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An Assessment of Public Health Facilities in the Earthquake Affected Districts of Pakistan 2006

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An Assessment of Public Health Facilities in the Earthquake Affected Districts of Pakistan 2006 An assessment of public health facilities in the earthquake affected districts of Pakistan 2006 DRAFT-1 Disclaimer All reasonable measures have been taken to ensure the quality, reliability, and accuracy of the information in this report. However, the World Health Organization (WHO) has the right to delete, add to, or amend information in this report. WHO is not responsible for the contents of studies of any other agency, if contradictory to this report. Any statement, opinion, or view in relation to any person or organization which is not specifically attributed to the WHO may not necessarily reflect that of the WHO. This report is intended to provide information only. If you are seeking advice on any matters relating to information in this report, you should, where appropriate, contact WHO directly with your specific query. We encourage you to take steps to obtain the most up-to-date information and to confirm the accuracy and reliability of any information in this report by directly communicating with WHO. II An assessment of public health facilities in Earthquake affected districts of Pakistan- 2006 Acknowledgments The World Health Organization (WHO) and the Ministry of Health of NWFP acknowledges and appreciates the key contribution by the staff of the Emergency Humanitarian Action Program (EHA) of WHO Pakistan who were involved in planning and conducting this assessment. Gratitude goes to the partner organizations that helped wholeheartedly in collection of data. This includes UNFPA, UNICEF, Mercy Corps, Save the Children-US, MERLIN, ICRC, Malteaserwhole and the Pakistan Army. Our appreciation also goes to Dr. Mumtaz (MO-Kaladhaka), Dr. Syed Nasir and Mr. Sarbuland (EPI Corodinator, Pattan, Kohistan) for their help. We are grateful to our Operations Manager Dr. Rayana Bou-hakah for her initiative, technical input and continuous support as well as Dr. Khalif Bile, WHO Representative, Pakistan for his encouragement and leadership. We also appreciate the constant partnership and support from EDOs of all Districts as well as their staff; District Health Officers, and the staff from the WHO field offices including our drivers and logisticians. Last but not least, we are indebted to the staff of all the health facilities we visited for welcoming us to their facilities and being cooperative, open and forthcoming in every way. III An assessment of public health facilities in Earthquake affected districts of Pakistan- 2006 Table of contents Chapter 1: Introduction .................................................................................. 1 Chapter 2: Methodology.................................................................................. 3 2.1 Limitations ......................................................................................... 4 Chapter 3: Results and Discussion.................................................................... 6 3.1 Accessibility ........................................................................................ 7 3.2 Physical Infrastructure ......................................................................... 9 3.3 Service utilities at health facilities .........................................................12 3.4 Human Resources...............................................................................13 3.5 Service Provision ................................................................................14 3.6 Status of equipment and medical supplies ..............................................16 3.7 DEWS: Disease Early Warning System...................................................18 3.8 Gender Issues....................................................................................21 3.9 Perceived needs .................................................................................22 3.10 Management of health facilities...........................................................23 CHAPTER 4: CONCLUSION AND RECCOMENDATIONS .........................................25 Annexes ......................................................................................................27 1. District Bagh..........................................................................................28 2. District Muzaffarabad ..............................................................................39 3. District Poonch .......................................................................................50 4. District Battagram ..................................................................................56 5. District Mansehra....................................................................................62 6. District Neelum ......................................................................................78 7. District Shangla......................................................................................84 8. District Kohistan.....................................................................................90 IV An assessment of public health facilities in Earthquake affected districts of Pakistan- 2006 EXECUTIVE SUMMARY An assessment of public health facilities was conducted in all eight earthquake affected districts (Mansehra, Kohistan, Shangla and Battagram in NWFP and Muzaffarabad, Bagh, Poonch and Neelum in AJK) to assess the functionality of public health facilities in the district (staffing, services, supplies, utilization etc.), to perform a comprehensive mapping of all facilities, to identify issues relating to quality health service delivery and to establish baseline data on health facility status for future assessments and evaluation of interventions. This report presents information collected in the field as well as secondary data compiled from many sources including regular monitoring reports of partner organizations and brings forward recommendations for further interventions relating to recovery and reconstruction. A pre-tested questionnaire was used for this cross-sectional survey and consisted of closed- ended questions regarding facility information, access indicators, physical infrastructure, staffing position, equipment and supplies, and reporting. The selection criteria were ‘functioning first level health care facilities including Basic Health Units (BHUs) and Rural Health Centers (RHCs)’. GPS coordinates were also taken as was visual documentation. The assessment was carried out in almost 300 facilities (106 from AJK 130 in NWFP). Of all facilities assessed, 28% are being supported by an external agency (NGOs or the Pakistan Army). Some districts, like Shangla and Kohistan, had none of the facilities being supported by an external agency. Most facilities assessed (65%) were located close to a tarmac or jeep road and were accessible by all types of vehicles. However 47 BHUs (25%) were accessible only by 4X4 jeeps and 19 (10%) were accessible only by foot. The average walking time to the facilities from the closest population pocket was 22 minutes (range: 2 minutes to 60 minutes) while the average time taken to the farthest catchment village was 141 minutes (range 25 minutes to 720 minutes). In three cases, clients in the farthest catchment village would have to walk for up to two days to get to the closest health facility. Average time to the preferred referral facility by vehicle was 108 minutes (range 10 minutes to 960 minutes). The original structures were being used in 60% of all facilities. In many places, the damage is either minimal, or parts of the original structures, such as a single room, are being used. Tents are being exclusively used in 9% of facilities, and pre-fabricated units in 8%, while multiple structures (a combination of tents, buildings, shelters and pre-fabricated) were being used in 23% of all facilities. Over two-thirds (68%) of all facilities had a functional toilet, 49% had a functional water supply within the facility premises and 65% had an electric supply. Half of the facilities (118) burned their waste, 27 (19%) threw it away, and 27 (11%) buried their waste. Forty-six (20%) used multiple methods. In sites where staff claimed to bury their waste, we noted improper waste disposal techniques, with shallow pits overflowing with hazardous waste. On the whole the most available category of staff present in all districts is the medical technician or dispenser (88%), followed by a vaccinator (67%), an LHV (63%) and male Medical Officer (47%). A female Medical Officer was available at only 13% of all facilities. The most common service provided was out-patient consultation (96%), followed by ORS provision (89%), EPI (80%), minor surgical procedures like stitches (69%) and family planning (68%). The least available services were laboratory services (21%), access to an ambulance (27%) and in-patient treatment (29%). Only 23 (10%) facilities were classified as well equipped, 108 (46%) were average and 105 (45%) were classified as poorly equipped. The situation was similar in the two provinces but with considerable variation between districts. Kohistan had the highest percentage of poorly equipped facilities (72%), followed by Neelum (55%) and Poonch (48%). The district with the highest percentage of well-equipped facilities is Muzaffarabad (21%), followed by Battagram (14%) and Bagh (13%). Most facilities (46%) were classified as average. When asked about their needs, staff in many districts mentioned several common issues: construction of staff quarters, improving the water supply, appointing appropriate staff, strengthening reproductive health services, supply of furniture and essential equipment
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