1.

Introduction
1.1 Background
DHQ Hospitals form a cornerstone of the healthcare system in Pakistan. Being a developing
country the state of healthcare in Pakistan leaves a lot to be desired. Our healthcare
infrastructure has ensured that many chronic and infectious diseases that have been
eliminated or controlled in the rest of the world, still endure in our country. Diseases like
Poliovirus, Cholera and HIV still take their share of the human capital of Pakistan. The
World Health Organization (WHO) in its performance report, places Pakistan to be about
122 from 190, globally. According to the Economic Survey of Pakistan, we annually
contribute about 2.6% of our budget on our healthcare.

In this abysmal situation of healthcare in Pakistan, there are few hospitals which can cater to
the needs of the poor in rural or semi-urban areas. BHUs (Basic Health Units), THQs
(Tehsil Headquarter Hospitals), and DHQs (District Headquarter Hospital), all form a system
of public hospitals meant at ensuring the public access to adequate healthcare. Among these
DHQs hold a special role in our overall infrastructure. Much larger and with better facilities
these ensure that in the event of BHUs and THQs lacking facilities and specialization for any
disease, a good hospital is just one ambulance drive away.

Growth literature recognizes well the role of human capital in the development and expansion
of an economy. Education and health conditions are the main parameters against which the
status of human capital of any economy is gauged. It is well established that healthy people
may not only work more effectively and efficiently, but also dedicate more time to
industrious activities, so overall development and wellbeing of medical care centers play a
vital role in boosting the economy and uplifting the flourishment of the whole nation.

The major aims of this study were to collect valid and reliable information on the
complications tackled by the staff of DHQ relating their daily routines as well as their long-
term job requirements, and to assess the health facility status and quality of the environment
being provided by the hospital. We have done a survey of about 140 people including
medical and paramedical staff at various DHQ’s. Due to time and space limitations we were
unable to take extensive interviews of that many varied DHQ’s, as such we have tried to
concentrate our endeavors at nearby or easily accessible.

The Table 1 given below provides an essential number of pertinent statistics about the
number of doctors in DHQ hospitals in Pakistan.

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STATISTICS
TOTAL NUMBER OF DOCTORS / DENTAL SURGEONS (G.P’s with basic degree
only)
REGISTERED UP TO 28th February, 2018
M.B.B.S. B.D.S. L.S.M.F.
Province Male Female Total Male Female Total Male Female Total
Punjab/Federal
35769 37057 72826 2560 5455 8015 511 54 565
Area
Sindh 30373 32683 63056 2038 5075 7113 284 22 306
K.P.K 13906 7495 21401 1200 1796 2996 52 2 54
Baluchistan 2834 2004 4838 259 288 547 44 11 55
A.J.K. 1906 1738 3644 167 198 365 3 1 4
Foreign
2912 1019 3931 363 140 503 98 8 106
Nationals
Total 87700 81996 169696 6587 12952 19539 992 98 1090
RMP RDP LSMF/LDS

TOTAL=169696+19539+1090= 190325

Azad
Type of
Jammu Gilgit Khyber
Health National Baluchistan FATA Punjab Sindh
and Baltistan Pakhtunkhwa
Facility
Kashmir

Teaching
39 0 4 0 0 9 19 7
Hospital

DHQ
108 0 27 4 5 21 34 11
Hospital

THQ
280 12 10 14 27 77 84 56
Hospital

The DHQ Hospitals are further divided into various categories, depending on the patient
capacity of the hospital. In a typical hospital, the number of beds is generally used to describe
this. For DHQs, further classifications compromises of three main categories namely A, B
and C, in descending order of size. Category C hence represents the smallest level of hospital.
The number of beds in category C can be anywhere from 125-250, Category B 250-400 while
A has above 400 beds. The tables below further elaborate the distinct categories of DHQ
Hospitals including the number and specialization of staff. Each category of DHQ hospitals
contain a requisite number of medical specialists in the following order.

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1.2 Objectives
During the course of this survey we have prepared a questionnaire to ask a set number of
questions about the situation of DHQ hospitals in various regions of Pakistan. Note
beforehand the topic of our report was DHQ Staff in Pakistan, hence our questionnaire and
the questions we have asked during the course of our report reflect not that much on the
hospital but the condition of the overall staff working in it. Here is a list of our questions.

1. The questionnaire asked the respondents to specify their sexual category so to avoid
any biased based on their gender and the overall statistics would not communicate
incorrect solutions.

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 2. The respondents also have to specify their age as well. Different generations have
dissimilar views regarding various matters. Normally older people tend to assess
things from a more orthodox point of view while younger audiences may go for a
fresh sight.
3. Due to the disparity between the regions, respondents are asked to specify their areas.
Giving us a direct answer of which areas, the government should focus on more.
4. The number of patients who visit the hospital in a day. The number may vary
according to what area the hospital is located in and what are the charges a patient has
to pay per consultation.
5. Does the hospital have enough beds and wards to satisfy the number of patients? Are
they being under used or is there a dire need of increasing the number?
6. The role of the respondent in their respective institution. Each hospital has
specialization of workforce to improve efficiency, however this causes a problem of
not knowing the issues, the other departments are facing. Therefore, to account for all
problems in an institution, the survey should be filled by a number of people hailing
from the orderly to the chief of medicine.
7. Availability of medical equipment to carry out regular test. This would tell us whether
the patients have to use outside facilities to get their tests done and then come to the
hospital for further consultancy.
8. Is the paramedical staff available day and night? Under staffed hospitals are generally
associated with overburdened doctors and therefore of low quality.
9. Emergency services account for the majority cases inside a hospital and ambulances
should be available all the time. The number of ambulances would be according to the
population density of the area.
10. Personal views were also taken into consideration. Is there any discrimination towards
a certain group of people from the administration of the institution? How is it being
done? And what are the consequences?
11. Participants may agree or disagree to various situations and therefore, their responses
are highly helpful understanding quality health service which is being provided.
12. Job satisfaction is vital in the relationship between an employer and an employee. The
medical staff reflects this in the manner of service they provide to the patients.
13. Personal insight is also asked because it gives us a direct answer to the problem at
hand of how to improve the standard of health service in the country.
Health systems are expected to serve the population needs in an effective, efficient and
equitable manner. Pakistan, being a developing country, has a struggling health care system.
Comparable to other South Asian countries, health and sanitation infrastructure is adequate in
metropolitan areas but is generally deprived in rural areas. Pakistan is at major intersection in
terms of relation between health and development, being the 6th most populous country with
a total population of 212.74 million and a growth rate of 1.91% per annum. Major portion of
population is residing in rural areas but due to swift urbanization there has been surfacing of
mega cities such as Karachi, Lahore & Islamabad which have caused various social and
cultural changes.

Currently, Pakistan is spending 0.4% of its GDPs on health and this amount is about 50
billion PKR. On the other side, rural areas offer little to none of the basic services.

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The health system of Pakistan has different tiers of organizations and delivery service. The
Primary health care facilities are provided by Government Dispensaries (GD), Basic Health
Units (BHU) at the village level, and Rural Health Centers (RHC) at the level of the town.
Secondary health care facilities include Tehsil Head Quarters (THQs), and District Head
Quarter (DHQs) at the level of tehsil, district and large cities respectively. In addition,
Maternity and Child Health Centers (MCHCs) play their part and provide basic obstetric care
the community with the collaboration of lady health workers.

In order to deliver comprehensive Emergency Obstetric & New born Care services at the
secondary health care hospitals, including DHQ and THQ hospitals, the required
infrastructure components include an OPD, female ward, labour room, operation theatre,
pediatric ward, pediatric nursery, blood bank, clinical laboratory and residences for the
Maternal New born & Child Healthcare related staff, for the delivery of 50 services 24 hours
a day, 7 days a week. In the 280 surveyed THQ and civil hospitals of the country, on average
42% of the assessed infrastructure components were available, ranging from 54% in Punjab
to 27% in Federally Administered Tribal Areas and Gilgit Baltistan. In 108 surveyed DHQ
hospitals of the country, on average 58% of the assessed infrastructure components were
available, ranging from 76% in Federally Administered Tribal Areas to 46% in Baluchistan.

1.3 Significance of Research

The Pakistani health sector has been badly neglected by the policy makers. The common man
is ignorant to what are their health care needs which has resulted in the quality of life of
people to remain low and the nation has been unable to accomplish better levels economic
movement due to underdeveloped human resources.

Though the government is trying to advance the health and nutrition status of the country
using promotional, preventive and rural services. Programmes aimed at immunization to
reduce polio cases, prevent malaria and dengue are being introduced in DHQ’s and THQ’s in
cities and rural areas. This may still be inadequate due to the rapidly increasing population.
Public and Private Partnership are emerging in the form of private hospitals with generous
government funding.

However, the output may only be as good as the data the government has available. The
significance of this report is that the government urgently needs superior research tools to
assist them in understanding the type and volume of health services which area requires.
Secure surveys, customized to specific areas, conducted using updated portals provide us
with admirable data which can be acted upon to ensure a quick and positive consequence to
the governments’ efforts.

Doctors and medical personnel are the category which have first-hand knowledge of the
issues that are a part of the day to day life inside a medical facility. The number of beds and
operation wards are the major concern for them as their number limits the number of patients
they can treat.

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The research conducted in this report provides us with numeric as well as analytical
responses. The sentiment doctors and the staff have towards the overall institution they are
working under. Is their role valued in the day to day workings of their hospital? Does the
wage justify the exertion they do during their shifts? Do they require most medical equipment
assist them to get a quicker diagnosis of their patients? Job satisfaction is a vital part of the
relationship between an employee and his/her employer, medical staff is no different.

2. Literature Review
DHQ facilities in Pakistan, like various other public sector and government run healthcare
facilities, suffer from many chronic problems, related to facilities, quality etc. The problem of
healthcare facilities, in the Pakistan is widespread, and we have discussed it in detail, in the
Introduction. This section of our report is devoted entirely to the analysis of existing data, and
prior studies performed by other sociologists.

Although healthcare services in Pakistan are provided by public and private providers, the
government is considered by far the main provider of preventive care throughout the country
and the major provider of curative services in most of the rural areas. With increasing levels
of complexity and coverage from primary, to secondary and tertiary health facilities, it’s
becoming more and more difficult to equip DHQ’s with proper aptitude.

The functional capacity of any health facilities is assessed, against four specified inputs,
which include:

1. Infrastructure.
2. Human resources.
3. Drugs and supplies.
4. Equipment.
The focus of our report is based upon the facilities regarding human resources specified to
doctors in particular. One of the major issues of DHQ doctors is the amount of salary they are
being provided with, which is proving to be a serious concern, as now mindset of doctors is
diverting more towards the private sector as prior to what doctors use to think a decade ago.
The house rent, and convenience facilities are also poor as only 18000 rupees are given to an
eighteenth-grade officer, and no transport services are being given which does hinder the
daily routine of a doctor, who is unable to afford any personal vehicle. The clinical
orientation during 3 year of posting especially from 3rd to final year is also not that
overwhelming as it should be. The lack of presence of on duty doctors and paramedical staff
is also emerging to be a major concern for patients which ultimately puts the future of the
hospital in jeopardy.

Although there are some challenges currently faced by the DHQ’s but on the other side these
hospitals are also stocked with the latest modern technology which is uplifting are health care
conditions significantly. Along with this, the most vital attribute being provided by a DHQ is

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that the overall the services are free of cost which is why these health care units are the back
bone of our health system.1

DHQ Hospitals can also suffer from a lack of basic facilities and necessary equipment.
According to research conducted by JPMA (Journal of Pakistan Medical Association).
“lack of facilities and security” was marked true by 80% of doctors.

Also, in the same research “insufficient lab facilities including working equipment in
comparison to number of beds” was marked true 44% of doctors.2

Another report based on monitoring 65 DHQ Hospitals across Pakistan by FAFEN Health
Institution Monitor (2) mainly focused on general facilities and physical health facilities
provided in DHQ. General facilities include the provision of proper roads leading up to the
DHQ, condition of buildings, cleanliness of DHQ, availability of fans in wards during
summer season, availability of electric generators in hospitals etc.

According to survey conducted by FAFEN, all DHQs had electricity connections, 64 had fans
and 62 had a generator for power backup. The three DHQs that did not have a generator were
in Baluchistan. While 57 DHQs had clean drinking water, five in Baluchistan and one each in
Punjab, Sindh and KP were in need of such arrangements. As for cleanliness, 59 out of 65
monitored DHQs were clean.3

Sick leave is the time when employees or workers are away from their job or employment
duties because of sickness or injury. Sick leave may be used for medical appointments.

Each medical specialist recognized by a component society is qualified for paid leave
(ailment advantage) for a time of 121 days (in a schedule year) if there should be an
occurrence of normal infirmities and 365 days in the event of cancer or tuberculosis. The
disorder advantage for customary diseases is for a time of 121 days, is 75% of wages last
drawn while for Cancer and Tuberculosis for a time of 365 days, the laborer must be paid
100% of last wages drawn. In the event that there is a business related damage, a specialist
has the privilege to draw 100% wages for a time of 180 days. 4

Normally 12 days are allowed for an employee who has been working for a year or almost
50% of all day who are scheduled to work and who have completed six months of service on
job who use all available sick leave may normally use the vacation leave to continue to
receive salary during an illness.

Leave for absence or sick leave for medical reasons for an employee may also use up to 40
hours of their total sick leave to care for any sick family member for their medical
examination care.

1
(TRF Pakistan, 2012)
2
(Saeed, 2005)
3
(DHQs Lack Specialized Medical Services, 2012)
4
(The Provincial Employees Social Security Ordinance, 2011)

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Income levels are among the top factors affecting the attractiveness of different professions in
the health sector and the job satisfaction of incumbents. They also have a direct impact on the
health care costs, as wages represent one of the main spending items in health systems.
Data are included specialists who are salaried and for nurses who work in hospitals, as the
focus is primarily on government workers. In Pakistan, specialists earn the most, followed by
general practitioners and by nurses. This partially reflects the varying skill sets of the three
occupations as well as the time needed to be fully trained.

In 2017 the Government revised the pay scales and allowances of civil servants of the Federal
government. The basic pay of an employee in service would be set according to the grade
occupied by him/her. An annual increment shall be continuing to be admissible, subject to
existing conditions. The entry grade level for nurses is 16 while for doctors it is 17; the rest of
the stages of pay are set according to the following table:5

O.M.No.F.1(3) Imp/2017-500 Dated 03-07-2017

BASIC PAY SCALES OF THE CIVIL SERVANTS

Basic Pay scales 2016 Stages Basic Pay scales 2017

BPS MIN INCR MAX MIN INCR MAX

1 7,640 240 14,840 30 9130 290 17,830

2 7,790 275 16,040 30 9310 330 19,210

3 8,040 325 17,790 30 9610 390 21,310

4 8,280 370 19,380 30 9900 440 23,100

5 8,590 420 21,190 30 10260 500 25,260

6 8,900 470 23,000 30 10620 560 27,420

7 9,220 510 24,520 30 10990 610 29,290

8 9,540 560 26,340 30 11380 670 31,480

9 9,860 610 28,160 30 11770 730 33,670

10 10,180 670 30,280 30 12160 800 36,160

11 10,510 740 32,710 30 12570 880 38,970

12 11,140 800 35,5140 30 13320 960 42,120

13 11,930 80 38,330 30 14260 1050 45,760

5
(Finance, Revision of Basic Payscale and Allowances, 2017)

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 14 12,720 980 42,120 30 15180 1170 50,280

15 13,510 1,120 47,110 30 16120 1330 56,020

16 15,880 1,280 54,280 30 18910 1520 64,510

17 25,440 1,930 64,040 20 30370 2300 76,370

18 31,890 2,400 79,890 20 38350 2870 95,750

19 49,370 2,560 100,570 20 59210 3050 120,210

20 57,410 3,750 109,910 14 69090 4510 132,230

21 63,780 4,150 121,880 14 76720 5000 146,720

22 68,540 4,870 136,720 14 82380 5870 164,560

Although many employees are at least somewhat satisfied with their jobs, many consider the
possibility of seeking employment elsewhere in the next 12 months. The leading reason for
employees looking for external positions is higher compensation, followed by better overall
benefits. Other reasons for leaving that could be related to benefits where career advancement
opportunities and flexibility to balance work and life issues with a better pension plan for
there retirement are available. Thus, an attractive benefits package that includes professional
development support and flexible retirement plan that rival those of an organization’s
competitors could help with employee retention and recruitment. Many multinationals are
shifting their focus towards more employee development and helping them get a better work-
life balance.

The Pakistani government was very much obliged to sanction an increase of 10% of net
pension in 2017 to all civil pensioners of the Federal Government including medical officers
of all public hospitals.6

One of the most difficult situations that doctors face is being threatened, abused, or physically
harmed by one of their patients. This is not an uncommon problem. Aggression and violence
against doctors is reportedly high in Pakistan yet no peer reviewed published studies
addressing this issue could be found. The form of security risk faced by doctors may be
because of their gender, ethnicity, the language they speak or the area where they are
working. The risks may range from verbal abuse to even death. Most of the violence is from
the family members of the patients who may be diagnosed wrongly or were not given enough
attention. Female physicians feel less safe than male physicians, both at work setup and
during on-calls.

6
(Finance, Grant of increase in Pension To Pensioners, 2017)

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Advisor to Chief Minister Punjab on Health Hanif Khan Pittafi has said that initial work on
proposed “Doctors Security Bill” has been drafted and with the consultation of all
stakeholders a comprehensive law would be approved from provincial legislature. “Despite
some problems overall performance of doctors from public sector health facilities was
satisfactory” said the Advisor.7

The number of people coming to the DHQ Hospital is estimated by District Health
Information System (DHIS) to be total about 48,088 people (Dr Munir Ahmad). This runs to
be about 1850 people per DHQ, assuming the total number of DHQ to be 26 (in Punjab).

The most important tool to ameliorate the quality of health care in a country by a hospital is
by virtue of efficient and reliable ambulance service. The possession of a competent
inventory does uplift the caliber of a hospital; furthermore, an effective transport system
could make a difference of death or life. Most DHQ’s of Pakistan does provide an ample
amount of ambulance resources, which are well equipped with incumbent tools capable of
making a difference in a situation of crisis. Especially in Punjab the ambulance requirement
has been met with competence as now most DHQ’s of Punjab have collaborated with the
1122 service which facilitates the hospitals requirements accordingly.

Well just being stocked with essential ammunition is not enough, until qualified and
experienced personnel are not the ones using it then there is no useful outcome which could
be expected. The paramedical staff is the one which governs the utilization of an ambulance
and their unavailability may result in someone losing their life. The stats regarding the
availability of proper paramedical staff in an ambulance are not that overwhelming as around
25% to 35% of the times the paramedical staff is either not present or is not qualified up to
the mark according to the situation.

Another question we have asked in our report is regarding the overall conditions of doctors.
Since our project is about DHQ staff, our entire project can be said to be leading up to this
point. According to existing research conducted by Pakistan Medical Journal by Sohag
Memon and Rao (2012), on doctors at Isra University Teaching Hospital, about 76.2% of
doctors said that they were dissatisfied by their job. However according to another study
conducted in the Journal of Pakistan Medical Association (JPMA) by Ashraf, Shah and
Anwer (2014) about 74% were satisfied with their jobs at the Hospital.8

DHQ’s are one of the major patient bearing health units of a country, although there is
variation in the number of patients incoming and outgoing but overall a large number of
patients are expected at a DHQ on a daily bases. The average number of patients which the
hospital has to deal with on a daily basis is around 1000 to 1500, which is quite a lot and this
number has escalated dramatically during the last decade.

7
(Doctors Security Bill’ drafted, says Punjab health advisor, 2018)
8
(Sohag, A comparative study on factors causing job dissatisfaction among serving doctors at teaching
hospitals, 2012)

10 | P a g e
3. Methodology
During the course of our investigations, we visited different DHQs situated in different
districts across the country to know the health care situation and job satisfaction of the staff
members. The respondents belonged to different professions that included doctors, nurses,
clerical staff, pharmacy staff and other staff members working in the hospital. Our
questionnaire has already been discussed in the introduction part of our report. The findings
are discussed in the later sections of our report for detailed analysis to link to compare with
the data that we got from different sources in the literature review section.

18 questions were asked in the questionnaire, with 17 required and 1 optional question where
they were asked to give suggestions on how to improve the current situation of DHQs. The
questions were of mainly two types with the first section focusing on the health care situation
of the hospital and second being the satisfaction level of the members. To know the quality
level of hospitals in order to check the lags and shortcomings of DHQs while comparing
them with previous year’s data reports. We also asked them about the hospital policies
towards their staff and measures undertaken to solve existing problems.

The hospitals that were surveyed mainly belonged to Punjab, KPK and Sindh regions. Fewer
responses were received from Baluchistan and Gilgit Baltistan. The main reason was to
diversify the respondents’ opinions and views. We also wanted to look upon the overall
performance of the management staff or clerical staff. In addition, we also focused on the
existing facilities available at the hospital like availability of ambulances, paramedical staff
and the total number of beds.

A sample size of 140 respondents were taken in total. The responses were taken through
questionnaire on Google forms

Questions about the quality and the facilities available at the hospital were to rightly evaluate
the attitude of the staff towards them. Personal questions regarding the individual’s age,
gender and profession were asked. Names were not asked to keep anonymity of the
respondents.

The respondents were also asked to give their feedback on the measures that should be taken
to increase their satisfaction as an employee. The measures about the sick leave policy,
hospital plan and also their agreement or disagreement with several policies were asked.

3.1 Softwares
Using the information collected in the questionnaires all the information we collected by
extracting an excel sheet directly from the Google form. A Google form helps in collecting
data from users online. It allows for customizable questions including MCQs, linear scale
answers, short answers, paragraph, checkbox, dropdown, multiple-choice grid and some other
types than can be used as required. Personal questions like gender had a third option of
“others”, in case a respondent did not want to answer that particular question. Age groups
were divided into 5 categories for analysis purpose. The different age groups diversified the

11 | P a g e
results and hence different experiences, skills, backgrounds, education also contributed to it.
The results are displayed in the Findings section of the report in the form of pie charts and bar
charts to allow the direct comparison of the data received.

The software that we used to evaluate the reliability of the statistical data is SPSS made by
IBM in 2009. It has a simple to explore GUI (illustrations UI). The typical method to indicate
investigations is to enter menu determinations. The setup is simple for a fledgling to utilize
and gives a genuinely extensive variety of choices for further developed clients. It can create
punctuation; linguistic structure can also be altered or spared.

It has accommodating information about executives highlights (recoding and changing

scores, choosing cases based on score esteems, combining information documents by
including either cases or factors, etc.). Contrasted with a portion of its rivals, for example,
STATA, it is costly; and some propelled highlights must be acquired as extra highlights.

Cronbach's alpha is the most widely recognized proportion of inward consistency. It is most
normally utilized when you have different decision inquiries in a study or survey that shape a
scale and you wish to decide whether the scale is solid. On the off chance that you are
worried about between rater unwavering quality.

The reliability scale from the value of alpha are the following:

1. .00 to 0.69 = Poor

2. 0.70 to 0.79 = Fair
3. 0.80 to 0.89 = Good
4. 0.90 to 0.99 = Excellent/Strong

3.2 SPSS Results

The results that we obtained from the data we collected are the following:

Cronbach’s alpha value = 0.609

The screenshots of related values obtained from the SPSS are present on the following page.

12 | P a g e
13 | P a g e
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4. Findings

15 | P a g e
Gender No. of people

Male 58

Female 82

Others 0

Age group No. of people

20-29 66

30-39 25

40-49 28

50-59 14

60+ 7

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 Province No. of people

Punjab 57

KPK 48

Sindh 22

Baluchistan 10

Gilgit Baltistan 3

17 | P a g e
 Profession No. of people

Doctor 52

Nurse 16

Clerical Staff 19

Information technology staff 12

Food services staff 14

Pharmacy Staff 18

Others 9

Gender discrimination No. of people

Yes 45

No 70

Maybe 25

18 | P a g e
 Quality is a top
priority at the
hospital

Scale No. of People Percentage

Strongly Agree 46 32.86%

Agree 45 32.14%

Neither Agree nor Disagree 23 16.42%

Disagree 13 9.28%

Strongly Disagree 13 9.28%

19 | P a g e
 I believe my salary
is fair for my
responsibilities.

Scale No. of People Percentage

Strongly Agree 9 6.42%

Agree 60 42.8%

Neither Agree nor Disagree 35 25.0%

Disagree 22 15.71%

Strongly Disagree 14 10.0%

I would
recommend
employment at
this hospital to
my friend.

Scale No. of People Percentage

Strongly Agree 22 15.71%

20 | P a g e
 Agree 60 42.8%

Neither Agree nor Disagree 36 25.7%

Disagree 15 10.7%

Strongly Disagree 7 5.0%

I am satisfied
with the sick
leave policy.

Scale No. of People Percentage

Strongly Agree 27 19.28%

Agree 61 43.57%

Neither Agree nor Disagree 27 19.28%

Disagree 20 14.28%

Strongly Disagree 5 3.57%

21 | P a g e
 I am satisfied
with the security
plan from the
hospital.

Scale No. of People Percentage

Strongly Agree 23 16.42%

Agree 47 33.57%

Neither Agree nor Disagree 33 23.57%

Disagree 28 20.0%

Strongly Disagree 9 6.42%

I am satisfied with
the promotional
plan of the
hospital.

Scale No. of People Percentage

Strongly Agree 14 10.0%

Agree 52 37.14%

22 | P a g e
Neither Agree nor Disagree 36 25.71%

Disagree 28 20.0%

Strongly Disagree 10 7.14%

No. of Patients No. of people

Up to 500 13

Between 500 and 1000 42

More then 1000 85

23 | P a g e
 No. of Beds No. of people

125 to 250 25

Between 250 and 400 63

More then 400 37

Availability of paramedic staff No. of people

Yes 98

No 24

Maybe 18

24 | P a g e
Availability of ambulances No. of people

Yes 88

No 41

Maybe 11

Hospital well equipped No. of people

Yes 84

No 41

Maybe 11

25 | P a g e
 Scale No. of People

Very Satisfied 11

Satisfied 47

Neutral 51

Dissatisfied 21

Very dissatisfied 10

The last question was an optional question that asked the participants of the survey to provide
suggestions if they had any in order to improve their satisfaction. 30 responses were obtained
showing a 21.43% response rate. The suggestions are as follows:

1. More security and service structure enhancement for doctors

2. hospital should provide proper medicines and equal facilities to all the patients.
government must upgrade the hospital in terms of facilities.
3. Hospital should provide proper medicines and equal facilities to all the patients.
government must upgrade the hospital in terms of facilities.
4. There should be proper and fully trained security guards for security of doctors.
5. better administration and better medical care for the doctors.
6. Decrease working hours and increase on call allowance

26 | P a g e
7. Increase in salary, better equipment, separate cafeteria and on-call rooms for male and
female staff.
8. By increasing salary.
9. To have an equity towards patients.
10. By applying sops in every field.
11. To increase income.
12. Should increase salary.
13. They can increase my salary package
14. Being professionals, it should support our presence and should give us the authority
prescribed in pharmacy act or that we deserve, there should be no criticism among all
staff and all should be treated well n equally , also with the reference of job
description our salaries should be worth deserving as for house officers or other staff
15. Providence of fool proof security. availability of standard facilities for the patients.
Appointment of maximum doctors at the pt turnover to avoid pt's mismanagement.
good salary package a/t their profession and work. Awareness of the people about
their health professionals.
16. Can provide a better working environment.
17. Reward should be given according to our input and hardwork.
18. Increase salary
19. Improve security
20. Service structure and timely promotions, better working conditions & better salary.
21. Increase the clinical work
22. Should have clear job plan. and employees responsibilities according to allocated
time, should have annual fair appraisals and realistic targets and personal
development plan set for next year. Hospital should strongly help in professional
development according to role of persons.
23. Hospital must conduct a research study to identify the dimensions of satisfaction level
of their employees. findings of the research study will help the top management for
the formulation of policy. flexible policies and suitable salary package according to
position and education as well as experience of the individual can increase the
satisfaction level of the employee. Also health insurance, health coverage of the
employee and his/her family will also motivate the employee to show their full effort
in the workplace.
24. Discuss and facilitate my future development goals in line with the vision of the
organization.
25. Hospital needs to do work on extrinsic & intrinsic reward system to motivate
employee for better performance.
26. Increase salary with incentive according to the performance of every employee
working in institutions
27. Justice and merit policy
28. Increase the salary of employees
29. Provide good service
30. Increase wages, install computerised system and pay due wages on time

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5. Discussion
The survey that we conducted was responded by 140 people, majority were females (82,
58.6%) while 58 (41.4%) were females out of the total 140 sample size.

During the course of this investigation, we have tried our very best in order to get the most
accurate representations of the staff size and demographics, from our samples. A slight error
may be present as due to time and logistical considerations, we were unable to conduct a
study based on the total amount of DHQs in Pakistan (108).

The age category was divided into 5 categories for analysis purpose. The survey was filled by
majority of young staff members. 66 (47.1%) belonged to 20-29 age group, 25 (17.9%)
belonged to 30-39 age group, 28 (20.0%) from 40-49 age group, 14 (50-59) and 60+ (5.0%).

According to the data collected, most the participants belonged to Punjab 57 (40.7%). 46
(34.3%) belonged to KPK, 22 (15.7%) from Sindh, 10 (7.1%) from Baluchistan and 3 (3.1%)
from Gilgit Baltistan. This is indicative of the uneven socio-economic and political status, of
our various provinces.

During the course of this the survey our questionnaire was filled by a majority of doctors 52
(37.1%), 16 (11.4%) Nurses, 19 (13.6%) Clerical Staff, 18 (12.9%) Pharmacy Staff, and rest
of the respondents were from different departments of the hospital.

A major theme in our survey, was to assess the quality of the hospital, based on the
perception of the employees who work there. It is generally understood that the people who
work in the hospital are better qualified to judge, review and grade that particular hospital.

One of the questions, we asked during our interview, was to ask the number of perceived
patients into the hospital. As per, the Table in the Introduction part of this report, the total
number of doctors, paramedical and specialists in DHQ hospital as given to about 378 to735.
This is keeping in view the existing facts and figures of a disproportionate amount of doctor
to patient ratio. Our current research shows that the amount of people per day in a typical
amount of day, comes as about 1850 people per person.

Among our respondents, majority of the people 85 (60.7%) were from hospitals where more
then 1000 patients came to the hospital on daily basis. 42 (30.0%) said between 500 and 1000
patients were received daily and 13 (9.3%) said up to 500 patients arrived at the hospital.

Our research estimates, lies loosely in the acceptable range in respect to our research, keeping
in view that it is very difficult to put an exact figure to the amount of people in a rushed and
disordered environment such as a hospital

The number of patients is an indicator to the huge disparity to the number of doctors and
patients in Pakistan. The DAWN Newspaper report gives the figure of 6325 people per
doctor in Pakistan. Our evidence reinforces this part, as mentioned in great detail, previously
on the nature of DHQ, which serves as an important mid-tier hospital for the rural and semi-
rural areas of Pakistan. Our own questionnaire result reinforces this deplorable statistic that

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there is a disproportionate number of doctors to patients. While comparing this data it is
important to remember that it is unreasonable to assume that everyone will be sick at the
same time.

The disparity in the amount of people can be explained in great detail, in a variety of ways. It
is a great indicator of the lack capable doctors in Pakistan, cognizant of the educational gap in
our society.9

One of the questions asked was on the 37 (18.0%) responded the questionnaire from category
A of DHQ hospitals with more than 25 beds. 63 (45.3%) said their hospital had between 250
to 400 beds belonging to category B of the DHQ hospitals and 25 (26.6%) belonged to
category C DHQ hospitals with 125 to 250 beds.

To the question “Do you think paramedical staff are available 24/7?” 98 (70%) agreed to with
a positive response “yes”. 24 (17.1%) said “no” and 18 (12.9%) did not have any information
regarding this. The existing data, on this point is pretty clear. As per our research 25%to 35%
of the time, there is no paramedical staff available in ambulances.

In addition, with regard to 88 (62.8%) of the total respondents were satisfied with the
ambulance service provided by the DHQ hospitals at the emergency department, 41 (29.3%)
responded with a negative answer and 11 (7.9%) were not sure about the questions. Existing
research on this topic comes up with the conclusion that there is no problem with regard, as
mentioned in our literature review, ambulance services are often outsourced to emergency
services like Chippa, Eidhi Foundation e.tc

An important question we asked was whether the respondents thought that the hospital was
well equipped with the medical equipment. 84 (60%) answered “yes”, 41 (29.3%) said “no”
and 11 (10.7%) said maybe. 23 (16.42%) strongly agreed about the security plan from the
DHQ administration for their security. 47 (33.57%) agreed to it, 33 (23.57%) were neither
agreed nor disagreed, 28 (20.0%) disagreed and 9 (6.42%) strongly disagreed.

Existing research by the FAFEN Institute (already discussed in the literature review) finds
that 80% medical practitioner fled that the Hospitals did not have an appropriate facility of
equipment and security. FAFEN also found that 44% of doctors did not think that the hospital
had an appropriate ratio of medical equipment to beds. Our research also supports this, if we
consider the dual nature of FAFENS question.

To top our conclusions off, we asked an additional question whether quality was a top
priority for the DHQs was asked with five levels of agreement/disagreement scale. 42
(32.86%) strongly agreed to quality being the top priority. 45 (32.14%) agreed to it, 23
people (16.42%) were neither agreed nor disagreed, 13 (9.28%) disagreed and 13 (9.28%)
strongly disagreed.

Staff Satisfaction is an indicator of how much the staff regard their work in the hospital as
satisfying. This keeping in mind is an important check on how motivated the staff are as a

9
(Dawn, 2018)

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satisfied and happy employee is a good employee. Another study conducted in the Journal of
Pakistan Medical Association (JPMA) by Ashraf, Shah and Anwer (2014)10 about 74% were
satisfied with their jobs at the Hospital. Our findings parrot, a similar line with 11 (7.9%)
staff members were very satisfied with their job satisfaction, 47 (33.6%) were satisfied with
their jobs, 51 (36.4%) were neutral on this question, 21 (15%) where dissatisfied, while 10
(7.1%) were very dissatisfied.

5.1 Link with Sociological Theories

Current Sociological theories may go a long way in explaining the current situation of public
healthcare problems in Pakistan. News reports and Headline have always established the fact
that the public healthcare system lacks in a quality and essential services, and its staff face a
lot of problems with regard to their work environment. The Conflict theory of the Sri Karl
Marx Ji holds to the view that a lot of events can be interpreted in light of class conflicts. This
is true, certainly as a great deal of DHQ are built to serve solely the medical necessities of the
poor. The great deal of work we have done in this report, and the analysis of existing data has
shown that DHQ Hospitals face a lot of problems, ranging from the lack of adequate
facilities, not enough beds and the lack of general facilities. These hospitals being ill-
equipped and having a wide range of problems, is indicative of the not only the disparity
between the private sector and public sector hospital, but of the disparity between urban and
semi-urban/semi-rural areas of Pakistan.

Note beforehand, that we do not expect DHQs to provide facilities like Shaukat Khanum or
Mayo Hospital, or Lady Reading Hospital. These hospitals are much bigger and advanced in
size and specialization than a general purpose, ‘all-rounder’ DHQ Hospital. But a basic
expectation is that these hospitals which serve as the lifeline of millions of people are well
equipped.

Karl Marx conflict theory would say that the disparity between the services of DHQ hospitals
is representing the differences in the status of the proletariat and the bourgeoisie. The Modern
Pakistani Aristocracy (MAP), a term figuratively referring to the upper class and the upper
middle class and the middle class, have the means to afford the extravagant fees of private
clinics and private sector hospitals. Due to the fact that our bourgeoisie lives mainly in major
cities and towns, so more care and effort is put on the need of the privileged few instead of
the ‘poor huddled masses’. Hence the quality of the health services in DHQ, are not paid any
attention to, as it does not enter the light of the people who matter, who are far removed from
the realities of healthcare that the average Pakistani has to live, bear and die with.

Conflict Theory can also be applied on the motivation of the DHQ staff. Our statistics show
that only 41.5% were satisfied with their jobs at a DHQ. Underpaid public service are the
norm in Pakistan. See the Literature Review for further information on the specifics of the
pay of public employees. Citing both conflict theory and the Marxism-Leninism, the two
cornerstones of communism, we can conclude that the low pay of civil servants, in

10
(Ashraf, 2014)

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comparison to the upper elites of our society, prevents them from contributing a hundred and
twenty percent of their effort.

An alternate approach would be to apply the functionalist theory of Herbert Spencer, we

would first like to start with the fact that effective medical care is essential for the smooth,
well-oiled functioning of society. Ill health keeps us from playing our due role as the member
of society. In addition to this going into the details of patient- doctor relationship, you will
find the hierarchical relationship between them. The doctor gives the order the physician
follows. Keeping in mind our findings of a somewhat dissatisfied workforce, the current
status quo can seriously hamper the abilities of the medical staff to perform their role a
expected of them. Not to overstate, but the role of DHQ staff cannot be overemphasized.
They do a great function to society, per the functionalist theory, and the lack of facilities and
the unhappiness of the workforce can severely curtail that function!

6. Conclusion
6.1 Overview of Findings
Facilities:

The course of this report was to investigate the unanswered questions defining the
authenticity of Pakistan’s DHQ’s. Our research was basically questioning the standard of
facilities being provided and level of comfort being provided to the staff members. While
glancing upon the final inference it was evident that most of the DHQ’s lie in category B of
the catalog, this means they have the ability to accommodate at least of 250 to 400 patients
simultaneously. Regarding the presence of paramedic’s staff and the availability of
ambulances the survey has shown that most of the staff members are gratified by the service.
Nowadays a hospital is nothing without compromising an ample amount of modern
technology, and we were able to extract a comprehensive view upon this issue too which
showed that more than half of the staff members were confident that their hospital is on top
of things in this department. Upon being asked regarding the policy of the hospital on the
conduct of quality, we received a mixture of views but even so the people who disagreed or
strongly disagreed were only 18.54%.

Staff Satisfaction:

Through this report we were mainly examining the services being provided to the DHQ staff
and the conditions under which they are obliged to perform. With respect to the question of
salary majority nodded their head in favor of as being the salary sufficient according to the
input they are providing. Consulting the issue of sick leave policy, the hospitals have a set of
decent terms as 62% of the sample were either strongly agreeing or agreeing with the policy
being provided by the management. Regarding the matters of security, the turnout was
divided as a significant number of people were deviating towards the disagree option being
provided which is an alert that some precautions must be taken immediately. One of the most
compelling attributes about any government job is the promotional plan being provided to the
employee, but reviewing the results of the survey did inform us that the management is far

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from achieving their goal in this department. Relating the contention of gender discrimination
it observed that almost half the respondents were questioning the authenticity of the
recruitment committee.

All in all the overall satisfaction regarding the jobs of the staff was tipping slightly in favor of
being satisfied which could be viewed as a step in the right direction but still there is a lot of
room for improvement and in order to compete with the world we must stay on course.

6.2 Implications
DHQs are mid-tier hospitals which are the gateway to a somewhat sophisticated level of
healthcare to the lower portion of the country who are not able to afford the luxurious health
care of private hospitals. Most of lower level hospitals like Civil Hospitals and THQ’s often
fail in dealing with many advanced diseases, due to an inherent lack of specialists or medical
machinery stationed at these basic healthcare facilities. So for millions of people in rural and
urban areas DHQs serve as the nearest tertiary referral hospitals.

Upon analyzing the whole investigation regarding the facilities being provided and the
environment being given to the staff it could be said that the findings were split in mixed
opinions.

While considering the facilities, an ample amount of respondents did indicated that current
stocks are enough for fulfilling the needs of patients while on the other hand we also received
the opinions supporting the inadequate abundance of the proper equipment necessary for
coping with a disastrous situation; like 29.3% of the sample size suggested that the
ambulance availability is not up to the mark, which should be sensed as a real agitating issue
as ambulances play one of the most vital role in case of an emergency.

The overall glance of the environment under which hospital staff is fulfilling their duties it
was apparent that the scale is slightly pointing towards the higher satisfaction of the
members. As throughout the responses we observed that majority of the staff member did
approve of the benefits and perks being provided by the management, although some issues
must be addressed immediately such the adequate amount of pension and proper security but
overall are findings does indicate that our health care department is on the right path to
compete with the international standards.

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7. References
Ahmed, F. (2018). Violence against doctors, a serious concern for healthcare organizations. Annals of
Medicine and Surgery, 3-5.

Ashraf, H. (2014). Professional satisfaction of family physicians in Pakistan. JPMA.

Dawn. (2018, January). Doctor-Population Ratio. Daw Newspaper.

(2012). DHQs Lack Specialized Medical Services. Islamabad: FAFEN.

Doctors Security Bill’ drafted, says Punjab health advisor. (2018, November ). Retrieved from
Pakistan Observer: https://pakobserver.net/doctors-security-bill-drafted-says-punjab-
health-advisor/

Finance, M. o. (2017). Grant of Assistance By Government In the Case of Deaths. Islamabad:

Government of Pakistan.

Finance, M. o. (2017). Grant of increase in Pension To Pensioners. Islamabad: Government of

Pakistan.

Finance, M. o. (2017). Revision of Basic Payscale and Allowances. Islamabad: Government of

Pakistan.

(2017). Grant of Increase Pension 2017. Islamabad: Ministry of Finance.

Naseer-ul-Haq, S. (2006, November). Accountant General Pakistan Revenues. Retrieved from

http://www.agpr.gov.pk/services/pension:
http://www.agpr.gov.pk/download/A%20Manual%20on%20Pension%20Procedures%20(NE
W).pdf

Nation, T. (2015, April). Health Care in Pakistan. Retrieved from The Nation:
https://nation.com.pk/13-Apr-2015/healthcare-in-pakistan

Pakistan Medical & Dental Council. (2001, December). Retrieved from http://www.pmdc.org.pk/:
http://www.pmdc.org.pk/ethics/tabid/101/default.aspx

(2017). Revision of Basic pay scale of Civil servents of FG. Islamabad: Ministry of Finance.

Saeed, A. (2005). Reasons for the Problems faced by Patients in Government Hospitals: results of a
survey in a government hospital. Journal Of Pakistan Medical Association.

Sohag, A. A. (2012). A comparative study on factors causing job dissatisfaction among serving
doctors. Hyderabad: PJMA.

Sohag, A. A. (2012, September). A comparative study on factors causing job dissatisfaction among
serving doctors at teaching hospitals.

The Provincial Employees Social Security Ordinance. (2011, August). Retrieved from Punjab Laws
Online:

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 http://www.ilo.org/dyn/travail/docs/1003/Provincial%20Employees%20Social%20Security%
20Ordinance%201965.pdf

TRF Pakistan. (2012). Health Facility Assessment – Pakistan. Islamabad: TRF. Retrieved from
http://www.trfpakistan.org/LinkClick.aspx?fileticket=cGyiwxr1xkA%3D&tabid=2618

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8. Appendix
8.1 Questionnaire

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8.2 Turnitin Originality Report
Similarity Index = 14%
Internet Source = 12%
Publications = 2%
Student Papers = 8%

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