Perspectives on domestic violence: case study from Karachi, Pakistan

There is no adequate profile of domestic violence in Pakistan although this issue is frequently highlighted by the media. This case study used qualitative and quantitative methods to explore the nature and forms of domestic violence, circumstances, impact and coping mechanisms amongst selected women victims in Karachi. Violence was a continuum: all the women reported verbal abuse, often escalating into physical, emotional, sexual and economic abuse. The husband was the most common perpetrator. Women suffered in silence due to sociocultural norms, misinterpretation of religious beliefs, subordinate status, economic dependence and lack of legal redress. Besides short-term local measures, public policy informed by correct interpretation of religion can bring about a change in prevailing societal norms

Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan

A cross-sectional study of patient satisfaction with care was conducted over a period of 1 year from March 2004 to March 2005 in a secondary-level hospital in a peri-urban area of Karachi, Pakistan. Using the SERVQUAL tool and exit interviews, data were collected quarterly from a total of 1533 patients. Results sharing and capacity-building workshops were arranged during the 4 phases of the survey to sensitize the staff of the hospital to work towards improving patient satisfaction. The level of satisfaction of the patients with the outpatient health services provided showed a gradual increase from 34.4% to 82.0% over the 1-year period

Health workers for change: a tool for promoting behaviour change among health providers

Sensitizing health providers to customers' needs and women's health remains a challenge to the Pakistani health system. The Health Workers for Change methodology has been demonstrated to improve provider-client relationships in certain African and Latin American countries. This paper describes the experience of using Health Workers for Change participatory workshops in Pakistan to sensitize male and female health providers to gender issues. Health care providers identified the unmet needs of women clients as a function of individual, household and social factors, and, unlike the African experience with this tool, not predominantly confined to factors associated with the health facility

Health management information system: a tool to gauge patient satisfaction and quality of care

The health management information system [HMIS] is an instrument which could be used to improve patient satisfaction with health services by tracking certain dimensions of service quality. Quality can be checked by comparing perceptions of services delivered with the expected st and ards. The objective of the HMIS would be to record information on health events and check the quality of services at different levels of health care. The importance of patient assessment is a part of the concept of giving importance to patient's views in improving the quality of health services. Expected benefits include enhancing patient satisfaction through improved communication; greater provider sensitivity towards patients; enhanced community awareness about the quality of services; and overall better use of services in the health system

district health system: a challenge that remains

The health care system in Pakistan has been confronted with problems of inequity, scarcity of resources, inefficient and untrained human resources, gender insensitivity and structural mismanagement. With the precarious health status of the people and poor indicators of health in the region, health care reforms were finally launched by the government in 2001. There are, however, numerous challenges and constraints in the system. The future health of the nation depends on this decentralization initiative. All our efforts should be concerted to support and facilitate the new system, which will mature into institutionalization of the health services at the district level. Most importantly, it will help in strengthening the primary health care services catering to the major fraction of the population. Besides political commitment, we ought to maintain attitudinal, behavioural and cultural conditions conducive to letting this system flourish

Behind the counter pharmacies and dispensing patterns of pharmacy attendants in karachi

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries. This "study obtained background information on pharmacies, assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi. This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants. Of the 219 pharmacies surveyed, 62 percent reported more than 50 customers daily and 20 percent also sold items of general provision. Mean operating hours were 13. Only 24 [11 percent] had a visible license. On an average 3 attendants were employed per pharmacy. We interviewed one in each. Amongst the 219 interviewed, 77 [35 percent] were intermediate qualified and only 26 [12 percent] pharmacologically trained. Correct frequency of ORS administration was not known by 167 [76 percent] and 21 percent incorrectly suggested an anti-diarrhoeal preparation for viral diarrhoea in children. The knowledge of those with pharmacological training was significantly better. For respiratory tract infection in children approximately 60 percent did not know the correct dose of Paracetamol and Amoxicillin. Only 13 [6 percent] knew that Propanalol was contraindicated in hypertensive asthmatics. For Co- trimoxazole, metronidazole and lomotil only 40 percent, 21 percent and 15 percent respectively, were aware that these could not be dispensed without prescription. In the absence of trained pharmacists existing pharmacy attendants should be trained to improve drug-dispensing patterns