Curative Care Services
- Communicable Diseases Control
- Prevention and Treatment of Non Communicable Diseases
- Emergency Services
- Dental Care
- Medical and Surgical Care
- Diagnostic Services
Communicable diseases still account for 38 percent of the total burden of disease in Pakistan. The main ones, in terms of their disease burden, include diarrhoeal diseases (12.5 percent of total BOD), respiratory infections (8 percent of BOD), tuberculosis (5 percent of BOD), the childhood cluster of immunizable diseases (measles, pertussis, poliomyelitis, diphtheria, tetanus; 6.7 percent of BOD), and sexually transmitted diseases (2.2 percent of BOD). Diarrhoeal diseases, respiratory infections, and the childhood cluster of immunizable diseases, take their greatest toll from young children (under five years of age). Tuberculosis affects both children and adults.
Integrated Management of Childhood Illness (IMCI) approach was piloted in a few Districts of Pakistan and has been proved to be a cost effective strategy. This could be scaled up in the whole province of the Punjab.
The government should adopt a very proactive stance on preventing and treating communicable diseases. An important part of this effort should be health education together with public health measures. Government also should seek actively to identify and treat those already affected by communicable disease, and to maintain high levels of immunization coverage on a sustained basis. Government’s health staff should take advantage of all available opportunities. For instance, when a mother brings her sick child to an outpatient facility for treatment, the staff should seize the opportunity to find out whether the child has been fully immunized.
Presently only 33% of the natal care is being provided by a skilled birth attendant. 15% of the pregnant women suffer from pregnancy related complications and only 5% of these reach a health facility (UNFPA: CPA Report 2000). Therefore, RHCs should be equipped to provide Basic EmONC and comprehensive EmONC services should be provided at THQ and DHQ hospitals.
Most interventions to address communicable diseases, and maternal and child services, would be provided most cost effectively at the lower levels of the health system (in the household themselves, in the communities, and at first-level health care facilities). However, reliable referral services are also needed to handle emergencies and more serious cases. For most people in the Punjab, the first level of referral is Tehsil and District Headquarters hospitals.
Cardiovascular diseases account for another 10 percent of the total BOD. Other important problems are Diabetes Mellitus, cardiovascular diseases, Rheumatoid arthritis, and different causes of blindness, Obesity, Mental and conditions associated with aging (geriatric problems). These diseases are less easily treatable; the most promising approach would be health education campaigns to prevent their onset and promoting healthy life style behaviours. Anti-smoking campaigns and nutrition education to promote a healthier diet would be the main types of health education aimed at preventing cardiovascular diseases.
Also important are injuries, which account for about 11 percent of the total BOD. Their incidence could be reduced through public education programs on accident prevention, better work safety requirements, better automobile safety requirements, and other similar preventive measures.
Timely availability of emergency services and critical care can prevent and reduce number of deaths. Comprehensive emergency services should be available at RHC and above. BHUs should have a proper referral and transport system to carry patients to the higher facility. There is a need to increase capacity and to develop emergency services supporting critically ill patients throughout RHC and higher health care facility. Comprehensive information and data collection is required to support emergency services unit.
Strengthening of Emergency Services at SHC and SHC like Tertiary care hospitals is needed; in terms of physical infrastructure, human resource deployment and provision of drugs and supplies.
Oral health is very important and is a crucial aspect of maintaining general health. Problems in the mouth may be the first symptom of diseases like HIV infection and can also signify clinical progression. Open sores and exposed tissue is a potential entrance for infections into the body and proper dental care can reduce the presence of bacteria. Regular dental visits allow for early identification of conditions and infections. This allows for early treatment of these issues before they develop into serious problems. Specialist dental care both medical and surgical should be provided at RHC and above. THQ and DHQ Hospitals should be well equipped to deal with dental emergencies and surgeries.
Basic medical and surgical care will be available at BHU and RHC. Specialist medical and surgical care and advice for proposed specialties will be available at THQ and DHQ hospitals.
Basic diagnostic services that include Routine Blood and Urine examination, Malarial Parasite, X-ray, and Ultrasound should be provided at BHU and RHC. Advance services including sophisticated tests, Ultrasound, Gastroscopy, and Endoscopy will be provided at THQ and DHQ levels and CT scan at DHQHs only.