PPHI Balochistan: Case Study of Poor Management

Daniyal Baloch
The ingenuity of People’s Primary Health Care initiative (PPHI) was conceived back in 2007 by the then President of Pakistan General Pervez Musharraf to improve primary Health care services in order to assuage poverty through quality and accessible healthcare. After ten years, it is of the essence to evaluate whether this organization has been able to achieve its desired objective of catering quality Primary health care to the deprived masses. In the wake of 18th Amendment in the Constitution of 1973, the subjects contained in the current list were devolved to the provinces. Thus, the federal support Unit (FSU) which was the federal head office of PPHI was abolished and provincial support Units were left at liberty to continue their work. In Balochistan, the PPHI was registered under Companies Registration Act, 1984 consequently, a Board of Directors was appointed to supervise the activities and frame regulations for PPHI Balochistan.
Presently, PPHI has been entrusted with the management of Basic Health Units (BHUs) across the Balochistan. PPHI invariably claims that they have made BHUs functional as previously they had been dysfunctional but, such claims are nothing more than an eye wash. PPHI’s performance can be measured by looking at the figures of maternal mortality rate and infant mortality rate in rural areas where mostly the BHUs are located. The maternal mortality rate is exceedingly high in rural Balochistan and rate of infant mortality rate is also very high. The healthcare services are almost non-existent in rural areas because the inhabitants of rural areas always complain that the BHUs under the management of semi-NOG-PPHI are always found closed and staff posted in these BHUs do not turn up on their duties.
The administration of PPHI is a great deal busy in their shenanigans that they never bother to make endeavors to take the bull on horns and deliver to the masses by curbing absenteeism of healthcare staff posted at BHUs.  At the time of inception of PPHI, it was compulsory that the District managers would be taken into service from professional civil servants and particularly from Provincial Civil Service (PCS) or from Federal Civil Service (CSS) as the officers of these service groups have particular managerial experience, skills, capability, required trainings and they are experts in management of public affairs and they are not prone to political pressure. It was entirely this reason that in its early years PPHI did perform well across the country. However, after the 18th Amendment, the provincial chapters of PPHI became rudderless and hijacked by incompetent people thus; they felt comfortable to hire Managers from open market. The sole reason of doing so was that such people happen to be servile and are prone to any kind of pressures.

Initially it was compulsory that the District Support Managers (DSM) of PPHI would be taken from professional civil servants such as PCS and CSS but now they rule is not followed

The provincial government every year transfers huge chunk of funds to PPHI on account of the budget of BHUs. In addition, PPHI receives donations and grants from international donors and millions of rupees received by PPHI during District Governments have been invested in different commercial banks, the interest of which is also given to PPHI executive. The irony is that no proper audit mechanism exists within PPHI structure. However, PPHI claims to hire international standard audit firms to audit its accounts but, the fact of the matter is  that the annual external audit teams have never bothered to visit district offices of PPHI and audit their accounts. Simply reports are made while sitting in the drudgery and deluxe head office in Quetta. The audit reports are also not reasonable and on the fence.
Owing to the weakness of provincial government institutions, no one has felt obliged to review the matters of PPHI and overhaul the entire composition and to ensure bringing it in the government accountability ambit. It can safely be said that if PPHI draws its funding sources from government treasury so why government must not have right to held this organization accountable. A reliable source has alleged that millions of rupees have been spent by PPHI on the pretext of improving the infrastructure of BHUs yet not a single procurement, tendering and completion record exists in the district offices of PPHI. On the other hand, no significant infrastructural improvement can be observed in BHUs of rural Balochistan which is indicative of possibility of mega corruption scams in these funds.

Almost 99 per cent female staff of PPHI posted at BHUs remain absent from their duty

The basic mandate of PPHI is to provide quality and universal health care excess to the poverty-stricken masses of far-flung and rural areas of Balochistan. In order to achieve this objective, public centered approach was to be employed. Nonetheless, PPHI has never focused to work on this pattern to involve communities in the affairs of healthcare facilities. Nevertheless PPHI has appointed number of contractual social organizers but they lack training, experience, exposure and necessary transport facilities to carry out their consigned jobs to mobilize masses and make sure sense of ownership among them. The activities of social mobilization are restricted to photo sessions and no tangible efforts are made to achieve the target of sensitizing public regarding health facilities and improving quality health care services from BHUs. It has been observed that almost 99 per cent female staff posted at BHUs remain absent from their duty. Hence, antenatal services are almost illusory in BHUs. People are constrained to seek services of traditional birth attendants during deliveries due to which the infant mortality rate is very high in rural areas of Balochistan.
The other primary commitment of PPHI is to prevent diseases through two prong approach first through health education and secondly, through immunization activities. But, unfortunately, both services are suffering irreparably in BHUs. Expanded Program of Immunization (EPI) is supposed to establish immunization centers in every health facility yet almost in every BHU, EPI centers are not functional for numerous reasons. To begin with, the vaccinators posted in BHUs never turn up to their duties, secondly, vaccines are not available and thirdly refrigerators are usually found out of order or deliberately kept out of order. The immunization coverage in both rural and urban areas of the province is trivially low. Lethal diseases such as Hepatitis, Mea seals, gastro entities, tetanus, polio, scabies, Malaria and T.B are endemic in Balochistan. The sufferings of people living in rural and remote areas of Balochistan are unspeakable. They have to face death, disease, agony and languish at the hands of poverty and poverty related sicknesses. In spite of such appalling scenes in rural Balochistan, the new and expensive vehicles of PPHI can always been seen on the roads of Quetta and in front of expensive restaurants of Quetta city. Are these vehicles meant for delivering health services to the suffering masses or providing comfort to ham-fisted comfort-seeking supervisors of PPHI?
In wake of 18th Amendment, the state of affairs of PPHI has further deteriorated instead of improving. After a decade of its origin, it is high time the entire structure of PPHI be reformed if the state is to fulfill its  constitutional and internationally pledged obligations to cater universal and quality healthcare services to its most marginalized and deprived citizens. Provincial government must shed the policy of remaining aloof from the affairs of PPHI rather government must oversee and held PPHI and its administration accountable. Good Governance is the only panacea for all problems Balochistan is grappling with presently, if health and education will not remain top priorities of government, the tumult will persist for a long time to come and province will further plunge in the quagmire of instability and social conflicts. Thus, an inclusive government with a will to rescue public institutions like PPHI can steer society out from crisis and pave the way forward for social and economic human development.
Disclaimer: Views expressed in this opinion article are those of the author and Balochistan Voices not necessarily agrees with them.
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