Investment were channeled through development budgets into new schemes instead of repair and rehabilitating existing healthcare facilities. ~15% of planned cost1 for reform allocated
C&W was the only mechanism to provide infra upgrades and they have well-documented issues with their contracting.
DHO office responsible to plan and allocate expenditure to all health facilities with no capacity and capability to do so.
DHO led procurement of essential equipment and medicines usually delayed (~3 months to a year) and inefficient to fulfill immediate facility level requirements.
Apart from permanent staff on department payroll, other staff had no leverage to get additional help such has security, helpers and cleaning.
DHO and facility communication weak due which was a result of lack of interest from facility staff and DHO capacity
Poor physical outlook of facilities with absence of necessary functionalities
700+ facilities damaged and never refurbished
Irregular presence of staff (Medical Officers, Lady Health Visitors etc.)
MO Presence <50% across the province
Low availability of essential medicines and critical equipment
Medicine availability at 39% and Equipment availability at 77%
Poor management and oversight provided by district officials
No district routines set and no district oversight over facilities