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Health Resource Availability and Mapping System (HeRAMS) in Health Facilities of FATA, Pakistan 2018

The overall security situation in FATA has markedly improved. Over 1.6 million people who were initially displaced in KP and other provinces have returned to FATA. Access to health care in the return areas of FATA is poor. A study conducted in October 2017 in FATA by UN agencies revealed that 24% of women who gave birth in the past three years did not seek medical attention during their pregnancy, and utilization of Expanded Programme on Immunization (EPI) is also very low. During the meetings of Director Health Services FATA with WHO Representative in Pakistan, he put forth the need of a scientific assessment of the health facilities in order to facilitate the process of informed decision making. These findings and many others prompted WHO to support FATA Health Directorate to conduct HeRAMS in FATA with the objective of:

  1. Assessing and evaluating the public sector Primary and Secondary level health care facilities using WHO HeRAMS tool.
  2. Identifying the gaps and needs in resources and services at the Primary and Secondary level health care facilities.

Findings from the assessment revealed that there are 996 health facilities in FATA/FR Areas, out of which 851 health facilities (that were visited) provided all the basic health care services. Total of 300 health facilities have some form of damage to the infrastructure. Concerning infrastructure, 46 health facilities were housed in a temporary/rented building and 49 health facilities were housed in a semi-permanent building. The Agencies most affected in terms of infrastructure are North, South Waziristan, Orakzai and Mohmand Agency.

The available Human resource position at Basic Health Unit are 75% for Medical Officers/Women Medical Officers, 63% Lady Health Visitor, 72% Primary Health Care/Pharmacy, 14% Laboratory Technician and 6% Dai. For Civil Dispensary, the available human resource position is; 71% dispenser/ medical technician, 69% Lady Health Visitor and 39% Expanded Program on Immunization technician. For the Rural Health Centre the filled human resource positions are 53% for Medical officers, 7% Nursing Officers, 30% Lady Health Visitor’s position and 77% medical technicians. There are no Health educators at the RHC in FATA. At the AHQ hospitals level the human resource positions were: 29% Physicians, 36% Dental surgeons, 29% eye specialist, 43% Radiologist, 71% General Surgeons, 36% Gynecologist, 21% Anesthetist and 22% Medical officers. The Agency most affected by the Human Resource challenges is North and South Waziristan Agency and Mohmand Agency.

Regarding provision of services, 40% of the RHCs, 57% of the THQ and 39% of the CHs provide basic Laboratory Services. Only 29% of CDs, 62% BHUs and 80% of RHCs were providing EPI services. Regarding use of IMNCI protocols, only 7% of the Civil Dispensaries, 22% of BHUs, 39% of Civil Hospitals and 43% of THQs were following IMNCI protocols. Child screening for malnutrition were being conducted in 57% of AHQ Hospitals. The availability of Ante-Natal Care services was very low at all levels except AHQ Hospitals. Only 25% of CH, 43% of THQH, 36% of RHC, 16% BHU, 7% of CHC and 5% CDs offers ANC services. Basic EmONC services were being provided in only 23% out of the 252 health facilities (BHU, RHC, THQs where as Basic EmONC services are supposed to be provided in 100% facilities). The most affected Agency/FRs where most of these services were not provided includes; South Waziristan, Mohmand Agency, Khyber Agency, FR Tank, FR Kohat and FR D.I.K.

Availability of equipment and other medical supplies was also a challenge in many of the health facilities. For instance only 46.7% of the health facilities had refrigerator, 22% of health facilities had safe delivery kit, 19% of health facilities had sterilization equipment, 23.7% of the health facilities had delivery table. It is worth mentioning here that some Agencies/ FRs like North Waziristan, South Waziristan and Kurram were more affected as compared to other Agencies/FRs.

There is an urgent need to support FATA to construct new health facilities especially where the infrastructure is totally damaged, repair/renovation of damaged facilities, recruitment of more health workers especially medical officers, nurses and medical technicians. Other areas of support should include training and capacity building of health workers on standard protocols such as IMNCI, ENC etc., provision of medical equipment/supplies and support to FATA health Directorate and Agency/FR health offices regarding monitoring and supervision of the health facilities.

Operation(s)/ Webspace(s): 
World Health Organization
Original Publication Date: 
13 Nov 2018
Document type: 
Assessment Report
Khyber Pakhtunkhwa