he healthcare sector is seriously overburdened in Pakistan; the professionals are overworked; the budgets are strung taut. With economic and fiscal challenges multiplying daily, providing healthcare support and quality care to an ever growing, financially challenged population has become a big ask.

It is estimated that 40 percent of Pakistan’s population is living in multidimensional poverty; barely 20 percent has access to public healthcare. Considering it’s the world’s fifth most populous country, the numbers are staggering.

According to Pakistan Economic Survey 2021, the country spent only 1.2 percent of its GDP on healthcare in 2020 and “lags behind its neighbouring nations on key health indicators such as infant mortality and eradication of polio.”

Inefficiencies in the public health sector are a result of limited government spending, as the provision of necessary resources is essential for effective management of the sector.

However, when it comes to the everyday running of a public hospital, the responsibility falls on the shoulders of the hospital management and care providers. The government is responsible for providing the budget to buy new linen for hospital beds; it’s the administration’s responsibility to ensure that blood-stained sheets are removed and fresh ones are available for every patient.

“When the caretaker chief minister [of Punjab] visited Services [Hospital] a couple of months back, he noted that some sheets in the ER had blood stains on them,” a member of the Services’s staff, speaking on condition of anonymity, said.

“Cleanliness is off course an absolute must; compromises are unacceptable.”

Services Hospital, located on Jail Road, Lahore, is one of Punjab’s busiest public hospitals, providing treatment and care to thousands of people on a daily basis. From outpatient care to emergency support, the hospital has over 25 departments, 1,460 beds, 1,390 doctors and 751 nurses. (It is important to note that the number of beds does not indicate the number of patients who visit the hospital’s outpatient department daily.)

“The hospital is like a labyrinth,” complains a visitor who faced difficulty finding the cardiac care unit.

“The caretaker CM ordered the much-needed renovations, but they have resulted in chaos,” says a member of the CCU staff. Some departments have had to be shifted from ground floor to first floor. “Water seepage had already been a problem, the situation has worsened since the renovation began.”

Even though Services employs hundreds of nursing staff, the numbers aren’t sufficient. “We have enough doctors, but we need more nurses,” says the head nurse. “On most days, we are running over capacity. The patient overload cannot be taken lightly. We are easily accessible, so our emergency is overburdened and often short on staff.”

“When the caretaker chief minister [of Punjab] visited Services [Hospital] a couple of months back, he noted that some sheets in the ER had blood stains on them,” says a member of the Services’s staff, speaking on condition of anonymity.

Two patients per bed is a common sight in Services, especially during the dengue fever season. “Changing sheets every time a patient is moved is not possible,” says a staff member, shrugging their shoulders.

“Patients have high expectations from public sector hospitals,” says Naheed, 43. “Doctors and staff there are well-trained, but there’s a shortage of medical equipment, especially considering the number of patients the hospitals receive on a daily basis.

“Private sector is too expensive for low- and middle-income populations. They rely on the government sector because healthcare is free of cost there,” she adds.

Access to quality medicine is the right of every citizen, but often the medicines available at public hospitals aren’t of the best quality. “There are medicine shortages, but we make do with what we have. At other times, we ask the patients to purchase a medicine that is not available in the hospital pharmacy,” says a senior staff member at Services.

The disparity in care provided by the private and public sector hospitals also adds to the problem. Sophisticated medical facilities available in the private sector are not affordable for most Pakistanis, whereas the public sector is so overwhelmed that getting an MRI appointment alone can take several days, though it is often free of charge.

“I’ve been coming to Services for many years,” says Sana, 39. “Their diabetes centre is quite efficient, and the doctors are always available, except in the event of a strike.”

Strikes by doctors and nurses remain a problem for public healthcare sector. A week-long closure of OPDs, including those of the Services, by the Young Doctors’ Association in June this year, over an incident of violence against a young doctor at another public hospital, disrupted patient care significantly.

“The YDA enjoys great clout. Sometimes disruptions can result from these strikes,” comments a member of Services’s staff, not wanting to be named.

From overbearing hospital unions to lack of staff and equipment; overworked doctors and nurses to constant scrutiny, the public sector hospitals in Lahore are under constant stress. Services is no different.

The writer is a staff member