Jamal Uddin Malikyar still remembers the day his family rushed a pregnant woman to a health facility, hoping that medical care would save her life. Instead, the journey ended in tragedy. His 34-year-old cousin’s brother Aminullah’s wife had already delivered three children through normal deliveries.
Baluchistan: strengthening basic health units to stop rural maternity wards from becoming death traps
Matiullah Mati
Quetta, Aug 24 (APP)::Jamal Uddin Malikyar still remembers the day his family rushed a pregnant woman to a health facility, hoping that medical care would save her life. Instead, the journey ended in tragedy. His 34-year-old cousin’s brother Aminullah’s wife had already delivered three children through normal deliveries.
But during her fourth pregnancy in 2022, the family faced a problem that remains common for women in rural Baluchistan: the nearest basic health facility was there, but the medical staff needed to handle childbirth were not.
The family first took her to the Basic Health Unit Malikyar just three kilometers away from their
home.
But there was no doctor available. With no option left, they began traveling to the BHU Dub Khanzai around 14 kilometers away. Before they could reach the BHU, Aminullah’ s wife died on the way.
For Jamal Uddin, the tragedy was not simply the loss of a loved one; it was a painful reminder that having a health center in a village does not necessarily mean that healthcare is accessible.
Jamal Uddin says the BHU in Malikyar was also badly affected by the floods of August 26, 2022. Roads were washed away, making travel even more difficult for residents, particularly when they needed medical treatment outside the area.
Although the BHU is now functional, he says key positions, including those of a female doctor and Lady Health Visitor (LHV), remain vacant. As a result, women requiring maternity care often have to travel to Dub Khanzai.
Jamal Uddin is now hopeful that the recent announcement of new posts will finally bring an LHV to the Malikyar BHU. He believes that if the facility is properly staffed, other families may not have to experience the loss his family suffered. According to Jamal Uddin, families have to take maternity cases either to District Headquarters Hospital, around 12 kilometers away, or to the BHU Dub Khanzai, which is 14 kilometers away from Malikyar.
Private doctors charge between Rs 8,000 and Rs 10,000 for each case, Jamal Uddin says. For poor families, this is not affordable. His cousin’s brother’s wife had already successfully delivered three children. There was no reason for the family to expect that the fourth delivery would end differently.
Baluchistan carries Pakistan’s highest maternal mortality burden. According to the Pakistan Maternal Mortality Survey 2019, Baluchistan has the highest maternal mortality ratio in Pakistan, with 298 maternal deaths for every 100,000 live births.
Bearing the province’s staggering maternal mortality burden, the provincial health department has set its sights on a critical uphill battle: driving down the maternal mortality ratio from 298 to 200 deaths per 100,000 live births while aggressively tackling preventable fatalities during pregnancy and childbirth.
A shortage of female healthcare workers data available on the website of the People’s Primary Healthcare Initiative (PPHI) shows that its 903 functional BHUs have 396 Lady Health Visitors, 351 midwives or traditional birth attendants and only 63 female medical officers.
PPHI reported 24,589 normal deliveries at its BHUs during 2025. The figures reveal a significant gap between the number of facilities serving rural communities and the availability of female medical professionals.
At the BHU in Dub Khanzai, however, the situation is somewhat different. Dr. Gran Tareen, a doctor at the facility, says the BHU is located about 17 kilometers away from Pishin Bazar and currently has two LHVs providing services. One works in the morning shift, while the other performs 24/7 duties.
The LHV responsible for round-the-clock services lives near the BHU so she can respond to emergencies when required. The facility also has an ambulance available for emergencies and referrals. According to Dr. Tareen, the BHU handles an average of around 70 normal deliveries every month with the support of the two LHVs.
According to the Baluchistan Health Policy 2018-30, a BHU is generally established for a population of around 25,000. Given the province’s sparse population and vast distances, however, BHUs are also established for communities of around 5,000 to 8,000 people.
The standard structure of a BHU includes four rooms and a storeroom, with staff positions including a medical officer, female medical officer, female medical technician, male medical technician, vaccination, watchman and sweeper. But the availability of female medical doctors remains a major gap.
Baluchistan is Pakistan’s largest province by area, covering around 347,000 square kilometers, while its population is approximately 14.9 million. More than 10 million people live in rural areas, where healthcare facilities can be separated by long distances and difficult terrain. For women in labor, such distances can turn a routine delivery into a life-threatening emergency.
Senior gynecologist Dr. Najma Ghaffar considers the province’s vast geography one of the major barriers to healthcare access. Baluchistan’s population is scattered across a vast area, and we cannot provide hospital-based health care to everyone, she says.
She believes the gap can be addressed through community-based services. She advocates deploying mobile health units and training local female health workers to provide essential services in communities where people cannot easily reach hospitals.
Training local LHVs in areas where people cannot reach hospitals is essential, she says, adding that strengthening such services is particularly important in the aftermath of floods.
To bridge the alarming gap of skilled maternity care in remote terrain, the provincial government is turning to a targeted grassroots solution. Provincial Health Minister Bakht Muhammad Kakar explains that authorities are tackling the severe shortage of trained birth attendants head-on through a dedicated two-year midwifery program rolled out under the People’s Primary Healthcare Initiative (PPHI).
Under the programme, women living within the catchment areas of BHUs are enrolled in a two-year midwifery induction, training and employment programme. After completing their training, they will be deployed at BHUs serving their own communities.
The approach is intended to overcome one of the major challenges facing remote areas: attracting and retaining trained female healthcare workers. Instead of relying solely on staff recruited from distant areas, the programme seeks to train women from the communities themselves.
Gynecologists say home deliveries remain common in rural areas, where untrained hands often turn manageable births into race-against-time emergencies. Arriving too late leaves doctors with dwindling options, sealing a tragic fate for both mother and newborn.
To combat this, PPHI provides specialized training to healthcare staff at 70 BHU Plus centers in the expert management of complicated maternity cases.
The training includes maternal assessment and initial triage, monitoring labor through a pantograph, assessment of newborn health, safe childbirth and delivery, management of severe bleeding during pregnancy and after childbirth, eclampsia, prolonged and complicated labor, breech delivery, multiple pregnancies, retained placenta, and vaginal and cervical tears.
The 24/7 BHU Plus model is designed to provide continuous maternal and newborn healthcare services closer to rural communities. These centers provide basic emergency maternal and newborn care, antenatal care, normal and assisted deliveries, postnatal care, family planning and birth spacing services.
They may also provide routine vaccination, laboratory testing, ultrasound, essential medicines for women, 24-hour ambulance and referral services, as well as maternal, newborn and child health counseling.
For women living far from district hospitals, such services can mean the difference between receiving care in time and arriving too late.
Baluchistan Health Minister Bakht Muhammad Kakar says maternal, newborn and child health as well as nutrition are directly linked to the strength of primary healthcare. He acknowledges that the existing system suffers from inadequate monitoring and resource constraints, which prevent many BHUs from functioning effectively.
He says improving procedures at BHUs and increasing public awareness are necessary to restore people’s confidence in the primary healthcare system. Kakar says he will fully support PPHI in improving transparency and healthcare delivery.
For the financial year 2026-27, Rs 96 billion has been allocated to the health sector in Baluchistan, including Rs 90 billion for non-development expenditure and Rs 6 billion for development spending. This represents an increase of around 30 percent from approximately Rs 71 billion allocated in the previous financial year. The government has also allocated Rs 8.8 billion to PPHI in the new fiscal year’s budget.
While the government vows to bridge the distance with mobile health units and renewed resolve, Jamal Uddin carries a quieter, heavier hope.
He dreams of a day when labor in Malikyar no longer triggers a desperate, life-or-death race across the plains and when no other family is forced to bury a loved one simply because an empty clinic doors locked away a mother’s only chance at survival.
