Islamabad — On an early October morning, women and children waited outside the paediatrician’s clinic in the weathered compound of the Tehsil Headquarter (THQ) hospital in Rawalpindi’s Kahuta tehsil.
The clinic, a separate small building behind the 60-bed hospital’s main wing, stands next to a shed where metal benches have been set up to accommodate the patients. A man sat at a desk near the shed and handed out token numbers to the incoming patients so they could know their turn to enter the clinic for examination.
Asma Bibi waited in line with her newborn child.
“This is the first time I have brought my son here,” Bibi said. “I think he has the flu.”
She said she had her delivery at a hospital in Islamabad.
“They have put a notice inside the gynaecology ward here that for serious cases one should visit Rawalpindi,” Bibi said. “They are not equipped for complications during delivery. I could not risk it.”
Staffing records shared by the Rawalpindi District Health Authority show that half of the sanctioned posts for surgeons and anaesthetists in the Kahuta THQ are vacant. The THQ, which covers a population of around 220,000 residents, is also working with two paediatricians and gynaecologists each when it has three sanctioned posts for each of these categories. The hospital’s emergency is open 24 hours, but there is only one radiographer for its X-ray machine.
The shortage of staff is not unique to the Kahuta THQ. Statistics shared by the health authority in response to a Right to Information request by Media for Transparency show a similar situation of understaffed THQs across the Rawalpindi district.
The problem is more severe in Kotli Sattian, where there are no surgeons or anaesthetists at present and 18 vacant posts for nursing staff, according to the records. At the 100-bed Wah General Hospital, there are no radiographers to operate the single X-ray machine. The 110-bed Gujar Khan THQ, which offers healthcare services to over half a million residents, has only one surgeon, one paediatrician, and one gynaecologist on its specialist staff.
THQ hospitals are secondary-care health units in the public healthcare infrastructure in Punjab. Cases from basic health units and rural health centres are referred to the THQ, which have in-patient capacity of 40 to 100 beds, X-ray machines, laboratories, and operating rooms for surgeries. Serious cases are referred to the district headquarters hospital.
A chart displayed in the Kahuta THQ Medical Superintendent’s office claimed the hospital receives 18,000 to 20,000 patients every month in its outpatient department and refers around 900 patients to the district hospital monthly. The Medical Superintendent Dr. Samina Khalid Bhatty admitted her medical officers and nurses were overworked due to the understaffing issue.
“The workload is being divided among the current staff which means extra working hours for us and no 24-hour cover for the patients,” Dr. Bhatty said.
Overall around 40% of all medical and specialist staffing positions are vacant at the Kahuta THQ, according to the health authority. Nursing staff shortage is most acute. Only 14 nurses are working at the hospital against 26 sanctioned posts for nurses.
“Four nurses travel all the way from Islamabad to work at the THQ,” Dr. Bhatty said.
The commute from Islamabad to Kahuta is two hours round-trip, she said, and some nurses have to change two buses to reach the hospital. Dr. Bhatty said the nurses are often tired because of the commute and have to leave for their homes as soon as their shift ends.
“We do not have housing facilities for the staff near the hospital, which is not an ideal situation,” she said. “If we need more nursing staff in case of an emergency, we cannot arrange for help on short notice.”
Dr. Khalid Mahmood, the Chief Executive Officer of Rawalpindi’s District Health Authority, said the government wants to prioritise housing for THQ hospital staff but has financial constraints. He said the health authority tries to make amends for the inconvenience by giving housing and travel allowances to their staff.
Across the district’s five THQs and the Wah General Hospital for which data was made available, 75 posts for medical officers and nurses and 31 posts for specialists and technicians are vacant. These statistics do not include the THQ in Rawalpindi’s Tehsil Murree, which did not supply the requested information.
According to the health officials, the previous government had sanctioned new posts at the THQs but hiring was delayed. Now, there is some activity on this front.
Dr. Bhatty, the Medical Superintendent at Kahuta THQ, said 11 medical officers were hired in September.
“Three male and eight female general doctors have been hired,” she said. “The government is working but the process is slow.”
She said young doctors want to work but there are no incentives for them. The lack of incentives has also caused a shortage of anaesthetists, who have a crucial role in the operating room during critical surgeries.
“A major issue for all hospitals is the lack of good anaesthetists,” Dr. Bhatty said. “The government should intervene and provide incentives and anaesthesia programmes for medical officers so that they take interest in the field.”
She said the shortage of anaesthetists means many surgeries cannot be performed at the THQs, including child delivery cases where the doctors expect complications. The medical superintendent’s point suggests Asma Bibi was perhaps wise in avoiding the Kahuta THQ during her pregnancy. But many other mothers in the Kahuta tehsil may not have the luxury of travelling to private or public hospitals in Rawalpindi and Islamabad.
Dr. Mahmood, the head of the District Health Authority, admitted the shortage of staff at the THQs affects patient care, but he said there is some expertise available.
“We have senior doctors present in THQ hospitals which help reduce the pressure,” Dr. Mahmood said.
He said the current medical examination system has created a lack of interest in the THQ positions.
“Working in THQ hospitals is not incentivised,” he said. “The medical officers prefer Basic Health Units and Rural Health Centres because working there adds 10 points to their FCPS exams.”
Dr. Mahmood was hopeful that the new Punjab health minister Dr. Yasmin Rashid will take radical steps to improve the healthcare system because the minister is a healthcare professional herself. He said the minister has announced to hire more women medical officers as soon as they are recruited by the Punjab Public Service Commission.
“With the new recruitment, the vacant seats will be filled and the shortage will decrease,” Dr. Mahmood said.