Gilgit Baltistan's health conundrum

Writer: Muhammad Junaid Research Student Pakistan Institute of Development Economics
Islamabad.
Gilgit Baltistan’s Health Conundrum:
Despite being a major tourist destination, Skardu city faces significant health challenges that
impact both the tourism industry and the overall health statistics of the region. Skardu, one of the
largest districts in Gilgit-Baltistan, is served by a single Regional Headquarter Hospital (RHQ).
This hospital also provides healthcare facility for residents from other districts of the Baltistan
division, leading to a constant struggle to provide adequate services to patients from remote
areas. What are the underlying reasons for this situation? The reasons for this situation are
numerous, including a shortage of doctors and their frequent unavailability, a lack of trained
paramedical staff and their unprofessional attitudes towards patients, insufficient laboratory
facilities, and the absence of state-of-the-art medical equipment and machinery. Due to these
deficiencies at the only government hospital, the number of private hospitals in Skardu city is
rapidly increasing. These private hospitals offer necessary services but at a high cost, making
them inaccessible to poor patients. If private hospitals can provide such facilities, why can't the
government do the same?
People who can afford to travel to bigger cities like Gilgit and Skardu for medical treatment
often overcrowd the outpatient clinics and emergency rooms. These facilities have few specialist
doctors and limited treatment options. As a result, patients often have to travel further to major
cities in the south for better care. Many people, especially those living in remote towns and
villages near areas like K2 and Siachen, can't access or afford these tertiary care hospitals. They
are left to rely on fate or suffer in silence.
Since doctors are rarely available, only a small number of laboratory investigations are being
conducted, there is a severe shortage of trained laboratory and operating theater technicians as
well as trained nursing staff, and no basic medicines are available, the DHQs, THQs, BHUs, and
dispensaries provide very little benefit to the community. Life-saving medications are scarce at
accident and emergency rooms, which are in a terrible shape. Even the emergency room is
lacking a wheelchair, which is a need, and the necessary medications, which should be available
at the emergency department, must be purchased at a nearby pharmacy. Standard operational
procedures for hospital laundry collection, disposal, and segregation are lacking in hospital
setups. Furthermore, there is hardly any hospital waste management policy. There are also
serious problems with water supply shortages in some hospitals, which makes it very difficult to
provide basic hygiene and maintain hospital cleanliness and patient care. Winter is hard; patients
trickle into hospitals and other facilities constantly, but there isn't a well-managed, 24-hour
heating system available for adult and pediatric ward patients, as well as for caregivers in waiting
rooms.
The silver lining in this crisis are the Lady Health Visitors (LHV), Lady Health Workers (LHW),
and Dai (Traditional Birth Assistant, TBA), they are the caretakers of maternal and child health
at the grass root level. They offer door to door antenatal checkups and assisted home deliveries.
Despite of this there are many reported cases of complications during labor and delivery such as
obstructed labor and postpartum hemorrhage, due to the unskilled management of patients by
untrained health workers and TBAs.
International NGOs, donor organizations, and public-private collaborative projects have
frequently made donations to health facilities, providing laboratory equipment, examination
apparatus, dental chairs, examination couches, and other essential hospital items. However, it is
crucial to use these donations properly; otherwise, they risk being wasted, as has happened in the
past due to misuse or neglect. It is frequently asserted that the unfortunate state of health
facilities is solely the result of a lack of funding; however, it would not be incorrect to assume
that, if used wisely and honestly, the funds available or allocated to the respective health
departments are adequate commensurate with the population load. However, it is equally
important to emphasize how crucial physicians are to enhancing the state of healthcare in this
challenging location. Most doctors are extremely hesitant to travel to remote, inhospitable areas
that are hard to reach from the rest of the nation and lack appealing facilities in order to provide
medical care. These medical professionals should assiduously acknowledge their obligation to
provide their services to their own people. Unfortunately, despite recent efforts by the Gilgit-
Baltistan government to lure doctors with a financial incentive package, the dearth of doctors
continues. In order to address this at an early stage, medical education must be restructured to
significantly include the aspects of primary and secondary health care and their unmatched
importance in enhancing health indicators; this will define the core responsibilities of social
physicians and public health specialists for medical students. The supply and delivery of life-
saving medications should also be guaranteed to every healthcare facility in GB, and the
medicine supply chain should be managed and maintained extremely carefully.
In order to provide healthcare in a more professional manner and lower the likelihood of
complications during labor and delivery for both mother and child, LHVs, LHWs, dais, and other
paramedical staff also require refresher trainings and knowledge of the most recent guidelines
regarding maternal, neonatal, and child health care. Last but not least, a creative health care
model that updates the infrastructure, trains medical staff effectively, and equips healthcare
institutions to manage fundamental medical emergencies should be developed and put into
practice. Overcoming all of this should be wise leadership and insightful management, whose
critical function in the efficient implementation, management, and redesign of the present health
program cannot be overstated. It is depressing to witness the average person denied access to
basic healthcare facilities, while developed countries, like the United States, have championed
the provision of affordable and high-quality healthcare by instituting universal health-care
coverage plans and have made access to cutting-edge healthcare the primary indicator of their
rapidly expanding economies. However, we have made the decision to overlook the dire
circumstances facing our healthcare system and the suffering of those who are less fortunate than
us. Health represents one of the lowest spending categories in Pakistan, accounting for 0.9% of
the country's GDP when including provincial and federal levels combined. This small figure
clearly illustrates the government's indifference and disregard for healthcare. Private hospitals
are largely used by the wealthy, leaving the impoverished to suffer in quiet and finally vanish
from view. The state of government hospitals around the country is terrible.

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Writer: Muhammad Junaid Research Student Pakistan Institute of Development Economics

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