Upper Dir's healthcare system under strain

A severe shortage of doctors and healthcare facilities has raised serious concerns over the state of public health in Upper Dir, where around 1.08 million people are being served by only 207 doctors, including just 13 female doctors for an estimated 530,000 women. According to available figures, each female doctor in the district is responsible for the healthcare and gynaecological needs of approximately 40,770 women. Meanwhile, 195 male doctors are serving around 550,000 men, with each doctor catering to nearly 3,000 patients. The shortage has particularly affected maternal and child healthcare, with deaths of mothers and infants during childbirth reportedly remaining high compared with other districts. A large number of Upper Dir residents are compelled to travel to Timergara, Swat, Mardan, Peshawar, Islamabad and Lahore for diagnosis and treatment. The sight of ambulances carrying critically ill and injured patients from Upper Dir towards Timergara and Peshawar, often with sirens blaring along the Dir-Peshawar GT Road, has become common. Concern has also been growing over a reported rise in deaths from heart attacks in the district. Residents have demanded that the authorities determine the causes and ensure immediate and free treatment for affected patients. The entire district is currently facing an outbreak of cholera. Reports suggest that 200 to 300 cholera patients are being brought daily to District Headquarters Hospital Dir alone. A water-testing laboratory team established a camp at the RHC Chooran and collected samples from different areas of Ashiri Dara, but the outbreak has yet to be brought under control. Upper Dir has one Category-B District Headquarters Hospital in Dir, two Category-C hospitals at Wari and Barawal Banda, five Category-D hospitals at Patrak, Sheringal, Bibior, Chooran-Taptar and Nahag Dara Banda, besides 32 basic health units and several dispensaries in rural areas. The government claims that 54 per cent of the required healthcare facilities are currently available in the district. However, the continued movement of thousands of patients to hospitals outside Upper Dir has raised questions about the adequacy of these facilities. The situation became particularly serious when staff at Timergara Headquarters Hospital reportedly issued a written directive refusing treatment to patients referred from Upper Dir. The decision was withdrawn following protests on social media. District Health Officer Upper Dir Dr Khalid Khan, who also holds the additional charge of Medical Superintendent at DHQ Hospital Dir, said the government was making efforts to improve healthcare services. He said 32 BHUs had been made functional, with two doctors posted at each facility, while 207 doctors, including 50 to 60 specialists and 13 female doctors, were currently performing duties in the district. According to Dr Khan, DHQ Hospital Dir provides initial and emergency treatment for cardiac, orthopaedic, psychiatric, trauma, prostate and hernia cases, besides conducting major and minor surgeries. He said work was underway at a cost of Rs980 million to upgrade DHQ Hospital Dir with modern technology and facilities to Category-A level. Work was also in progress to upgrade the Category-C hospital at Wari to Category-B level and equip it with modern healthcare facilities. Dr Khan said a new referral mechanism was being developed to reduce pressure on major hospitals. Under the proposed system, patients would first visit their nearest BHU. If the case could not be treated there, the patient would be referred electronically to the appropriate higher-level hospital. He acknowledged that providing adequate healthcare and protecting the lives of mothers and children remained a priority, but admitted that the authorities had not yet achieved complete success in this regard. Responding to concerns over only 13 female doctors serving nearly half a million women, he said the shortage was a challenge not only for Upper Dir but for the entire province and country. He added that referrals to Timergara and Peshawar could not be completely eliminated because some patients were in critical condition and required specialised treatment. However, he said efforts were underway to expand local facilities and reduce unnecessary referrals.