There are 68 BHUs with 24/7 or BHU Plus facilities in Balochistan. This initiative of converting the BHUs into 24/7 or BHU Plus facilities were originated in 2012 and initially 17 BHUs were converted into 24/7 or BHU Plus facilities. The number has increased to 68 since then.

A BHU is the primary/first level of the healthcare system, considered to maintain an organized primary level curative care and adequate health; and prevention from diseases of the catchment population. It has an approved essential drugs list and provides basic curative, EmONC and preventive (immunization) services. Complicated cases are normally referred to higher level health facilities such as Rural Health Centres (RHCs), District Head Quarter (DHQ) Hospitals or tertiary care hospitals.

Balochistan has some of alarming health indicators in the world, especially in mother, neonatal and child healthcare (MNCH). The BHUs, being the first level healthcare facilities, are an important place for the poor and rural women to receive basic healthcare facilities but these BHUs (being the public sector facilities) only remain open from 0800 to 1400 daily. These hours of operation severely constrain access to basic healthcare services. PPHI Balochistan, having the management control of all the BHUs in Balochistan, first implemented the initiative of 24/7 BHUs in 2012, to provide round the clock healthcare services. These BHUs were aimed at providing the basic healthcare services including mother, neonatal and childcare (MNCH) services throughout the week round the clock. To support the 24/7 operations, these BHUs were provided Lady Medical Officers (LMOs), Lady Health Visitors (LHVs), ultrasound machines, labor room equipment, women specific medicines, micro lab for diagnostic tests, generators and ambulances. Institutional deliveries and basic EmONC services are encouraged through these facilities; however, the complicated pregnancy cases are still referred for comprehensive EmONC to higher level health facilities. services as well. In addition to the normal BHU functions, 24/7 BHUs are designed to facilitate following

  • Basic EmONC.
  • Antenatal & Postnatal Care. Family planning services. Immunization.
  • Laboratory services.
  • Women specific medicines. Ultrasound services.
  • 24 Hours ambulance services. MNCH counselling.

Some of the important protocols that revolve around the concept of 24/7 BHUs include the essential obstetric care principles and labor management. These protocols are observed to address the main complications of the delivery such as ante-partum hemorrhage, eclampsia, prolonged labor, uterine rupture, post-partum hemorrhage, management of vaginal and cervical tears and retained placenta. The protocols include the following:

  • Initial assessment, duration, use of a partograph.
  • Assessment of fetal well-being.
  • Episiotomy.
  • Special care for women who have undergone genital mutilation.
  • Use of vacuum extractor.
  • Management of hemorrhage management of eclampsia.
  • Issues related to multiple births.
  • Breech deliveries.
  • Referral to next level of care, if necessary.