Challenges to health sector in Rural Sindh

Sindh continues to face deep and persistent health challenges rooted in structural weaknesses, unequal development, demographic pressures, and severe disparities between its urban and rural populations. Although Karachi and a few major urban centers possess relatively better medical facilities, the health landscape across rural Sindh remains fragile and underdeveloped. Larkana district, despite being politically prominent and home to major public hospitals such as Chandka Medical College Hospital, presents a clear picture of the province’s systemic health problems. Recurrent disease outbreaks, inadequate maternal care, weak infrastructure, and governance failures highlight the need for a comprehensive, equity-focused health policy.

One of the most fundamental issues in Sindh’s health system is the weakness of governance and institutional capacity. After the 18th Constitutional Amendment, health became a provincial subject, but administrative devolution did not strengthen district-level systems. Many districts, including Larkana, rely on overstretched health offices that lack authority, funding autonomy and operational efficiency. Political interference continues to shape hiring and posting decisions, leading to misallocated staff, absenteeism and uneven service delivery. Even in high-profile hospitals, overcrowding, unhygienic conditions and shortages of essential medicines are common. These governance gaps weaken emergency response, procurement, monitoring, and overall accountability.

Primary healthcare in rural Sindh is particularly fragile. The network of Basic Health Units and Rural Health Centers, intended to serve as frontline facilities, is largely dysfunctional. Many centers are understaffed, lack trained personnel or remain closed for significant portions of the day. Irregular medicine supplies, dilapidated buildings, absence of functional laboratories and lack of electricity or clean water severely limit the capacity of these facilities to provide even basic services. In many rural areas of Larkana, families often travel long distances to reach the district headquarters for treatment, resulting in delayed care and preventable complications. This weak primary-level foundation directly affects women, children, and elderly patients who have the least mobility and the greatest need for timely care.

Women’s health in Sindh, especially in rural districts, represents one of the most urgent but neglected areas. Maternal mortality remains high, driven by a shortage of skilled birth attendants, inadequate antenatal care, and limited access to emergency obstetric services. Cultural norms often restrict women from traveling alone for medical treatment, and decisions about their health are frequently influenced by male family members. Many women deliver at home without trained midwives, increasing the risks of postpartum hemorrhage, infections, and neonatal complications. Rural areas of Larkana face an acute shortage of gynecologists and female doctors, and taluka-level hospitals often lack functioning labor rooms, blood transfusion facilities and newborn care units. Malnutrition, anemia and vitamin deficiencies among women stem from limited knowledge of nutrition, poverty and household practices where women often eat last.

Child health is similarly compromised. Immunization rates remain inconsistent across Sindh, and Larkana has experienced repeated outbreaks of measles, pneumonia and gastroenteritis. Weak cold-chain management, absentee vaccinators, limited outreach in remote villages and mistrust of vaccines contribute to the problem. Malnutrition among children remains widespread, with stunting and wasting driven by contaminated water, poor sanitation, poverty and inadequate maternal nutrition. The high burden of diarrheal diseases in Larkana’s rural villages, often linked to unsafe drinking water, further undermines the health of children and increases mortality risks.

The burden of infectious diseases in Sindh is heavy and continues to grow. Larkana came to national attention after HIV outbreaks, particularly the 2019 outbreak that affected hundreds of children. Investigations pointed to unsafe injection practices, unregulated clinics, and poor infection control standards. These issues are not limited to Larkana; quackery is widespread across rural Sindh due to weak enforcement and limited availability of trained professionals. Hepatitis B and C rates remain among the highest in Pakistan, largely due to reused syringes, contaminated dental equipment and lack of public awareness. Tuberculosis and dengue are persistent concerns, worsened by poverty, dense living conditions and weak public health surveillance.

Infrastructure and human resource shortages further deepen the crisis. Many hospitals lack functioning diagnostic machines, ventilators or emergency equipment, and breakdowns often go unrepaired for months. Specialists are reluctant to serve in rural postings due to poor working conditions, lack of security and limited career incentives. Female doctors, in particular, face mobility and safety concerns, contributing to the acute shortage in rural areas. Training programs for nurses, midwives, laboratory technicians and community health workers remain limited and unevenly distributed. This shortage of trained personnel weakens both curative and preventive health services.

Environmental and sanitation-related problems add another layer to Sindh’s health challenges. Many rural communities rely on contaminated water sources containing bacteria, arsenic and agricultural chemicals. Proper sewerage and waste disposal systems are often absent, especially in Larkana’s villages, where open defecation and poorly managed waste contribute to the spread of diseases such as typhoid, cholera and diarrhea. Climate vulnerability, particularly flooding, further strains the health system and disrupts services.

Addressing these challenges requires a holistic and practical policy approach. Strengthening primary healthcare through well-equipped, 24/7 operational BHUs and RHCs is essential. Incentives for doctors—especially women—to serve in rural areas, along with expanded midwifery and community birth-center programs, can significantly improve maternal health outcomes. Regulation of medical practice, strict action against quack clinics, and comprehensive training in infection control are critical to preventing future outbreaks. Immunization programs must be strengthened through robust cold-chain management and community engagement. Investment is needed in diagnostic facilities, mobile health units, emergency response systems and water purification infrastructure. Finally, a strong accountability framework that minimizes political interference and ensures transparent resource allocation is essential for sustainable reform.

Sindh’s health challenges are serious but solvable. Larkana, with its mix of political importance and persistent vulnerabilities, represents both the urgency and potential for change. By investing in primary care, women’s health, regulation, and equitable infrastructure, the province can move toward a more resilient and just health system that benefits all its people, especially those in rural areas who have long been underserved.

 Khurhseed Ahmed is the regional coordinator of YEW chapter Larkana. He has done his bachelor of Business Administration from SZABIST Karachi.