By Dr Sajid Shiek Pakistan’s social protection programmes have helped many vulnerable families. The Benazir Income Support Programme (BISP) and its health and nutrition-linked initiatives are meant to support mothers, children, and low-income households. BISP’s Nashonuma programme is described by the programme itself as a conditional cash transfer initiative for health and nutrition, and it works through facilitation centres at government health facilities. In Sindh, the Mother and Child Support Program, also known as MAMTA, is similarly designed to provide cash support to pregnant and lactating women while linking assistance with regular health checkups. These efforts are important and deserve recognition. At the same time, public programmes should also be reviewed for how they affect service delivery inside already crowded health facilities. Having worked as a Medical Officer in the Health Department since 2014, I have seen that the implementation of these programmes in government hospitals can create practical difficulties, especially in rural areas. This is not a criticism of the welfare idea itself. It is a concern about how the system is being managed. Many rural government hospitals in Sindh already face limited space, staff shortages, and pressure on basic resources. When programme-related procedures are carried out in the same facilities, the number of visitors increases further. In some centres, outpatient attendance has risen sharply, not only because of illness, but also because beneficiaries must visit hospitals to complete formalities linked to these programmes. As a result, outpatient departments become crowded for much of the day. Doctors and paramedical staff must divide their time between patient care and administrative work. Medicines, supplies, and other hospital resources are used more quickly, which can affect patients who come for treatment of genuine medical problems. Crowding also makes infection prevention more difficult. The World Health Organization says infection prevention and control is essential for safe and quality healthcare, and that without effective IPC, quality health care delivery is not possible. In busy facilities, long queues and congested waiting areas can increase the risk of spreading communicable diseases, especially among pregnant women, infants, and older patients. Another issue that deserves attention is the possible effect on family planning services. Financial support linked to pregnancy and safe delivery can encourage maternal care, but policymakers should also consider whether such incentives are fully aligned with broader reproductive health and population management goals. This is an area that needs careful assessment rather than assumptions. The burden is not only physical. Healthcare workers are also under pressure. The WHO has noted that high levels of stress, burnout, and workforce strain are linked to staff shortages, unsafe working conditions, and stressful environments, and that at least a quarter of health and care workers reported anxiety, depression, and burnout symptoms between January 2020 and April 2022. In crowded facilities, these pressures can grow further and affect the quality of care. The solution does not require reducing social welfare programmes. It requires better coordination. A practical step would be to establish separate BISP and MAMTA facilitation centres outside hospitals, or at least in dedicated administrative units with separate staff. This would allow beneficiaries to receive support without interrupting clinical work. Hospitals could then focus on diagnosis, treatment, emergency care, maternal services, immunization, and disease prevention. Better coordination between social protection and health departments would reduce congestion, improve infection control, and allow medical staff to spend more time on patient care. It would also make the welfare system more efficient and easier for beneficiaries to use. Pakistan does not need to choose between social protection and healthcare. Both are public responsibilities, and both should strengthen each other. If welfare administration is kept separate from clinical services, hospitals can remain focused on healing, while social programmes continue to support the poor in a more effective way. This issue deserves review at the policy level. A small structural change could improve both healthcare delivery and social protection outcomes across the country. The writer is a senior Medical Officer. He can be reached at doctorsajid07@gmail.com
