he District Health Authority, Faisalabad, is in the process of closing 62 out of its 114 dispensaries, in compliance with a directive that went into effect on July 1.

Most of the dispensaries that are shutting down are located in rural areas of the district where access to primary medical care is limited.

The staff at these dispensaries has been directed to report to their nearest basic health units (BHUs), rural health centres (RHCs), tehsil headquarters hospitals or district headquarters hospitals.

The notification issued by the Primary and Secondary Healthcare Department in this regard says that the decision to close the dispensaries was taken in compliance with orders issued by the office of the provincial ombudsman. However, Shahid Abbas, the public information officer for the Office of Ombudsman says that no such directive has been issued. Abbas says while the matter had been brought to the attention of the Office of Ombudsman, a “detailed decision would be issued soon to clarify the matter.”

Adviser to the Ombudsman Nasir Jamal also maintains that the decision to close the dispensaries was taken by the Health Department. He says the ombudsman had directed the Health Department to bring the issue of inactive dispensaries to the notice of the chief secretary and the competent authorities and submit a report on the steps taken to resolve it.

“After a meeting with the chief secretary, the secretary for the Primary and Secondary Healthcare Department issued a notification to close the dispensaries and submitted a report to the ombudsman that the inactive dispensaries were being merged with the nearest health facilities.”

He says a letter has been issued to the health secretary to rectify the notification and submit a compliance report.

Dr Asfandyar, the chief executive officer of the District Health Authority, Faisalabad, says that only the health facilities and dispensaries that ‘were not performing well’ are shutting down. “Dispensaries all over the Punjab, not just Faisalabad, are shutting down where they failed to perform,” he tells The News on Sunday.

“We have started implementing the orders sent to us by the Health Department,” says Asfandyar. “Instructions have been issued to the staff. The transfer of medical supplies has also started,” he says.

Sadaqat Ansari lives in a Faisalabad suburb. The dispensary closest to his home, in Chak 242 RB Dasooha, was established in 1908. It is now on the list of medical care units shutting down this month. According to Ansari, 100 to 150 people have been visiting the facility daily. “This place was of great benefit to those living in the nearby communities,” he says.

“I found out only two days ago that our dispensary was closing,” he says. “I had a splitting headache and I went there to get a prescription. That’s when the staff told me,” he adds.

“This adds to my problems. From now on, when I get sick, I will have to go to the basic health unit at Baloch Wala, eight kilometres away,” he complains.

Dr Muhammad Arshad, in charge of a dispensary located in Peoples Colony No 2 in Faisalabad City estimates that over 1,500 patients visit the dispensary every month.

“Mostly out patients facing seasonal diseases come to us,” says Dr Arshad, “Dispensaries are the first touchpoint in primary healthcare,” he adds.

“We have a lady health worker to provide gynaecological services and a vaccinator to immunise children, he says.

The Pakistan Medical Association (PMA) has termed the Health Department’s decision to close the dispensaries inappropriate.

Dr Muhammad Irfan, the PMA-Faisalabad general secretary, says that the closure of the dispensaries will shift the entire load of patients to the teaching hospitals which are already overburdened.

“4,000 to 5,000 people visit the outpatient department (OPD) of Allied Hospital. They have to wait for hours to see a doctor,” he says.

“Because the doctors are overworked, they are unable to pay proper attention to individual cases,” he says.

Dr Irfan says that instead of closing down the dispensaries, the government should increase their number at the Union Council (UC) level and link those with teaching hospitals. “This way only those who cannot be treated at the dispensaries will visit the teaching hospitals,” he says.

On the other hand, a staff member at a dispensary in the city tells TNS on the condition of anonymity that the dispensaries were shutting down because doctors and medical staff do not like being posted there. He says the real reason for these facilities shutting down was a shortage of staff. “The buildings of most of the dispensaries established in the suburbs are dilapidated. These have not been provided adequate funds for repair and maintenance. Not only are they short on staff, they are also short on medicines and other facilities,” says the official.

“This problem has been there for a while. Some time ago, the district administration started a campaign called ‘Own A Dispensary’ to end the shortage of funds faced by the dispensaries. It urged affluent people to ‘adopt’ dispensaries by paying their expenses”.

There have also been reports that several complaints were lodged with the Office of the Ombudsman by the staff posted in these dispensaries. Some of these argued for shutting down the dispensaries since they were not useful.

Asked about this, Dr Asfandyar says he is not aware of such a complaint.

“As far as Faisalabad is concerned, I can say that no employee from here has made such a complaint to the ombudsman. Some of the employees in other districts may have made such complaints,” he says.

It should be noted that a few years ago, Faisalabad Medical University vice-chancellor Professor Dr Zafar Ali Chaudhry had proposed a referral system at the dispensaries to reduce the patient load at Allied Hospital and the District Headquarters Hospital.

He had suggested that teaching hospitals should treat only the patients referred by the dispensaries.

Acknowledging the usefulness of this proposal, Dr Asfandyar says, “It is already happening. Patients suffering from low-grade fever and cold are going to the teaching hospitals for treatment, forcing the doctors there to work long hours in the OPDs.”

“Hundreds of patients have to be treated every day. If such patients are provided with the required treatment at the dispensaries, we can significantly reduce the footfall at the teaching hospitals,” he says.

Dr Asfandyar says the problems faced by the people affected by the closure of dispensaries were discussed in a meeting presided over by the commissioner.

“Some of these dispensaries will be merged. Others will be converted to vaccination centres. A proposal to revive the closed dispensaries in areas where Basic Health Units or Rural Health Centers are far away was also discussed in the meeting,” he tells TNS.

According to Dr Asfandyar, there is a BHU in every union council of Faisalabad.

Faisal Manzoor, project manager of the Centre for Peace and Development Initiative (CPDI), a non-governmental organisation working on budget and governance in Pakistan, says that historically the health sector has never been a top priority of the governments.

“The health and education sectors have never really been considered important for national development in policy-making. They are largely neglected which is why the country is lagging in these domains,” says Manzoor.

According to District Health Officer III Dr Muhammad Adnan, who is responsible for the implementation of this decision in Faisalabad, the closure of dispensaries will be completed in two to three phases. “In the first phase, we will close about forty dispensaries run by the district council,” says Adnan.

According to Dr Adnan, the higher authorities did not seek input from the administration of any district regarding the closure of dispensaries. He says they remain unaware of the reasons behind the decision.

Highlighting the performance of the dispensaries, Dr Adnan says, “Even the most neglected dispensaries received 40 to 50 patients a day. Some of the more popular dispensaries treated 200 to 250 patients a day.”

In some areas, citizens have approached courts to challenge the closure of dispensaries. “A court has issued an injunction against the closure of the dispensary located in Union Council 172 GB in Faisalabad,” says Dr Adnan.

“Citizens in Multan and Lahore have also obtained injunctions from the courts against the closure of dispensaries,” says Adnan.

The writer has been associated with journalism for the past decade. He tweets @ naeemahmad876