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Health and education – still basic, vital issues in Balochistan

Last year, Balochistan government led by Chief Minister Jam Kamal Khan decided to impose health and education emergency in the province. The government declared that establishing boys’ and girls’ schools in every union council of the province is mandatory. It also decided to take strict action against absentee doctors who were not performing duty on the places of their appointment. It was decided that an apex committee headed by the chief minister would be set up in the health department to make decisions about devolution of powers in the department up to lower level. It also approved requirement of doctors on contract bases for primary health care. The provincial government is giving special focus on education and health sectors in proposal of Public Sector Development Program (PSDP) financial year for provision of better facilities to public in province. The government plans to expand nursing schools and colleges across province for ensuring provision of health and education opportunities of relief to masses at districts level.

The state of health care in the province as revealed by Pakistan Demographic and Health Survey 2018 portrays a gloomy picture. The survey report reveals that “only 56 per cent of the women in Balochistan receive antenatal care from a skilled provider and only 38 per cent of the births in Balochistan are assisted by a skilled care provider. Almost every second child (over 47 percent) in Balochistan is stunted and less than one-third of children in the province are likely to receive all basic vaccinations.”

Major causes of water-related diseases include lack of water supply and sanitation facilities, absence of proper sewerage disposal, waste mismanagement and contaminated water. Malaria, Typhoid, Hepatitis, gastrointestinal and respiratory disorders are common in the province. These diseases can be prevented by facilitating the population with proper sewerage and sanitation disposal systems. In rural areas, the health status is relatively poor. Lack or absence of female health staff including female doctors in rural areas worsen the situation. In rural Balochistan, the health status is relatively poor.

According to an estimate, there is only one doctor available for 7300 persons in average. An amount of Rs18 billion had been allocated for health sector in the Balochistan budget 2017-18 which had a five percent increase than the past year.

Though health sector in Balochistan remained the focus of welfare programs launched by every government in the past, but the leakage, misuse of public funds and irregularities in this sector caused no relief to the people in the most backward province. The non-availability of medical staff, medicines and necessary facilities is the tragedy of the government hospitals in Balochistan.

Balochistan Health Department is responsible for aims delivery of key health services to the people through hospitals, Basic Health Units (BHU) and Rural Health Centers (RHC). The Department operates more than 550 BHUs, 90 RHC’s and 89 Maternal Child Health Care Centers (MCH) to provide health services throughout to the province. The Provincial capital Quetta has five hospitals namely; Bolan Medical College (BMC), Civil Hospital, Fatima Jinnah Chest & General Hospital, Helper’s Eyes Hospital and Sheikh Khalifah Bin Zayed Hospital. The provincial health department has developed its Health Sector Strategy (2013-2018) to address challenges of service delivery, quality of care, lack of skilled health workforce, governance and regulation, and to ensure adequate health coverage for the poor and vulnerable populations in the province. The key emphasis of the strategy is on integrating health services through a strong monitoring and evaluation system. The provincial government has committed funds from development partners, however, to ensure implementation, the strategy recommends an overall increase in health budget from 5 to 10 percent over the course of five years (2013-2018).

A health insurance scheme for the people in different parts of the province should be launched in order to provide the people free healthcare facilities. The wider coverage of poor sections of society under health insurance scheme will be a great step towards making the country a welfare state.

The situation of educational facilities in all parts of the province excluding Quetta is worst. The major problem is lack of quality of instruction due to teacher absenteeism, poor facilities, and lack of school supplies. With low participation in general education and low completion rates at primary and secondary levels, the unemployment and underemployment rates in the province are higher than the national rates. Education would be instrumental in combating backwardness in the province.

Quality of education is the major factor resulting in low enrolment and high dropout rates. Lack of access is a problem for certain remote population in Balochistan, as schools remain closed due to unavailability of teachers. Expansion of elementary and secondary schools may be required in certain locations to accommodate remote areas and increasing enrolment of students, especially girls. Special efforts are needed to rationalize resources and to improve the internal efficiency of the education system.

Dropout rate of children is higher in the rural Balochistan where schools lack the physical infrastructure and educational facilities. Most of the schools lack basic amenities like drinking water, latrines, and electricity. Most of the schools are either single- or two-teacher schools. There is extreme shortage of female teachers in rural districts. The literacy rate among the female is even less than 5 percent in most of the districts. The private sector has almost lost interest in providing education to the poor in rural Balochistan where the fragile public school infrastructure has failed to give better access to the poor and girls.

The provincial government must continue to increase its spending on education. It should encourage private sector but put checks on commoditization of education and ensure educational system free from discriminatory practices for all the citizens. Most of the private educational institutes have commercialized the professional education by charging high fees making it unaffordable for the common people. The government should provide both financial and technical support to improve primary enrolment and completion rates, reduce gender disparities, and encourage the private sector to participate in provision of education in the least developed province.

A lethal combination of militancy and poverty continues to keep the province far behind the other provinces in performance improvement in the educational arena killing all efforts and frustrating any prospect to bring improvement in poor state of education. For obtaining human capital in Balochistan, there is a dire need to resolve basic and pressing issues related to the education and health sector.

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