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

Karachi: Sindh’s biggest paediatric hospital, the National Institute of Child Health (NICH), has been functioning for years with major staffing gaps, as 800 of its 1,200 sanctioned posts remain vacant despite a heavy patient burden, according to hospital officials and staff representatives.

The shortage has placed doctors, nurses and paramedical workers under intense pressure and has affected the timely provision of treatment. Surgeries are being scheduled three to six months ahead, while MRI and CT scan facilities are often unavailable because the machines remain out of order. The lift used to move children to upper floors also frequently does not work.

NICH has a capacity of 500 beds, but more than 2,000 children are being accommodated at a time, resulting in three to four patients sharing a single bed. The outpatient department receives between 500 and 700 children daily, while about 300 patients arrive at the emergency department every day. The emergency department has been handed over under a public-private partnership.

Families described long waits and repeated visits for treatment. A father from Thatta said his four-year-old son, who had a urinary tract problem, was advised surgery after an MRI.

“The machine remained out of order for weeks, requiring repeated visits. After the test was finally conducted, surgery was scheduled three months later, leaving my child in pain for months”, he said.

Another parent from PIB Colony said his two-year-old daughter, who was born with a cleft lip and palate, was given a surgery date three months later after laboratory tests.

“Private hospitals quoted unaffordable costs. When the surgery was eventually performed at NICH, medicines were not provided by the hospital”, the parent said.

Vacancies and recruitment delays

At the hospital, 64 of 89 approved doctor posts are vacant. Of 200 sanctioned nursing positions, 80 are unfilled, while 250 of 410 paramedical posts are vacant. Recruitment has not taken place for several years because of legal complications.

The annual medicine budget is Rs32 million. At present, the hospital has 65 house officers, four FCPS trainees, 120 FCPS Part-II trainees, 34 MCPS trainees and 15 trainee RMOs. These trainees are not regular employees, although they receive stipends from the Sindh government, and the administration depends heavily on them to keep services running.

No permanent recruitment has been made from 2011 to 2026. NICH was previously under Jinnah Postgraduate Medical Centre before being separated in 1990, when senior paediatric surgeon Professor Nizam-ul-Hassan became its first honorary director.

Employees have also been waiting for promotions for a long time, while postgraduate trainees and house officers continue to carry much of the operational workload.

Officials and staff representatives cite severe shortages

Aijaz Kaleri, president of the Young Nursing Association, said that of 210 approved nursing posts, only 110 had been filled.

“Four nurses care for 60 children during the day, while three manage the same number in the evening. The hospital urgently requires 450 nurses along with more doctors and paramedical staff”, Kaleri said, adding that the shortage was a major reason for delays in surgeries.

A doctor, speaking on condition of anonymity, said only 18 to 20 senior doctors who are employees of Jinnah Sindh Medical University were linked with NICH.

“Their salaries are paid by the university, though they receive additional benefits from NICH. In this regard, 30 consultant specialist posts, 12 medical technologist specialist posts, 15 pharmacist posts, 106 staff nurse posts, and 53 specialist doctor posts approved in 2024 remain unfilled despite allocated funds. Hence, many children are referred from emergency without admission due to lack of beds”, the doctor said.

NICH Executive Director Professor Dr Nasir Saleem Saddal confirmed that 800 of the 1,200 sanctioned posts were vacant, though around 150 NGO workers were assisting the hospital.

“NICH provides free treatment to children from birth to 14 years and offers laboratory, radiology and emergency services”, he said while also confirming the acute shortage of staff and stating that plans for contractual hiring had remained stalled because of legal complications.