When the first cases of COVID-19 emerged in Wuhan, few people imagined how quickly an unfamiliar health threat could cross borders. Within months, the virus had exposed the vulnerability of health systems around the world.
Sindh faces a different kind of health emergency today. It does not spread through the air. It can spread through unsafe injections, contaminated equipment and unregulated medical practices.
In districts such as Naushahro Feroze, unqualified practitioners, commonly known as quacks, continue to provide medical treatment despite lacking the qualifications required to do so. The problem is not limited to a handful of illegal clinics. Evidence from Sindh has shown widespread weaknesses in infection prevention and unsafe practices among untrained healthcare providers.
A study covering private practitioners across 29 districts of Sindh in 2019–20 found poor infection-control practices at a large majority of the facilities inspected. It also reported the reuse of syringes or intravenous drip sets among many untrained practitioners. The study further identified cases in which qualified doctors had allowed their names to appear on clinic signboards, giving unlicensed establishments an appearance of legitimacy.
These practices can have consequences that remain hidden for years. Sindh’s experience with the HIV outbreak in Larkana in 2019 demonstrated the danger of unsafe healthcare practices. Hundreds of people, including a large number of children, were diagnosed with HIV during the outbreak. Subsequent investigations pointed to unsafe practices in both formal and informal healthcare settings as important factors behind the spread.
Hepatitis C presents another serious concern. Research on Sindh has identified unsafe medical injections among the significant preventable factors associated with HCV transmission. For a patient seeking treatment for something as ordinary as fever, weakness or pain, an unsafe injection can create a health problem that may remain undetected for years.
The question, therefore, is why people continue to visit such practitioners.
For many low-income families, the answer is access and affordability. A qualified doctor may be located far away, while transport costs, consultation fees, diagnostic tests and medicines can make formal healthcare difficult to afford. A local practitioner offering immediate treatment at a much lower price can appear to be the only practical option.
This is why quackery cannot be treated solely as a law-enforcement problem. Closing an illegal clinic is necessary, but it does not address the conditions that brought patients there in the first place.
Sindh’s anti-quackery authorities have carried out actions against unqualified practitioners, but enforcement needs to be sustained. A clinic sealed during one operation has little impact if the same operator returns a few days or weeks later. Effective regulation requires proper records, follow-up inspections, identification of repeat offenders and meaningful legal action where violations are established.
At the same time, government must strengthen healthcare services at the district level. A poor patient should not have to choose between an expensive journey to another city and an unqualified practitioner in the local neighbourhood.
District hospitals need adequate doctors, medicines, diagnostic facilities and emergency services. Where specialist treatment is unavailable locally, an effective referral and transport system should help patients reach the appropriate facility without placing an unbearable financial burden on their families.
Infection control must also become a basic requirement across the healthcare system. Syringes and other single-use equipment should never be reused. Reusable instruments must be properly sterilised, while medical waste should be safely disposed of. These standards should apply equally in major cities, district centres and rural communities.
Patients should not be blamed for a system that leaves them with limited choices. Most people cannot easily determine whether a person treating them has the required medical qualifications. They seek whoever is nearby, affordable and available.
The responsibility for closing that gap rests with the state.
Sindh will not eliminate quackery through occasional raids or the sealing of a few clinics. The province needs continuous inspection, reliable documentation, action against repeat offenders and stronger access to qualified healthcare.
The measure of success should not simply be the number of clinics sealed. It should be whether those clinics remain closed, whether illegal practitioners are prevented from returning, and whether ordinary citizens have better access to qualified medical care.
A future public-health crisis does not necessarily have to arrive from another country. It can emerge quietly within a community when unsafe medical practices become normal. Preventing that crisis requires more than enforcement. It requires a healthcare system in which people no longer feel compelled to choose between affordability and safety.
Wazir Ali is a civil servant working in the Government of Sindh.
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