2013 Cambridge Business & Economics Conference
ISBN : 9780974211428
Possibilities Exploration for Public –Private
Partnership (A Study of Social Security Systems Employees)
By
Dr.Muhammad A. Quddus *
Dr. Mazhar Ul Haq Baluch**
Khawar Ata***
* Director, Punjab Economic Research Institute, Lahore /Pakistan
**Senior Research Fellow, Lahore school of Economics Lahore/Pakistan
*** Research Economist, Punjab Economic Research, Lahore/Pakistan
Punjab Economic Research Institute
48-Civic Centre, Johar Town, Lahore-Pakistan
Lahore School of Economics, Main Campus Burki
Road, Lahore/Pakistan
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Possibilities Exploration for Public –Private Partnership
(A Study of Social Security System Employees)
Dr.Muhammad A. Quddus
Dr. Mazhar-Ul-Haq Baluch
Khawar Ata
Abstract: The objective of this evaluation exercise was to study the health care facilities provided by these two types of hospitals (one
functioning under the control of Government and the other managed by a company under public-private partnership) and to assess
their performance and quality of service in terms of patients’ satisfaction. For impact evaluation, two hospitals of PESSI viz Shahdara
Hospital, Lahore and Khawaja Farid Social Security Hospital, Multan of 100 beds each were selected. Regarding the hospitals
managed by PSSHMC, both the hospitals located at Manga-Riawind Road and Muzaffargarh of 150 beds each were taken in the
sample. Total number of patients/beneficiaries interviewed by the PERI’s survey teams for this study was 500 i.e. 125 beneficiaries
from each hospital. The necessary information for the study was also collected from the hospitals administration. The Institute’s
survey teams interviewed the doctors and paramedical staff/other staff as well in order to know their viewpoint about service delivery
and service conditions/job satisfaction. The results of the study provide useful information on functioning of these two categories of
hospitals with regard to their organizational structure, staff strength, number of specialists/doctors, paramedical staff/other staff,
infrastructural facilities, salaries of doctors/staff, outdoor/indoor patients, lab facilities, facilities available in the operation theaters,
income & operational expenditure, patients referred from/to the hospital, patients satisfaction regarding waiting time in the reception
area/OPD, availability of doctors/paramedical staff, medical check-up and treatment by the doctors/specialists, behavior of
doctors/staff, laboratory tests conducted, operations performed, post operation facilities, and satisfaction of service providers
(Doctors, Paramedics and Other Staff) about their salary package, Job security, service conditions & working environment etc.It was
observed that PSSHMC hospitals have generally better infrastructure, properly equipped with latest machinery/equipment and
laboratory facilities but their performance is not as good as it should have been, when compared to the PESSI hospitals in terms of
number of clinical pathology tests performed, number of emergency / outdoor / indoor patients attended, surgical operations
conducted, satisfaction of the patients about their medical check up, treatment and behavior of the doctors / other staff, quantity /
quality of medicines and satisfaction of the service providers (Doctors, Paramedics and other hospital staff) about their salary
package, job security, after retirement benefits, service conditions and working environments etc. It was found that the overall
performance of PESSI hospitals was better as compared to PSSHMC hospitals with regard to these indicators.
Introduction
Punjab Social Security Health Management Company (PSSHMC) was established under public
– private partnership, as a non – profit organization, registered under the Companies Ordinance,
1984 and was incorporated on 23rd June, 2004 as a company limited by guarantee having share
capital subscribed by the Government of the Punjab. Authorized Capital was Rs. 150 million
divisible into 15 million ordinary shares. Paid-up capital was Rs. 50 million (Rs. 20 million)
subscribed so far.
The primary purpose of setting up the PSSHMC was the provision of health care through
establishment and management of hospitals and health care facilities. An agreement was signed
between the Punjab Employee’s Social Security Institution (PESSI) and the Pakistan Social
Security Health Management Company (PSSHMC) on 19-7-2004.
According to this agreement, PSSHMC was required to manage and establish hospitals and
provide medical care services in the allocated areas to the secured persons and their dependents
defined in section 2(25) and 2(6) respectively of the Punjab Employees Social Security
Ordinance,1965. The Company was required to provide all kinds of medical care facilities as
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were being provided presently by the institution to the beneficiaries in term of section 38, 38-A,
44 and 45 of the ordinance in the allocated area as mentioned below.

Manga-Riawind Road and from 43 K.M at Lahore- Multan Road up to Iqbal Nagar
including the areas of Phoolnagar, Chunian, Pakpattan and Arifwala.

From Chowk Pir Bahar Shah to G.B Canal i.e., up to 20 KM on Sheikhupura - Faisalabad
Road and from Feroze Wattwoan to 8-K.M up to Warburton.

Muzaffargarh District
According to the aforesaid agreement, the institution is under obligation to transfer to the
company 80 percent of net social security (after deduction of the administrative costs of the
institution) received by it with respect to secured persons of each allocated area. Under the
agreement, the company was required to build, staff, equip and operate three hospitals at:
Manga – Raiwind Road

Muzaffargarh
------------------ 150 Beds

Sheikhpura
--------------------100 beds.
-------------150 beds
Hospitals at Manga- Raiwind road and Muzaffargarh were established which started functioning
on July, 4, 2007 and 1st August 2007 respectively. Construction of Sheikhupura hospital could
not be started due to litigation before the Lahore High Court.
The company was managed by the Board of Directors consisting of 26 members, 17 from private
sector, 5 from the government of Punjab and 4 labor representatives. The administrative control
of each hospital was exercised by the Local Hospital Management Committee, Executive and the
Board. The chairman of the Board was from the Private sector. The Chief Executive Officer
(CEO) of the company had control over the affairs of both the hospitals of Mange- Rewind Road
and Muzaffargarh. There was one administrator for each of the hospitals at Manga and
Muzaffargrah.
The total number of industrial units in the area allocated to the PSSHMC Hospital Manga –
Riawind Road was 1295 units. The PSSHMC Hospital Muzaffargrah was located in
Muzaffargrah city and the allocated area for this hospital was the Muzaffargrah district.
According to administration of PSSHMC diet charges, medicines, disposables and all test
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charges were paid by the company. Accounting and financial records were being checked by
Internal Auditors on monthly basis and External Auditors on annual basis.
Overall bed occupancy ratio remained from 60 percent to 80 percent of both the hospitals at
Manga – Riawind Road and Muzaffargrah. This comparative study of assessment of service
delivery of Selected Hospitals of Punjab Employees’ Social Security Institution (PESSI) and
Punjab Social Security Health Management Company (PSSHMC) was conducted on behalf of
the Punjab Social Security Institution. The purpose of this comparative study was to explore
possibilities of practical options for public –private partnership for health service delivery system
to provide better health care facilities to the secured workers and their dependents,
Methodology
Two stage sampling technique was adopted for selecting the representative sample. At the first
stage , a sample of two social security Hospitals of the Punjab Employees Social Security
Institution (PESSI) viz Shahdra Hospital, Lahore & Khawaja Fareed S.S Hospital, Multan were
selected for study. On the other hand, both the hospitals managed by the Punjab Social Security
Health Management Company (PSSHMC), Manga and Muzaffargrah were taken for study
purposes.
At the second stage, a sample of patients of these two types of health providers was selected. For
determining the sample size of patients, the following statistical formula with known population
and guessed variability for maximum sample size was applied:-
n=
=
=
= 249.63 say ---250
This sample was equally distributed between both the hospitals i.e., 125 from each of Shahdra
and Khawaja Fareed hospital.
The same formula was applied to determine the sample size for Manga and Muzaffargrah the
Hospitals, controlled by (PSSHMC)
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n=
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=
= 249.60-----250
The estimated sample size was also the same250 i.e., 125 from each of the hospitals viz Manga
and Muzaffargrah.
Results of the Study
To derive the factual results of comparison of the facilities available at both the sets analyzing
the strengths and weaknesses of both the systems i.e., PESSI and PSSHMC hospitals on the basis
of infrastructural facilities and capacity of the hospitals such as staff strength, number of
functional departments, laboratory facilities available and number of lab tests performed since
the inception of the hospitals. The other considering fact was of patients, referred by PSSHMC
Hospitals, Muzaffargrah and Manga to Social Security Hospitals (Khawaja Fareed in Multan and
Nawaz Sharif Social Security Hospital, Lahore), in case of non-availability of specialists /
facility for the disease or due to other reasons. All the facts considered essential for presentation
were discussed in this section.
The basic information of both PSSHMC and PESSI hospitals are discussed in Table 1. The data
in above table reflected that there were 36 wards in PESSI hospitals and 50 wards in PSSHMC
hospitals. Other facilities such as number of rooms for doctors in OPD, operation theaters, admin
staff, labs, waiting areas, pharmacy store and other stores were reported to be 36, 6, 16, 21, 8 and
7 in PESSI hospital and 23, 10, 21, 14,16,6 and 9 in PSSHMC hospital. Both the PESSI
hospitals were 100 bedded each and the PSSHMC hospitals were 150 each. The existence and
functional status of different wards / departments in both type of hospitals are presented in
Annex-I.
Staff Strength
Staff strength refers to sanctioned, filled in and the vacant posts of professional and supporting
staff including workers hired on daily wages in an institution. Since the functioning capacity of
an institution depends upon the availability of the required staff, the staff situation was examined
for both types of the hospitals functioning under PESSI and PSSHMC. The data in the table
reflects that about 96.0 percent of the posts in different cadres were reported filled in the
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considered hospitals. Consequently, Professional staff strength environment reflected good
situation in both types of the considered hospitals (PESSI and PSSHMC) hospitals. (Table-2)
Laboratory Facilities
To examine functioning pattern, the availability of different laboratory / diagnostic test facilities
and the number of tests performed during the last three years 2007-08 to 2009-10 were assessed.
The results reflected that plain X-rays were performed more than double (25601) in PESSI
hospital as compared with (12562) in PSSHMC hospitals. Only 146 dye-induced x-rays were
performed in PSSHMC hospitals, while the corresponding figure in PESSI hospitals was 1433.
In-brief PESSI hospitals were far ahead in case of about all the laboratory tests performed during
the considered period (2007-08 to 2009-10). This could be assessed that newly initiated system
was not yet common to be availed medical facilities in the areas (Table-3). Ultimately, this
situation might be due to time concerning of establishment of the institution (PSSHMC), since
the health care provision is generally dealt with by the people having past experience of the staff
and the dealing of the lower staff of the institution, which is again time concerning of the
establishment of the relevant institution.
3.5: Number of Patients Referred
As per agreement, the secured person was needed to be referred to other hospitals under situation
of non availability of the department / specialty, some complication or non-availability of
specialist doctors for that particular disease. To assess the performance, the cases of the social
security hospitals, which were referred to other hospitals were verified in this context. The
information provided for these cases were reflected in the table-4.
The total 4,242 patients of cardiology were referred to other hospitals from PESSI hospitals
during 2007-08 to 2009-2010. Furthermore, 397 patients of cardiac surgery were referred to
other hospitals due to non-availability of cardiac surgeon in these hospitals. At second number
was Neurosurgery / Neurology department, where the number of patients referred was 1258.
This specialty was not available in PESSI
hospitals so they referred the patients to other hospitals. About 913 patients of urology
department of PESSI hospitals were referred to other hospitals. (Table-4)
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However, the Chief Executive of PSSHMC reported that most of the patients referred by
PSSHMC hospitals to other hospitals were from Cardiology department (834 patients), and
Orthopedic department (811 patients). It was strange to observe that these hospitals have their
own departments functional and yet they referred the cases to other hospitals. About 692
patients of Eye department were referred to other hospitals by PSSHMC hospitals despite having
their own department being functional.
Ultimately it was concluded that PESSI hospitals referred those patients to other hospitals for
which they had no facility or specialty for their treatment. However, PSSHMC hospitals referred
patients from almost all departments to other hospitals, even having their own departments
functioning, and this aspect leads towards inefficient performance or intention of improper care
of the patients registered for treatment in PSSHMC hospitals, while PESSI proved relatively
efficient in their performance with respect to reference matters.
Exclusive to the cases referred reflected above the cases of PSSHMC hospitals which were
treated in Nawaz Sharif, Social Security Hospital, Lahore and Khawaja Fareed Social Security
Hospital, Multan have been shown in the table-5.
PSSHMC Hospital Manga referred more than 7 thousand patients (7321 patients) during 2007-08
to 2009-10, while the corresponding figure for PSSHMC Hospital, Muzaffargarh was 3097.
Most of the patients referred were related to Medical (2736 patients), followed by Orthopedic
(1294 patients), General Surgery (876 patients) and Gynae / Obs (815 patients) departments.
The PESSI hospitals treated these referred patients of PSSHMC hospitals without any payment
from PSSHMC. These PSSHMC checked the patients in their hospitals and after giving some
treatment referred them to PESSI hospitals and the Company did not pay even a single penny to
them. Thus PESSI hospitals had to spend a lot of money from their own resources for the
treatment of the patients referred by PSSHMC.
It was noted that PSSHMC patients have a choice for their treatment. If they want to visit their
registered PSSHMC hospital they may go there, otherwise they can go to PESSI hospital for
their free medical treatment and PESSI hospital will not charge any amount from patients of the
PSSHMC hospital. However, example was not noticed that PESSI patients visited the PSSHMC
hospital for free medical treatment. Table - 6 gives this crucial information regarding those
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patients who are registered in PSSHMC hospitals but they have chosen PESSI hospitals for their
medical treatment.
Budget and Expenditure
The performance of the institute mainly depends upon the annual budget allocated for provision
of the necessary matters and materials with exceptional provision of the professional and
supporting staff. Though the employed staff has already been working with the available
resources, yet their performance is basically linked with the yearly sanctioned and provided
funds allocated in the budget, and consequently the staff may pretend of non - availability of the
medicine stuff required for the treatment of some specific patients. The data presented in the
Table-6 elaborates the annual budget of four hospitals under study. It was important to note that
PSSHMC hospitals had no specified sanctioned budget heads (Accumulated Allocation).They
spent the money under different heads during the year according to their needs. On the other
hand, PESSI hospitals were sectioned head-wise budget and they were to spend the amount
considering heads. The data also indicated that total budget of Shahdara Hospital during 2009-10
was Rs. 116,186,447. The expenditure incurred on medicines during the year was 24.2 percent,
while the share of Pay and Allowances was 55.8 percent.
Total annual budget of KFSSH Multan in 2009-10 was Rs. 104,268,392. Total amount spent on
medicines during the year was 15.8 percent, while the budget spent on Pay and Allowances was
62 percent respectively.
Total budget of Manga Hospital managed by PSSHMC for the year 2009-10 was Rs.
113,705,796. The expenditures incurred on medicines during the year were 36.7 percent. The
share of expenditure on Pay and Allowances for the year was 40.8 percent. Total annual
expenditure of PSSHMC hospital, Muzaffargarh was Rs. 85,361,811 for 2009-10. The
expenditure on purchase of medicines during the year was 39.2 percent. However, the
expenditure incurred on Pay and Allowances for the year was 38.1 percent. The situation reflects
that PSSHMC hospitals were spending more on medicines and less on Salary of Staff as
compared to PESSI hospitals. This may be the reason that PSSHMC staff was not satisfied with
their salary package. On the other hand, the patients of PSSHMC hospitals were also not fully
satisfied with the services provided by PSSHMC hospitals.
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The situation reflects that PSSHMC hospitals were spending more on medicines and less on
Salary of Staff despite having low allocation as compared to PESSI hospitals. This may be the
reason that PSSHMC staff was not satisfied with their salary package. On the other hand, the
patients of PSSHMC hospitals were also not fully satisfactory.
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Job Experience and Salary Structure
Since the PESSI hospitals were the older, all the staff working in the PESSI hospitals has more
experience except lab technicians than PSSHMC hospitals. In PSSHMC hospitals nurses were
only with 3 years job experience. (Table-7)
The table also reflected the average salary of the staff. The average reported salary of all the
professional staff was relatively higher in PESSI hospitals as compared with PSSHMC hospitals.
This could be justifiable on the basis of relevant job experience, since increase in salary mostly
depends upon the length of service or experience of the staff. The PESSI staff was more
experienced with better salary package and, therefore, they might be expected to perform better
in service delivery.
Along job security and higher salaries, PESSI staff has also pension benefits and medical facility
up to one month basic pay, while in case of PSSHMC hospitals the staff has only medical facility
up to Rs. 1000/- only.
About all of the consultants working in PESSI were satisfied, while 42.9 percent performing job
in PSSHMC were reported dissatisfied with their monthly remuneration. Only a small proportion
(12.5%) of MOs and WMOs working in PESSI expressed dissatisfaction with respect to their
monthly remuneration. All other staff in PESSI reported satisfaction with respect to
remuneration. However the staff working in PSSHMC, except DMO, reported dissatisfaction
regarding monthly salary was 42.9 percent of Consultants, 55.6 percent of MOs/WMOs, 66.7
percent of Laboratory Technicians and 50.0 of nurses. (Table-7)
Work Performance Satisfaction Status
Work performance was assessed by considering daily work load of the doctors through checking
the patients, nursing staff competency satisfaction level, and satisfaction status of the staff with
respect to administration behavioral attitude. In PESSI hospitals about 84.8 percent and 9.1
percent of the doctors reported complete satisfaction and satisfaction to some extent respectively
regarding daily workload of checking of the patients. In PSSHMC hospitals the complete
satisfied level and satisfied to some extent level of doctors were 44.1 percent and 20 6 percent
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respectively. However about 35.3 percent of the doctors of PSSHMC reported dissatisfaction
regarding daily work load of checking the patient as against 9.0 percent of the doctors of PESSI
hospitals.
Majority (88.6%) of the doctors of PESSI expressed complete satisfaction about performance /
competency of their nursing staff, while the proportion of the doctor with similar response in
PSSHMC was 48.5 percent. The doctors, satisfied to some extent about performance
/competency of nursing staff, were 11.4 percent and 39.4 percent in PESSI and PSSHMC
hospitals respectively. However the dis-satisfied doctors with respect to performance of the
nursing staff were 12.1 percent in PSSHMC hospitals. In PESSI hospitals all the staff i.e., 97.4
percent and 2.6 percent were complete satisfied and satisfied to some extent with respect to
working performance of the hospital administration. No person reported dissatisfaction in this
regard. In case of PSSHMC hospitals complete satisfied behavior of the administration staff
was reported by 75.7 percent, satisfied to some extent (8.1 percent) and dissatisfied (16.2
percent). (Table-8)
*Ranking of Hospital by Hospital Staff
Hospitals under both systems i.e., PESSI and PSSHMC were ranked by the respective staff
on the basis of working/performance considering ‘Very Good’, ‘Good’, ‘Average’, and ‘Poor’.
The data in table-9 reflected that 73.8 percent of PESSI staff ranked their hospitals as ‘Very
Good, The remaining 26.2 percent of the staff of PESSI ranked their hospitals as ‘Good’. About
44.4 percent and 47.2 percent of the staff belonging to PSSHMC ranked their hospitals as ‘Very
Good,’ and ‘Good’ respectively. However about 6.0 percent and 3.0 percent of PSSHMC staff
ranked their hospitals ‘Average’ and ‘Poor’ respectively. No such ranking ‘Average’ and ‘Poor’
was suggested by PESSI staff. This situation reflected better performance of the hospitals of
PESSI as per ranking of the staff.
Preference of Institutions’ Staff Regarding Public – Private Partnership
PSSHMC has been established under public – private partnership, registered under company
Ordinance, 1984, parallel to Punjab Employees Social Security Institution (PESSI). The principal
objective of both the institutions was the provision of medical care services to the secured
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persons and their dependents. This was a quite new experience specifically in Pakistan, so its
continuation might be made capturing the perceptions / views of the staff as well as considering
comparative performance of allocated work pattern to both the institutions and also the
experienced opinions of the beneficiaries. Ultimately, the views of the staff of both the
institutions (PESSI and PSSHMC) expressed have been presented in the table-10.
A significant proportion of staff (56.8 %) working in PSSHMC hospitals ( A Company setup)
and 97.6 percent of PESSI staff did not prefer the Public –Private Partnership, whereas 5.4
percent of PSSHMC staff preferred the partnership to some extent. When inquired about the
reasons for not preferring PPP setup, 76.2 percent and 65.9 percent
staff of PSSHMC and
PESSI hospitals Respectively reported that there was no job security in PPP setup, whereas 33.3
percent and 22.0 percent of PSSHMC and PESSI hospitals’ staff reported no-pension benefits
after job the reason for not preferring the PPP setup. However personal respect factor in Govt.
setup was reported by 4.8 percent and 12.2 percent of the staff of PSSHMC and PESSI hospitals
respectively as the reason not preferring the PP partnership.
All the considered staff of PESSI reported favoring PPP set up due to the solution of the
problems and better atmosphere and working condition, while 57.1 percent and 21.4 percent
favored preference for PPP system because of immediate problem solution and better working
environmental conditions.
From the above indicated environmental situation almost the entire PESSI staff did not prefer the
PPP system, so the staff of PESSI strongly supported the Sole Government setup and they were
quite satisfied and comfortable with the existing Government system.
Views of Beneficiaries
The Sample beneficiaries were distributed on the basis of usage of the hospital facilities such
Outdoor Patients, Emergency Patients and Indoor Patients. The views expressed by all the three
types of beneficiaries are discussed below.
Out Door Patients (OPD)
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A comparative behavior of the staff of both the hospitals with the secured persons regarding their
check up behavior of the doctors and waiting time in OPD has been assessed. An equal number
of patients i.e., 99 percent of both types of hospitals reported that the doctors (specialist,
MO/WMO) were available in their respective room
In PESSI hospitals 98.5 percent and in PSSHMC hospitals 99.5 percent of the beneficiaries
reported that the concerned doctor checked them. About 89.0 percent and 93.0 percent OPD
patients of PESSI were satisfied about their check up and behavior of the doctors respectively,
while the corresponding figures in case of PSSHMC were 59.9 percent and60.8 percent. About
21.3 percent and 21.6 percent of the respondents were not satisfied with their medical checkup
and behavior of the doctor respectively.
The patients, who had to remain waiting for more than half an hour to get themselves checked
up, were 10.5 percent in case of PESSI hospitals and 40.8 percent in case of PSSHMC hospitals
(Table-11). A relative better situation was obvious in PESSI hospitals considering reported
satisfaction level by the beneficiaries regarding check up and doctor’s behavior as compared
with PSSHMC hospitals.
Experience about Availability and Quality of Medicines
Respondents Experience about availability and quality of medicines for outdoor Patients and
indoor patients were considered for making comparison of the dealing of both types of hospitals
to assess for the continuity of the PPP hospitals on the basis of the experience of the patients by
visiting themselves or with their dependents there.
Since the availability of free medicine is a part of services provided to the secured workers by
the hospitals, their views might get appropriate weight to make decision in the context of
continuity of PPP hospitals.
A great majority of beneficiaries i.e., 95.6 percent of PESSI and 92.1 percent of PSSHMC
hospitals shared their experience that they got full quantity of medicines as prescribed by the
doctor. However 3.4 percent and 7.9 percent patients of PESSI and PSSHMC hospitals
respectively indicated negating responses in the context of provision of full quantity of medicine
as prescribed by the doctor, From them75.0 percent of patients of PESSI patients reported that
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hospital staff arranged the medicine where as 25.0 percent from negating response reported
purchase of the medicine by themselves, while from the negating responding patients of
PSSHMC hospitals, 50.0 percent reported purchasing the medicine by themselves (Table-12).
Emergency Patients
Emergency unit is very crucial with respect to attending patients. Consequently this unit provides
chances for patients to attend the other units of the hospital considering the dealings, quality of
services, availability of doctors and medicines in the emergency unit of the hospitals. The
information regarding performance of the emergency unit of both types of the hospitals on the
basis of patients’ responses has been obtained and presented in Table-13.
Since the time is the most critical factor for the emergency patients, time taken to treat the
patients was given top priority. The staff of PESSI hospital emergency units found ahead for
giving treatment within five minutes as it was reported by 85.3 percent beneficiaries, whereas
only 50.0 percent beneficiaries of PSSHMC hospitals were provided treatment in emergency
within 5 minutes. An equal proportion i.e., 25.0 percent of patients of PSSHMC hospitals have to
wait for 6 to 10 minutes and above 10 minutes to have treatment in the emergency. The indicated
situation was better in PESSI hospital relative to PSSHMC hospitals in all the considered
aspects.
All the patients were checked by the doctors in the emergency of PESSI hospitals as compared to
92 percent in case of PSSHMC hospitals. The patients (7.7 percent) not checked by the doctors
in the PSSHMC hospitals’ emergency was due to non-availability of the relevant doctors at that
time. Underlying reason might be less staff deputed in the emergency unit, nature of emergency,
holiday or late night emergency etc.
In-Door Patients
Indoor patients are referred the patients, recently admitted in the hospital for more than one day
due top minor or major operation or for medical treatment/ complication. The responses of the
indoor patients regarding their satisfaction level regarding frequency of visits of the specialists,
MO/ WMO and their availability and behavior of the nurses according to views of the
beneficiaries were obtained.
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About equal proportion of beneficiaries i.e. 38.1 and 40 percent stayed in the hospital up to 2
days in PESSI and PSSHMC hospital respectively. The stay of one third (33.7 percent) of the
PESSI hospital patients was more than 6 days as compared to one fourth (25 percent) in case of
PSSHMC hospital beneficiaries. (Table-14)
When the patients were inquired about their satisfaction regarding visits and behaviour of the
specialist, MOs / WMOs and nurses in the ward, the response was quite encouraging. It was
observed that more than 94 percent of PESSI hospital beneficiaries were satisfied with the visits
and behaviour of the Specialist, MOs / WMOs and Nurses during their stay in the hospital. For
PSSHMC hospital, 84 to 90 percent of beneficiaries showed their satisfaction regarding the same
indicators under review. It is thus evident that the PESSI hospitals beneficiaries were more
satisfied as compared to those of the PSSHMC hospitals.
Satisfaction of Indoor Patients regarding Availability and Quality of Medicines
As far as the availability and quality of medicines is concerned, about 99 percent of respondents
of PESSI hospitals got full quantity of medicines while their treatment in the hospitals, whereas
the corresponding figure in case of PSSHMC hospitals was 95 percent (Table - 15). The response
about the quality of medicines was also encouraging. About 98 percent and 95 percent
beneficiaries of PESSI and PSSHMC hospitals respectively were satisfied about the quality of
the medicines.
Views / Satisfaction of Indoor Patients about Facilities regarding Operations Performed
Those beneficiaries who had gone through the services and facilities available in the operation
theater of both hospitals, their views have been obtained to assess performance of both the
hospitals of the system under study. About 31 percent of PESSI hospital beneficiaries reported
that they were operated in the hospitals, whereas the corresponding figure for PSSHMC
beneficiaries was 36 percent. A significant proportion (about 96 percent) of PSSHMC hospital
beneficiaries and about 86 percent of PESSI hospital patients operated in the hospital were
satisfied with the facilities provided in the operation theater. It was noted that not even a single
person was dissatisfied with the facilities available in operation theater of PSSHMC hospitals
but 14 percent patients operated in PESSI hospitals showed their dissatisfaction (Table 16).
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Complaint Cell in the Hospital
Complaint cell reflects indirectly the performance of the hospital or provide guidance for the
management authority to make the working of the hospitals with introduced circumstances,
available resources and utilization of the available resources more effectively and efficiently for
the benefits of the beneficiaries considering their demands. About 78.5 percent of the PESSI
hospitals’ beneficiaries and 23.2 percent of PSSHMC hospitals’ beneficiaries stated that there
was a complaint cell established in the respective hospital. (Table-17).
Only 5.8 percent and 14.1 percent respondents of PESSI and PSSHMC hospitals respectively
informed that they did not know about the Complaint Cell in the hospital. About 73.5 percent of
the beneficiaries of PESSI hospitals reported their Complaint Cell as efficient when compared
with 42.9 percent patients in case of PSSHMC hospitals. About one third of the beneficiaries
(33.9 percent) of PSSHMC hospital opined that their Complaint Cell was not efficient as against
17.9 percent beneficiaries of PESSI hospital. Thus the Complaint Cell to deal with the problems
of patients was present in both types of hospitals but its effectiveness varied a lot as reported by
the beneficiaries of these hospitals. (Table-17)
Ranking of PESSI & PSSHMC Hospitals by the Beneficiaries
The beneficiaries of both types of hospitals were asked to give their opinion for their satisfaction
about the behavior of administration and overall performance of the respective hospitals and then
rank them accordingly. The response of the respondents is given in Table-18.
According to Table 18, a great majority i.e. 90 percent beneficiaries of PESSI hospitals were
satisfied with the behavior of their hospital administration, while 58.7 percent beneficiaries of
PSSHMC hospitals showed their satisfaction in this regard indicating better performance of
PESSI hospitals.
An interesting response came out when the beneficiaries of the both hospitals were asked to
evaluate and rank their hospitals i.e. ‘Excellent’, ‘Good’, ‘Average’ or ‘Poor’. A little less than
half of the respondents (47 percent) of PESSI hospitals ranked their hospitals as “Excellent’ as
compared to only 20 percent respondents in case of PSSHMC hospitals. 43.4 percent
beneficiaries of PESSI hospitals ranked their hospitals as ‘Good’ as against 32.3 percent
July 2-3, 2013
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2013 Cambridge Business & Economics Conference
ISBN : 9780974211428
respondents in case of PSSHMC hospitals. It is important to note that 34.3 percent and 13.7
percent beneficiaries of PSSHMC hospitals ranked their hospital as ‘Average’ and ‘Poor’
respectively, while the corresponding figures for PESSI beneficiaries were 8.0 percent and 1.6
percent this reflected that about 50 percent of the beneficiaries of PSSHMC hospitals were not
satisfied with the overall performance of their hospitals.
Conclusion and Recommendations
The conclusions derived from the above described results were briefly discussed as follows;
It was observed that PSSHMC hospitals have generally better infrastructure, properly
equipped with latest machinery/equipment and laboratory facilities but their performance
was not as good as it should have been, when compared to the PESSI hospitals . Overall
performance of PESSI hospitals was better as compared to PSSHMC hospitals.

The doctors/paramedics and other staff of PESSI hospitals generally were more
qualified, experienced, better paid, have job security, pension benefits and other facilities.
Therefore, they are more satisfied with their jobs and performance. The PSSHMC staff
performed their duties with less pay package, lack of job security and pension benefits,
which obviously affected their performance adversely.

PSSHMC Hospital Manga – Raiwind Road referred 7321 patients to Nawaz Sharif Social
Security Hospital, Lahore during 2007-08 to 2009-10. The number of patients referred by
PSSHMC hospitals, Muzaffargarh to Khawaja Fareed Hospital / Nishter Hospital, Multan
during this period was 3097. One of the reasons for referring the patients to PESSI
hospitals was better treatment in the hospitals of the PESSI. It was interesting to observe
that the PSSHMC hospitals referred a large number of patients to PESSI hospitals even
for those diseases whose departments were functioning in the Company’s hospitals. This
also reflected adverse effects on performance of PSSHMC hospitals.

The PESSI hospitals patients have a choice for their treatment. If they want to visit their
allocated / registered PSSHMC hospital they may go there, otherwise they can go to
July 2-3, 2013
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PESSI hospital for their free medical treatment and PESSI hospital does not charge any
amount from PSSHMC hospital. A large number of patients who were registered in the
Company’s hospital Manga-Raiwind Road for treatment have preferred / chosen Nawaz
Sharif Social Security Hospital, Multan Road, Lahore. This reflected the confidence of
the secured workers in PESSI hospitals due to better medical treatment/facilities. It was
reported by the doctors of Nawaz Sharif Hospital that the Manga-Raiwind Road hospital
referred the patients to their hospital at the stage when their condition was very critical
due to improper treatment and mishandling by the doctors of Manga – Raiwind Road
hospital.

The PSSHMC hospitals are 150 bedded hospitals with more infrastructural facilities
when compared with the PESSI 100 bedded hospitals. The number of doctors and other
staff is insufficient in the company hospitals. The result is that the daily workload of
checking / treating the patients is much more as compared to PESSI doctors / professional
staff. For instance, 29 percent PSSHMC doctors have to check more than 70 patients
daily as compared to 6 percent in case of PESSI doctors.

The PSSHMC hospitals at Manga-Riawind Road and Muzaffargarh have been
functioning for the last 3 years. Despite their good office buildings, better cleanliness and
working environments, equipped with latest machinery and above all financial autonomy
(in comparison with the PESSI hospitals), these hospitals could not perform their duties
as efficiently and effectively as they should have been. Rather, their performance was
much lower as compared to the PESSI hospitals.

The significant proportion of PSSHMC hospitals staff (57 percent) did not prefer Public
Private Partnership (PPP) because of job insecurity, lack of pension benefits and other
service conditions. The corresponding figure in case of PESSI hospitals was 98 percent.

About 94 percent, 98 percent, 89 percent and 95.5 percent of outdoor patients of PESSI
hospitals were satisfied with the behavior / guidance provided by the receptionist,
facilities available in waiting area of OPD, checkup by the doctors and quantity / quality
July 2-3, 2013
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2013 Cambridge Business & Economics Conference
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of medicines provided, respectively. The corresponding figures in case of PSSHMC
hospital were 76, 97, 60 and 92 percent respectively.

Around 95.5, 96.8, 97 and 98 percent in-door patients of PESSI hospitals were satisfied
about the frequency of specialist visits, visits of the doctors, availability / behaviour of
nurses, and quantity / quality of medicines provided, respectively. The corresponding
figures for the PSSHMC hospitals were 84, 89, 89 and 95 percent respectively.

About 44 percent staff of PSSHMC hospitals on the basis of overall working /
performance of the hospitals ranked their hospitals as ‘Good’ as compared to 74 percent
staff of PESSI hospitals. Moreover, 8 percent staff of Company hospitals ranked their
hospitals as ‘Poor’ to Average’ but none of the PESSI staff ranked their hospitals in this
category.
From the findings of the study, it was concluded that the overall performance and service
delivery of PESSI hospitals was better as compared to the PSSHMC hospitals.
6.2
Recommendations
Considering the prevalent circumstances the following options are suggested to be followed for
the better performance to win the favor of the people to make this public –
private partnership venture successful.
The PSSHMC was a company by its present set-up and status. In a company structure,
the salaries of the employees’ of hospitals were assumed generally higher than the
Government hospitals. But the salaries of the doctors / other staff of PSSHMC hospitals
were much lower as compared to the staff of PESSI hospitals. Moreover, there was no
job security, pension benefits and other benefits as in case of Government service. The
result is that the doctors / paramedical staff and other staff of PSSHMC hospitals were
not satisfied with their jobs which affect their efficiency adversely.
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1.
ISBN : 9780974211428
The company structure of organizations in our country had not proved effective as also
experienced in case of other companies such as PAMCO, Punjab Transport Company,
Punjab Entertainment Company and Rice / Cotton Companies etc. It would be more
appropriate that the Government should restructure / strengthen the existing government
organizations instead of converting them into company mode and increasing their budget
manifold.
2.
The working of our society was generally not company setup-oriented psychologically.
Public sector job was relatively secured having more short-time financial benefits as well
as long time pension benefits. The pay was less in the case of the doctors / other staff of
PSSHMC hospitals, which was merely past service phenomenon. With the result that the
staff was not satisfied with their jobs which is affecting their efficiency and consequently
the patients were dissatisfied with the service delivery of PSSHMC hospitals.
3.
The PSSHMC hospitals lacked the trained and experienced doctors / other staff, since the
hospitals were newly established and fresh qualified staff was recruited and appointed
there, they lacked the proper capacity and competency to deal with the complicated cases.
In – brief it was finally concluded, that the structure of the company with the salary of the public
sector institutions without job security, pension benefits and other benefits could not be
justifiable. Thus, the explored option of Public- private partnership would remain beyond
acceptance under the prevalent environment. The following alternatives are, therefore,
proposed:a.
The Punjab Social Security Health Management Company (PSSHMC) may be
wound up and their staff may be adjusted in the hospitals of Punjab Employees’
Social Security Institution. The PESSI may, however, be reformed/ strengthened
for the purpose.
b.
PSSHMC hospitals at Manga – Raiwind Road and Muzaffargarh may be
c.
converted to the status of autonomous bodies.
d.
Salary package of the staff of PSSHMC hospitals may be increased significantly
and their service structure improved so as to attract and retain the experienced and
qualified staff in the organization and minimize the turnover of the
doctors/professional staff.
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Table-1:- Basic Information of Both of PESSI and PSSHMC Hospitals
(Nos.)
Items
PESSI
PSSHMC
36
50
36
6
16
6
21
8
7
200
23
10
21
14
16
6
9
300
Number of Wards
Number of Rooms for:
Doctors in OPD
Operation Theaters
Admin Staff
Laboratory
Waiting Areas
Pharmacy Stores
Other Stores
Total Hospital Beds
Table-2:- Staff Strength in Both PESSI and PSSHMC Hospitals
(Nos.)
Items
Chief Executive Officer
Medical Superintendent
/ Administrator
Deputy Medical
Superintendent
Specialist Doctors
PESSI
Sanctioned Filled-in
Vacant
PSSHMC
Sanctioned Filled-in
Vacant
-
-
-
1
1
-
2
2
-
2
2
-
2
2
-
-
-
-
43
35
8
29
26
3
Medical Officer
85
75
10
39
37
2
Paramedical Staff
Lab- Technician
Supporting Staff
Daily Wages Staff
Total
248
3
260
643
239
3
259
615
9
1
28
153
13
175
20
412*
147
11
171
20
395*
6
2
4
17
Exclusive to Daily wages Staff
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Table-3:-
ISBN : 9780974211428
Availability of Laboratory Facilities Average Number of Tests Performed in both
PESSI and PSSHMC Hospitals During 2007-08 to 2009-10.
PESSI
PSSHMC
Lab/ Diagnostic Test
2007-08
2008-09
2209-10
2007-08
2008-09
2009-10
10187
(25601)*
4261
3550
4751
(12562)*
42
51
53
(146)*
-
-
-
838
558
1628
(3024)*
2551
12130
7011
26919
50
36
68
(154)*
-
-
-
-
-
-
907
1690
2391
(4988)*
-
-
-
44934
57259
(117853)*
Radiology
Plain-X-Rays
7173
8241
Dye- Induced X-rays ( IVP Barium
Meals)
357
468
Ultrasonograph
6424
7243
-
-
Memography
608
(1433)*
8154
(21821)*
-
Pathology
Clinical Pathology
10436
17262
Chemical Pathology
20144
48016
506
842
P.C.R Tests
118
145
Bone Marrow
20
29
ECG
2107
2195
Hematology
1665
5618
Histo-pathology
Elisa Test:
(H. HIV. –etc.)
17836
(45534)*
31654
(99814)*
905
(2253)*
175
(438)*
46
(95)
12738
(27419)*
35621
(69551)*
Other Tests
Total
48950
90059
2292
(6594)*
4276
(11559)*
76133
(215142)*
15660
*3 years total of respective rows
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Table-4:
ISBN : 9780974211428
Total Patients Referred by the Sample Hospitals to other Hospitals
PESSI
Departments
Medical
Renal
Dialysis
Psychiatry
Oncology
Urology
Orthopedic
Gynae & Obs
ENT
Dental
Surgery
Eye
Cardiology
Cardiac
Surgery
Neurology
Neurosurgery
Child
Surgical
T. B. & Chest
Radiology
Total
Shahdara
Multan
Manga
PSSHMC
Muzaffargarh
2007-8 2008-9 2009-10 2007-8 2008-9 2009-10 2007-8 2008-9 2009-10 2007-8 2008-9 2009-10
15
35
25
60
111
59
49
115
204
July 2-3, 2013
Cambridge, UK
10
12
18
-
-
-
-
-
-
-
-
-
31
60
50
-
-
-
-
7
16
-
-
-
6
7
13
-
-
-
-
5
23
-
-
-
160
226
269
108
88
62
-
39
113
-
-
-
35
45
25
-
-
-
85
223
165
50
108
180
20
25
60
-
-
-
15
129
141
10
50
98
4
10
7
78
58
43
65
23
-
-
-
2
7
5
-
-
-
-
12
7
-
-
-
25
35
28
-
-
-
51
154
164
37
116
170
446
543
600
1059
958
636
45
209
226
40
115
199
8
10
15
192
164
108
-
11
15
-
-
-
29
55
70
231
208
136
-
16
77
-
-
-
60
90
105
113
98
63
-
63
50
20
30
40
-
-
-
23
66
101
18
40
80
10
15
30
-
-
-
15
145
122
15
30
35
25
15
25
-
-
-
-
-
-
-
-
-
-
906
1220
1385
1781
1574
1048
294
-
-
-
-
-
182
163
-
-
-
1437
1465
219
574
966
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Table -5:
Department
Eye
ENT
Skin
Urology
Surgical
Medical
Dental
Child
Cardiac
Gynae
Orthopedic
NNN
Oncology
Nephrology
Psychiatry
C. Surgery
Dialysis
ICU
TB
Psychiatry
Total
ISBN : 9780974211428
Total Patients Treated in PESSI Hospitals Referred by PSSHMC
Referred by PSSHMC, Manga to Nawaz Sharif SSH,
Lahore (2009-10)
No
Admission
On Choice
Binding
Binding
38
32
4
78
83
164
47
77
103
98
33
46
9
14
19
312
9
19
1185
254
152
165
291
293
1166
46
134
493
231
546
152
18
45
44
148
148
486
8
62
235
83
207
-
-
68
Referred by PSSHMC, Muzaffargarh to
KFSSH, Multan
2007-8
55
23
165
189
547
1
183
218
224
146
183
66
4067
1737
332(7321)
 Indicate Total Nos. of Patients
2009-10
19
-
16
73
177
-
2008-9
37
187
1829
12
-
-
12
27
108
247
2
70
124
135
12
69
825
9
17
55
126
1
47
56
84
11
25
443 (3097)*
Table-6:- Budget of the Concerned Hospitals in 2009-10
Expenditure on (%)
Total Expenditure
Hospital
(Rs.)
Medicine
Pay & Allowances
Shahdara
116,186,447
24.2
55.8
KFSSH
104,268,392
15.8
62.0
Manga (PSSHMC)
Muzaffargarh
(PSSHMC)
113,705,796
36.7
40.8
85,361811
39.2
38.1
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Table-7:- On the Job Experience, Monthly Remuneration and Satisfaction Status of the
Professional staff in the Concerned Hospitals
Job Experience
Average Monthly Salary
Consultants/
Specialists
DMS
MOs /WMOs
Lab Tech.
Nurses
Dissatisfaction
(RS/month)
Designation
PESSI
PSSHMC
PESSI
PSSHMC
PESSI
PSSHMC
16.9
14.5
46244
43929
-
42.9
16.4
10.9
3.0
8.3
16.0
4.2
15.3
2.9
52600
38175
27900
20543
35000
24978
20133
14462
12.5
-
55.6
66.7
50.0
Table-8:- Assessment of Work Performance of the Concerned Hospital
Items
Work Load of
Doctors
Nurses’
Performance
Competency
Hospital
Administration
Performance
PESSI
Complete
Some Extent
Satisfied
Satisfied
84.8
9.1
88.6
97.4
PSSHMC
Complete
Some Extent
Satisfied
Satisfied
6.1
44.1
20.6
35.3
11.4
-
48.5
39.4
12.1
2.6
-
75.7
8.1
16.2
Not Satisfied
Not Satisfied
Table -9: Overall Ranking of the Hospitals by Staff
PESSI
(Percent)
PSSHMC
Very Good
73.8
44.4
Good
26.2
47.2
-
5.6
2.8
Rank
Average
Poor
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Table-10-: Preference of Staff of PSSHMC and PESSI Regarding Public – Private Partnership
Description
Preference about Public- Private Partnership
Preferred Public-Private Partnership
Not Preferred the Partnership
Preferred the Partnership to Some Extent
If Preferred public – Private Partnership, Reasons
Better Infrastructure
Problems Can be Solved
Better atmosphere and Working Condition in PPP Set up
If not preferred Public – Private Partnership, Then Reasons
No Job Security
Lack of Pension benefit
Better Atmosphere and Working Condition in Govt. Set up
Personal Respect in Govt. setup
Better Medical Facilities for Patients in Govt. Setup
Table -11:
PSSHMC
(Percent)
PESSI
37.8
56.8
5.4
2.4
97.6
-
21.4
57.1
21.4
100.0
100.0
76.2
33.3
23.8
4.8
19.0
65.9
22.0
26.8
12.2
36.6
Satisfaction Level of Outdoor Patients regarding their Check Up, Behavior of
Doctor and Waiting Time in OPD.
(Percent)
Item
PESSI
PSSHMC
Availability of Specialist / MO/WMO
99.0
99.0
Checked by Specialist / MO/WMO
98.5
99.5
Satisfied
88.7
59.9
Satisfied to some extent
3.4
18.8
Dissatisfied
7.9
21.3
Satisfied
92.6
60.8
Satisfied to some extent
4.5
17.6
Dissatisfied
3.0
21.6
10.5
40.8
Satisfaction About Check Up
Satisfaction Level about Doctor’s Behaviour
Waiting Time (Minutes)
Above Half an Hour
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Table 12:
ISBN : 9780974211428
Respondents Views about Availability of Medicines for Outdoor Patients
(Percent)
Item
PESSI
PSSHMC
Yes
95.6
92.1
No
3.4
7.9
Do not know
1.0
-
75.0
25.0
25.0
50.0
-
25.0
95.5
92.5
No
3.0
4.5
Do not know
1.5
3.0
Respondents received full quantity of medicines
If no, who purchased / arranged the medicines for you?
Hospital Staff purchased the medicines
Patient Purchased the medicines
Others
Was the Quality of Medicines according to the Prescription?
Yes
Table -13: Respondents Response about Medical Treatment and Availability of Medicines in the
Emergency Unit
(Percent)
Item
PESSI
PSSHMC
Time Taken by Staff for giving treatment to the patients (Minutes)
1–5
85.3
50.0
6 – 10
5.9
25.0
Above 10
8.8
25.0
100.0
92.3
-
7.7
Yes
100.0
84.6
No
-
12.8
Do not know
-
2.6
Whether the patient was checked by the Doctor?
Yes
No
Did the respondents receive full quantity of medicines?
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Table-14: Respondents Response of Indoor Patients
PESSI
(Percent)
PSSHMC
Up to 2
38.1
40.0
3–4
20.7
15.0
5–6
7.6
20.0
More than 6
33.7
25.0
95.6
84.2
Satisfied to some extent
1.1
8.8
Dissatisfied
3.3
7.0
94.5
87.5
Satisfied to some extent
2.2
8.9
Dissatisfied
3.3
3.6
96.8
89.1
Satisfied to some extent
1.1
7.3
Dissatisfied
2.2
3.6
95.7
89.3
Satisfied to some extent
2.2
8.9
Dissatisfied
2.2
1.8
96.8
87.7
Satisfied to some extent
2.2
8.8
Dissatisfied
1.1
3.5
96.8
90.0
3.2
8.3
-
1.7
Item
Stay in the Hospital (Days)
Satisfaction Level about Frequency of Specialist Visits
Satisfied
Satisfaction Level about Behavior of Specialist
Satisfied
Satisfaction Level about Frequency of MOs / WMOs Visits
Satisfied
Satisfaction Level about Behavior of MOs / WMOs.
Satisfied
Satisfaction Level about Availability of Nurses
Satisfied
Satisfaction Level about Behaviour of Nurses
Satisfied
Satisfied to some extent
Dissatisfied
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Table -15:
ISBN : 9780974211428
Respondents Response of Indoor Patients for Quantity and Quality of Medicines
(Percent)
Did the Respondents Received Full Quantity of Medicines
Yes
98.9
94.9
No
1.1
-
-
5.1
97.8
94.9
2.2
-
-
5.1
Do not know
Was the Quality of Medicines according to the Prescription
Yes
No
Do not know
Table-16:
Respondents Views / Satisfaction about Operations Performed in the Hospitals
(Percent)
Item
PESSI
PSSHMC
Yes
31.4
36.2
No
68.6
63.8
86.4
95.5
-
4.5
13.6
-
Yes
48.0
37.5
No
52.0
62.5
Yes
88.0
66.7
No
-
9.5
12.0
23.8
Were you /your Family Member Operated in the Hospital?
Satisfaction Level about the Services in the Operation Theater
Satisfied
Satisfied to some extent
Dissatisfied
Was the Blood required for Operation?
Were Post- Operation Facilities Provided?
Not Applicable
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Table -17:
ISBN : 9780974211428
Respondents Response about Complaint Cell in the Hospital
(Percent)
Item
PESSI
PSSHMC
Yes
78.5
23.2
No
15.7
62.7
5.8
14.1
Efficient
73.5
42.9
To Some Extent Efficient
8.2
23.2
Not Efficient
17.9
33.9
Don't know
0.5
-
Was there any Complaint Cell?
Not Applicable / Don't know
Was the Complaint Cell Efficient?
Table-18: Satisfaction about Hospital Administration and Overall Ranking of the Hospital
According the Respondents
Item
Satisfaction Level about Behavior of Administration
Satisfied
PESSI
(Percent)
PSSHMC
90.0
58.7
Satisfied to some extent
7.2
31.2
Dissatisfied
2.8
10.1
Excellent
47.0
19.8
Good
43.4
32.3
Average
8.0
34.3
Poor
1.6
13.7
Overall Ranking of the Hospital
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Annexure-1:
Departments
ENT
Eye
Gynae & Obs.
T. B. & Chest
Urology
Oncology
Medical
Skin
Radiology
ISBN : 9780974211428
Medical Wards / Departments Functioning
PESSI
Shahdara
Multan
*







*

*
*






(Nos.)
PSSHMC
Manga
Muzaffargarh








*
*
*
*


*



Pathology / Blood Bank




Gastroenterologist
*
*
*
*
Surgical




Orthopedic




Pediatrics/Child




Cardiology
*
*


Dental Care




Psychiatry


*
*
Physiotherapy




Anesthesia




ICU
CCU

*

*




Burn Unit
X
x
Hypertension/Diabetes

x

x

x
Hepatitis-C Clinic

x
x
x
Gastroscopy

x
x
x
Asthma Clinic

x
x
x
Satellite Clinic (Milk Pak)

x
x
x
Psychology

x
x
x
Functional =, Exist but Non-Functional = *, Not Existed = x
July 2-3, 2013
Cambridge, UK
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