ISLAMABAD - A recent study has found that a sizeable number of positions of healthcare providers are vacant, including two-third gynecologists’ positions in Punjab and three-fourths of gynecologists’ positions in Sindh.

For medical officers, majority of the sanctioned positions in FATA are filled but between a quarter and two-third of the positions are vacant in Gilgit-Baltistan, Sindh and Punjab and more than half the positions in Azad Jammu and Kashmir are vacant. A high proportion of the sanctioned positions for women medical officers are vacant in all regions. Filled positions of gynecologists and pediatricians are low in all regions except AJK and Punjab.

The Population Council released a report Friday titled “Assessing Retention and Motivation of Public Healthcare Providers in Rural Pakistan.” The policy-relevant research evaluated key factors that either constrain or motivate mid-level providers, particularly women, to serve in leadership positions in rural public health facilities. The study was funded by the Maternal and Newborn Health Programme - Research and Advocacy Fund (RAF).

The study was conducted in a representative sample of 28 randomly selected districts within seven regions in Pakistan. The study examined differences in the availability of Maternal Newborn and Child Health (MNCH) care providers across various regions; assessed the level of retention of MNCH care providers based on staff allocation; and summarised the challenges MNCH providers face that affect retention and motivation.

This study clearly highlights the issues confronting healthcare providers working in the public health system. Providers are dissatisfied with their existing salary and benefits, prospects for growth and promotion, and availability of equipment, supplies and medicines at their facilities. Specialists are of the view that the work given to them is not relevant to their qualifications and are also stressed and overworked.  This study also highlights issues specifically confronting female healthcare providers that include societal restrictions on their mobility, security and safety, issues at work, travel to place of work, harassment and perceived discrimination in promotions.

It said that more than half of the providers reported dissatisfaction with promotion opportunities, and more than a quarter were dissatisfied with the current method of annual appraisal. Political interference was also cited as a significant demotivating factor. One-fifth of providers interviewed had not received any training; only 14 per cent of Rural Health Centers (RHCs) are equipped to provide Basic Emergency Obstetric Care (EmOC), and 45 per cent of Tehsil Headquarters Hospitals (THQs) and District Headquarters Hospitals (DHQs) are equipped to provide Comprehensive Emergency Obstetric Care (EmOC).

This study also shows that the number of existing public sector facilities available is not commensurate with the size of the district population. The lack of functionality of these facilities to offer a full range of services further compromises service availability.  The study recommended to ensure implementation of a Human Resources for Health Management System strategy, Strict adherence to organisational policies on recruitment, transfer, and promotion, Improve the physical work environment and ensuring availability of equipment, medicine, and supplies, Offer incentives for attracting and retaining staff, especially female providers and Institute a national private practice regulation policy.

Speakers at the occasion also said that posting in rural areas should be promoted on a tenured basis and made mandatory by the Pakistan Medical and Dental Council (PMDC) as a requirement for registration. To increase access to specialised care in rural areas, the College of Physicians and Surgeons of Pakistan should make serving in these areas a requirement for fellowship.

In her opening remarks, Dr Zeba Sathar, Country Director Population Council, highlighted objectives of the national study, noting that the main purpose of the study was to explore the core issue of availability of health providers, especially female providers that are required for provision of maternal and neonatal healthcare in Pakistan.

The study also sought to determine the range of factors that either constrain or motivate providers to serve in key positions in public facilities in rural areas. The Minister of State, National Health Services, Regulations and Coordination Mrs Saira Afzal Tarar, was the chief guest at the event. Sarah Hall, Programme Manager, Research & Advocacy Fund and Secretary Health Khyber Pakhtunkhawar, Dr Fakhr-e-Alam also spoke on the event.