Barriers and Strategies: Implementation of Health-Related Projects in Gilgit Baltistan

By Asmat Ullah

Last year, I had the privilege of engaging in comprehensive work across all districts of Gilgit Baltistan, focusing on maternal and child health issues. Throughout this experience, I closely observed the existing health facilities and had the opportunity to interact with various stakeholders, including high-ranking government officials, representatives from the United Nations, civil society organizations, and other relevant parties. Moreover, I actively sought to comprehend the challenges faced by these communities through direct engagement with residents.

In order to bring attention to these critical matters, I previously composed articles for local newspapers. However, I now aspire to extend the reach of my message by expressing it in English, thereby appealing to a broader audience. It is my hope that both the government and relevant stakeholders will take heed of these issues and work towards their resolution, thereby catalyzing substantial improvements in the health facilities throughout Gilgit-Baltistan.

Implementing health-related projects in Gilgit-Baltistan, a mountainous region in Pakistan, face various barriers. Here are some common challenges that observed during the implementation of health project in Gilgit-Baltistan:

• Geographic Terrain and Inaccessibility: Gilgit-Baltistan is characterized by its challenging terrain, including high mountains, valleys, and remote areas. The rugged geography makes it difficult to establish and maintain healthcare infrastructure, transport medical supplies, and reach remote communities, resulting in limited access to healthcare services.
• Limited Healthcare Infrastructure: The region has inadequate healthcare infrastructure, including hospitals, clinics, and diagnostic facilities. The lack of well-equipped healthcare facilities hinders the effective delivery of quality healthcare services to the population.
• Human Resources and Capacity: Shortage of healthcare professionals, including doctors, nurses, and technicians, is a common challenge in Gilgit-Baltistan. Insufficient staffing, lack of trained personnel, and difficulty in retaining healthcare professionals in remote areas impact the implementation of health projects.
• Cultural and Linguistic Diversity: Gilgit-Baltistan is home to diverse ethnic and linguistic groups. Different cultural practices, beliefs, and languages pose challenges in effectively communicating health information, implementing behavior change interventions, and building trust between healthcare providers and the local population.
• Socioeconomic Factors: Socioeconomic factors, such as poverty, limited access to clean water and sanitation facilities, and low literacy rates in some areas, impact health outcomes in the region. These factors may hinder the acceptance and adoption of health interventions and limit the availability of resources for project implementation.
• Extreme Weather Conditions: Gilgit-Baltistan experiences harsh weather conditions, including heavy snowfall and landslides during winters. These weather conditions disrupt transportation, limit access to healthcare facilities, and delay the delivery of essential medical supplies.
• Limited Financial Resources: Adequate funding for health projects is crucial for their successful implementation. However, limited financial resources, budget constraints, and dependency on external funding sources pose challenges to sustained project implementation and the availability of necessary resources.
• Community Engagement: Engaging and involving the local community in health projects is essential for their success. Lack of awareness, resistance to change, and limited community participation pose challenges in implementing health interventions effectively.
• Limited Accountability: Without a proper M&E system, it becomes difficult to hold individuals and institutions accountable for their performance. This lack of accountability can lead to inefficiencies, mismanagement of resources, and the inability to address gaps or problems promptly.
• Inadequate Data Collection: Monitoring and evaluation systems enable the collection of accurate and timely data, which is essential for evidence-based decision-making. Without such systems, data collection may be inconsistent, incomplete, or non-existent, making it challenging to assess the impact of health projects accurately.
• Difficulty in Tracking Progress: Monitoring progress is crucial to ensure that health projects are on track and meeting their objectives. Without an M&E system, it becomes challenging to measure progress, identify bottlenecks, and make necessary adjustments to improve project implementation.
• Limited Learning and Improvement: M&E systems facilitate learning from project implementation by analyzing data, identifying successes, and learning from failures. Without such systems, opportunities for learning and continuous improvement may be missed, leading to the repetition of mistakes and the inability to optimize project outcomes.
• Uncertainty in Resource Allocation: Effective M&E systems provide insights into resource utilization and efficiency. Without adequate monitoring and evaluation, decision-makers may face challenges in allocating resources optimally, resulting in wastage or ineffective use of funds.

• Duplication of Efforts: Without effective coordination, different departments and partners unknowingly work on similar projects or initiatives, leading to duplication of efforts. This not only wastes resources but also creates inefficiencies and confusion among stakeholders.
• Fragmented Service Delivery: In the absence of coordination, service delivery becomes fragmented, with different departments or partners working in isolation. This can result in gaps or overlaps in healthcare services, leading to inconsistent and inadequate care for the population.
• Inefficient Resource Allocation: Lack of coordination and communication lead to suboptimal resource allocation. Departments and partners may not have a clear understanding of each other’s priorities and resource needs, resulting in resource imbalances and ineffective utilization of available funds and assets.

Strategies to address barriers and Gaps

• Establishing Regular Meetings and Forums between relevant stakeholders: Regular meetings, workshops, and forums can provide a platform for departments and partners to come together, exchange information, share progress, and coordinate efforts. This promotes a shared understanding of goals, activities, and resource needs.
• Developing Clear Roles and Responsibilities: Clearly defining the roles and responsibilities of each department and partner involved in health projects is essential for effective coordination. This ensures that everyone understands their specific contributions, avoids duplication, and fosters collaboration.
• Sharing Information and Data: Establishing mechanisms for sharing information, data, and best practices among departments and partners enhances coordination. This can be done through regular reporting, data-sharing platforms, and knowledge-sharing sessions.
• Strengthening Communication Channels: Utilize various communication channels such as email, phone, and online platforms to facilitate effective communication and timely exchange of information among stakeholders. Regular updates, newsletters, and bulletins can also help keep everyone informed.
• Encouraging Collaboration and Partnerships: Actively promote collaboration and partnerships among departments, non-governmental organizations, community-based organizations, and other relevant stakeholders. Foster an environment that encourages sharing resources, expertise, and joint planning to maximize the impact of health projects.
• Designating a Lead Coordination Entity: Having a designated lead entity responsible for coordinating health projects can streamline efforts and ensure effective communication and collaboration among departments and partners.
• Tailoring projects to the specific needs and context of Gilgit-Baltistan: Considering the unique geography, culture, and socioeconomic factors. Strengthening healthcare infrastructure by building and upgrading healthcare facilities, particularly in remote areas.
• Prioritizing the recruitment, training, and retention of healthcare professionals: especially in those underserved regions where these facilities are not available.
• Exploring innovative solutions: Such as telemedicine and mobile health clinics, to improve access to healthcare services in remote areas.
• Advocating for increased funding and support from relevant stakeholders: This includes government bodies and international development agencies who are working other parts of Pakistan specially in KPK and Baluchistan where in most of the areas situations are quite similar.

The writer is working as Research Specialist at the Mother and Child Health Division at the Aga Khan University, Karachi.