This is with reference to an article published in online newspaper Balochistan Voices on 13th may 2016 with title PPHI-Balochistan case study of poor Management by Mr. Daniyal Baloch (a pseudo name). A number of such articles are published daily on numerous topics in newspapers but some of such articles attract attention owing to their peculiar nature. This Article attracted our attention because of misleading facts about PPHI and we felt it necessary to un-earth the real facts which have deliberately been conceded and distorted in the article.
Also Read: Editorial Note: PPHI Mismanagement Article
The PPHI-Balochistan is a company registered under section 42 of Companies ordinance 1984 as Not for Profit organization. Through an agreement with Health department Government of Balochistan, the administrative control of Basic Health Units (BHUs) in the province was entrusted to PPHI. At the moment there are 618 BHUs, in the province and PPHI is engaged in delivery of primary healthcare services (PHC) in these BHUs.
The writer in his article has illogically linked the performance of PPHI with increased maternal mortality rate (MMR) and infant mortality rate (IMR) in the province without explaining the method for calculating MMR and IMR and what are the indicators for measuring MMR and IMR. Prior to discussing this, one should know the detail of health centers providing health services to the masses and controlling authority of such health centers. All these health centers are providing health services to the masses and are administratively controlled by Health Department government of Balochistan except the BHUs which are with PPHI. Immunization is the major indicator for IMR which means that higher the rate of success of expanded program for Immunization (EPI) in the province, lesser the rate of IMR. Now question arises whether the EPI and Immunization is with PPHI? The reply is no. The PPHI has no control on immunization and vaccination which is controlled by Government of Balochistan Health department yet PPHI has always complemented and supplemented the immunization program whenever required. Would it be justified to link PPHI’s performance with IMR.
Secondly, the major indicators for MMR include the availability of specialized Birth Attendant, Antenatal care (ANC) and postnatal care (PNC) and facilities of family planning. Higher the number of these facilities for the masses, the lower the number of MMR. 2/3 infant deaths takes place in first four weeks of age and among these 2/3 deaths 1/3 deaths take place in first week of life. The major reasons for such infant deaths include prematurity, acute respiratory infections, Birth asphyxia, Diarhoea, Neonatal sepsis, congenital anomalies with malnutrition being an aggravating factor. These facilities are being provided in all health facilities and should not only be expected in BHUs, as portrayed by a few. How can PPHI’s performance be linked with increased MMR in the province when PPHI is only responsible for maternal child health services in BHUs only. The writer has quoted misleading facts.
For decreasing MMR in the province, the PPHI has signed a MoU with IDSP for conduct of 03 month capacity building training of LHVs/FMTs of BHUs in Qatar Hospital Karachi and has completed training of 04 batch of LHVs. There is severe deficiency of Doctors and Lady Doctors in the province. The total numbers of BHUs in the province are 618 while the total sanctioned posts of Lady Medical officers for BHUs are 105. However, to meet the shortage, the PPHI in addition to regularly posted LMO and LHVs has appointed 26 LMOs and 158 LHV/FMTs on contract basis to provide maternal healthcare services in the communities and to decrease the MMR.
As per policy, the post of District Support Manager (DSM) in PPHI is filled through PCS i.e. BCS (EB), BSS and CSS cadres. However, in case S&GAD refused to post PCS cadre officers, then BS-18 officers of other cadres with relevant experience in health sector or incumbents served on managerial level in national and international Organization with sufficient experience in development sector are being posted as DSM. Owing to strict monitoring mechanism many DSMs, were repatriated to their parent departments owing to their poor performance. As such DSMs have been rejected by PPHI due to poor performance; that’s why these disgruntled elements recourse to such tactics of disseminating false and fabricated information, to betray the general public.
As far as the issue of release of funds to PPHI and audit of accounts of PPHI, it is to clarify that PPHI only receives funds for BHUs and have not received any donations or grants from international donors as maliciously mentioned in the said article. As PPHI is a company and audit of the accounts of the PPHI are governed through provisions of company’s ordinance 1984. Regular audit of PPHI accounts have been held by a renowned firm of chartered accountants as per Companies Ordinance, on end of every financial year and audit report is shared with Finance Department, Health Department, and Accountant General Balochistan. The decision of Selection of external Auditors is made by Board of Directors of PPHI-B. Each and every record of minute transaction is maintained in PPHI. The Board of Directors of PPHI-B comprise of 10 members including 3 ex-officio Directors from Government of Balochistan i.e. Additional Chief Secretary Dev, Secretaries of Health and Finance Department. Madam Zubaida Jalal Ex-Federal Minister is the Chairperson of the Board and all important decisions are being made through Board of Directors.
The allegation that 99% of PPHI female staff remain absent is totally baseless. How can it is possible that 99% staff absent and yet the affairs of BHUs are running. The fact of the matter is that PPHI is very strict about the issue of absenteeism and District Staff frequently pay visits to BHUs; salaries of such staff are withheld and disciplinary action is initiated against them. In health sector PPHI is the only organization where the BHUs reporting in District Health information system (DHIS) is 99%, whereas in other Health facilities which are not with PPHI the ratio is very low. The failure and low performance in Hepatitis, T.B, EPI, Malaria and Immunization has intentionally been thrusted on PPHI in the said article while the fact is that all these programs are run by Health Department government of Balochistan, rather PPHI is doing its utmost to help health department in strengthening these Programs.
Merit, Competency, Commitment to serve and continuous capacity building of the staff for better primary healthcare (PHC) to the poor masses are PPHI’s core values. Due to our sustained efforts and accountability based primary health delivery system today, we can claim that in spite of disturbed law and order situation, difficult terrain, scattered population and meager resources, the delivery of PHC system has improved in all BHUs of Balochistan things cannot be perfect and neither is there an ideal situation. There are many deficiencies and gaps in PHC in public and private sectors in Balochistan but PPHI is striving its level best to improve its work with a vision of inclusive development by further strengthening its partnership with department of health and civil society.
The performance of PPHI and level of trust of health department and UN Agencies can be judged from the recent tasks assigned to PPHI to hold polio plus health camps in three high risk union councils of districts Quetta, Pishin and Killa Abdullah. These health camps are meant to provide MNCH services contributing to address the broader challenges of maternal, newborn and child morbidity and mortality. In first phase 120 camps in these three district were successfully completed by PPHI in November- December 2015 and health camps for 2nd Phase has been started in May 2016 which will continue up to August 2016. This project is jointly implemented by D.G Health services, PPHI and UNICEF. As mentioned earlier that malnutrition is an aggravating factor in IMR, the government of Balochistan through World Bank funding as initiated a project namely Balochistan Nutrition program for Mother and Children (BNMPC) in 7 focused district of the province which include districts of Zhob, Killa Saifullah, Kohlu, Sibi, Nushki, Kharan and Panjgur. The Government of Balochistan Health department has signed a MoU with PPHI as a partner for implementation of the said project in these 7 districts.
Most importantly, the request by General Public and specifically by the health department to take over new BHUs is the major endorsement of better services of PPHI. We are open and transparent and will always welcome positive criticism based on facts, evidences with an aim to suggest improvements in the health delivery system.
Lastly, the prime focus should be on the beneficiary’s i.e general public. One should be very careful in spreading false information, which could ultimately affect the services to the neglected poor masses of this province.
Dr. Mukhtar Ali Zehri
Public Health specialist – PPHI
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