Health officers held responsible for dengue outbreak in Rawalpindi

ISLAMABAD: A probe committee has held the chief executive officer (CEO) of the District Health Authority and district health officer (DHO) responsible for the outbreak of dengue epidemic in Rawalpindi. A number of people have died due to the widespread dengue epidemic and deaths continue unabated.

Hundreds of patients are admitted in Rawalpindi hospitals and more affected people are rushing to medical facilities. The Punjab government ordered a district administration official to conduct a fact finding inquiry, a copy of which is available with The News.

“The responsibility for outbreak in Potohar Town, Rawalpindi, rests with CEO Health and DHO, who were responsible for overall supervision and monitoring of dengue surveillance, larval detection and monitoring of health teams in the relevant area.

The concerned DHO was responsible for overall management, direct supervision and effective monitoring of the indoor and outdoor teams, who miserably failed to discharge his duties. The concerned entomologists, sanitary patrol and teams (indoor, outdoor), who did not meet the required target of activities, surveillance and larval detection were responsible for the epidemic in the concerned areas while the management of Airport Employees Cooperative Housing Society did not fulfill its responsibility regarding ensuring cleanliness, clearance of vegetation and management of the society,” the probe committee said in its report.

The DHA CEO, who was held responsible by the committee, had been allowed by the Punjab government to proceed to Saudi Arabia for the Haj Medical Mission along with two other doctors of Taxila and Attock.

An official notification dated July 12, 2019 [peak dengue breeding season], a copy of which was made available to this correspondent, said that the competent authority of the primary & secondary healthcare department of Punjab, has no objection to joining of DHA CEO Dr Muhammad Rashid, who is said to be a close relative of a top constitutional position holder of Punjab, the Haj mission. It had nominated Dr Khalid Mahmood as his replacement. “If dengue breeding is not prevented through established, tested measures, the job of the hospitals start meaning that people are bound to be affected by the epidemic,” an expert said.

The report said that in compliance with Punjab government order of August 26, to probe the eruption of dengue epidemic in Union Council Dhoke Munshi, Potohar Town, Rawalpindi, a fact-finding inquiry was conducted. Reply was also sought from the health department while different indicators were checked. The role of District Emergency Response Committee (DERC) was examined; activities performed by the district health department, including dengue surveillance and larval detection were scrutinised and analysis of hotspot visits by allied departments was carried out.

The report gave details of DERC meetings held from January to August. It said that as per the reply received from the health department, Technologist Dengue Cell Potohar Town stated that due to involvement of teams with polio campaign, EPI [Expanded Programme on Immunization] crash programme, registration of houses for micro-planning work in Dhoke Munshi was disturbed.

He said that there was shortage of manpower, IRS [inside residual spraying] pumps and insecticides. The DHO stated that he supervised dengue surveillance and passed necessary directions accordingly. The DHO stated that shortage of all components of dengue programme were reported to higher offices while Dengue Cold Season activities were properly followed.

The comparison of month-wise data of surveillance activity and larval detection clearly depicts that surveillance and larval detection in the suggested area increased in the month of July while zero and negligible detection was reported in Jan, Feb and March, the report said. It said the month-wise summary of hotspot visits revealed that unvisited hotspots remained considerably high till March. It also showed that unvisited mosques, under-construction buildings, tyre workshops and junkyards were the points of concern.

The committee observed that the DERC forum was very effective and focused on each and every component of dengue prevention and surveillance activity. It is apparent from the minutes of its meetings that guidance and assistance regarding house registration, registration of new androids, check on zero activity users, comparisons of larvae with the previous years, requirement of coverage of all areas through planned surveillance, was provided to the health department at every step, the report said.

However, it noted, the deficiencies in dengue surveillance, larval detection, mechanical removal and need for redressal of zero activity data, as directed by the DERC chairman, were not removed by the health department.

At the DERC level, instructions were passed on to cover all the areas in general and areas pointed out by Punjab Information Technology Board (PITB) in particular. The PITB focus mostly remained on cantonment areas and in later months in the area under discussion whereas the PITB also reported that surveillance had improved and missing areas were being covered.

Besides, DERC meetings were also being held by the assistant commissioners once a week for micro-planning. User performance analysis, larval detection and surveillance reports from dashboard and hotspot analysis of allied departments reflected that the required activity had not been performed by the health and allied departments whereupon directions were issued to them to improve surveillance and larval detection.

The findings said that the reporting of the allied hospitals was not found as per the standard operating procedures (SOPs)--suspected and probable patients were not being reported, which was also pointed out multiple times during DERC meetings while, as per the record, the representatives of these hospitals remained absent from its sessions. This showed that performance of allied hospitals was not up to the mark whereby directions were issued and allied hospitals should improve their performance and patients should be reported as per SOPs.

In order to ensure quality of surveillance and verification of activities, third party validation by local government department was also conducted. However, they did not report any major deficiency, the report said.