Published on 06 Feb 2019
Since 2013, Pakistan has been receiving below average amount of rainfall. In 2018, less than 10% of the projected annual rainfall was received in Sindh and Balochistan provinces. This drought has had serious public health implications in the two provinces.
Over 4.4 million people have been affected by the ongoing drought in Balochistan. Around 670 000 children under 5 years and 370 000 pregnant and lactating women are in dire need of health services. The average distance to reach heath facilities is 30 kilometers (km). The per capita OPD utilization in 2018 is 0.4 which is far below the acceptable range of 1 to 1.2 in an emergency setting. In addition, less than 1% of the OPD patients scheduled for review return to the health facility for follow up treatment (DHIS report 2018). 73% of cases who attend OPD are suffering from communicable diseases. There is high suicidal tendency among the women due to this acute crisis (Ref: NDMA Assessment Report October-November 2018).
Over 2.5 million people in Sindh province are either directly or indirectly affected by the drought. There is severe shortage of water and poor access to sanitation. The current severe acute malnutrition level in Tharparkar is 22.7%. This figure is above the emergency threshold of 15% (Ref: National Nutrition Survey 2018-unpublished data).
The average distance to the health facilities is 19.8 km (range 11.4-41 km); the cost of transport to the health facility is high. In addition, the human resource for health in those facilities is inadequate; road infrastructure condition is very poor; and there is lack of transportation facilities. This is further compounded by the poor socioeconomic situation; the population is unable to access the health services. There is inadequate supply of essential life-saving medicines at the health facilities and non-availability of medical equipment.
The two provinces are reporting outbreaks of dengue. In Sindh, over 3700 cases were reported in 2018. In addition, there is ongoing outbreaks of Crimean Congo hemorrhagic fever (CCHF), chikungunya, leishmaniasis and malaria. All these are vector borne disease. In Balochistan, around 5000 cases of leishmaniasis were reported in 2018 from the district of Killa Abdulla. It is worth noting that with the ongoing drought, the population of vectors in these areas will increase. This will lead to further spread of the outbreaks.
The prevalence of acute respiratory tract infections (ARTIs) in the region is high. The proportion of fully immunized children at 24 months is just 29% in Balochistan (PDHS 2017-18) which is evident from the measles outbreaks in 2017 and 2018 where 29 and 36 documented measles outbreaks respectively were reported with death toll of 77 and 44 respectively. With the ongoing drought, the incidences of ARTI and measles are expected to increase.
Cases of water borne disease are also on the increase as indicated in OPD records which states that over 20% of the patients suffer from diarrhoea. This figure is an underestimation since it is health facilitybased and represents only 40% of the population who seeks health services at the health facility. Water borne diseases are attributed to poor access to safe water as a result of the drought.
The government of Balochistan has declared nutrition as an emergency across province on 4 January 2019. The National Disaster Management Authority (NDMA) has convened a national level consultative workshop on drought on 18 January 2019.
The WHO Emergency Response Framework (ERF) were followed to address the urgent health needs of the vulnerable populations. WHO and Health Working Group will ensure that all activities are implemented within the stipulated timeframe