of sacrificial animals for Eidul Azha.
Though diphtheria cases were reported in the outgoing year, the situation was much better than 2015 when 34 children lost their lives due to unavailability of Anti Diphtheria Serum (ADS). The government has planned to introduce booster dose in routine immunization to save children from six to 12 years from Diphtheria. Dengue outbreak in Rawalpindi and Faisalabad also smashed to the ground tall claims of the government regarding preparedness to fight against the menace