Staff shortages continue to strain care at Karachi’s largest children’s hospital

KARACHI: Sindh’s largest paediatric facility, the National Institute of Child Health (NICH), has been struggling under severe staff shortages for years, with around 800 positions lying vacant, placing immense pressure on existing doctors, nurses and paramedical staff amid a rising patient load.

According to a report by The Express Tribune, the 500-bed hospital routinely accommodates more than 2,000 children at a time, forcing multiple patients to share a single bed. Doctors say the strain has significantly impacted patient care, with surgeries being scheduled three to six months later and critical diagnostic equipment such as MRI and CT scan machines frequently out of order. Even basic infrastructure, including lifts used to transport patients, often remains nonfunctional.

The hospital’s outpatient department sees between 500 and 700 children daily, while approximately 300 patients arrive in the emergency ward each day. With limited capacity and resources, many patients are either forced to wait for months or seek costly treatment at private hospitals.

Parents described prolonged delays and hardship in accessing care. A father from Thatta said his four-year-old son had to wait weeks for an MRI due to a faulty machine, followed by a three-month wait for surgery, leaving the child in persistent pain. Another parent from PIB Colony said his daughter, born with a cleft lip and palate, was given a surgery date months later, and even after the procedure, medicines were not provided by the hospital.

Hospital data shows that of 89 sanctioned doctor positions, only 25 are filled. Similarly, 80 out of 200 nursing posts and 250 out of 410 paramedical positions remain vacant. Overall, only about 400 of the hospital’s 1,200 approved posts are currently filled, with no permanent recruitment made between 2011 and 2026 due to ongoing legal complications.

As a result, the hospital relies heavily on trainees, including house officers and postgraduate residents, to maintain operations. While these trainees receive stipends from the Sindh government, they are not permanent staff, further straining service delivery.

Aijaz Kaleri, president of the Young Nursing Association, said staffing levels were critically low, noting that just four nurses attend to around 60 children during the day, while three manage the same number in the evening. He stressed that the hospital requires at least 450 nurses in addition to more doctors and paramedical staff to function effectively.

A doctor, speaking on condition of anonymity, said several approved posts — including specialist doctors, pharmacists and technologists — remain unfilled despite allocated funds, contributing to overcrowding and forcing hospitals to refer patients without admission due to lack of space.

Executive Director Professor Dr Nasir Saleem Saddal confirmed the shortage, stating that while around 150 NGO workers are assisting, recruitment plans remain stalled. He said the hospital continues to provide free treatment to children up to 14 years of age, but acknowledged that staff shortages are severely affecting service delivery.