HYDERABAD: Four doctors, a dispenser, a lady health visitor (LHV) and a midwife have been suspended, while explanation letters have been issued to seven hospital heads — including the medical superintendents of Liaquat University Hospital (LUH), Hyderabad, and Tando Allahyar district hospital, as well as the director of the Shahdadpur Institute of Medical Sciences.
The health department took the action on the directives of Chief Secretary Asif Hyder Shah, following lapses identified in the handling of anti-rabies vaccination cases that led to the deaths, within the last three weeks, of five people, including minors, even after reporting at the ARV units set up at health facilities. AR-related deaths were otherwise 38 this year till Aug, according to an official working on ARV units.
The victims included Shahnawaz, 48, a resident of Shahdadpur in Sanghar district; Shakeel Ahmed, 55, from Tando Allahyar; Farman, five, a resident of Kotri; Rayan Hussain, six, a resident of Hyderabad; and Ms Begum, 35, a resident of Tando Mohammad Khan.
“The purpose of this disciplinary action is, in fact, to find out the lapses in the system, despite the arrangements at the health facilities, so that these gaps can be covered. We are tracking each and every case of dog-bite mortality,” the chief secretary told Dawn over the phone on Tuesday evening, after a follow-up meeting of the Sindh Anti-Rabies Treatment Strengthening Programme.
Explanation sought from heads of seven hospitals; chief secretary orders audit, dashboard tracking and stricter protocols in Sindh’s 278 ARV units
According to an official dealing with Sindh-wide dog-bite case analyses, the chief secretary wanted to establish where things had gone wrong in the management of these cases. “The record of each victim was analysed to find out why mortality occurred when anti-rabies vaccine (ARV), along with rabies immunoglobulin (RIG), was administered to them,” he said.
The chief secretary’s office had begun monitoring cases after developing a system within the health department over the past several months. This included the creation of a dashboard to trace and track each ARV case, indicating the availability of vials at ARV units set up across Sindh in compliance with World Health Organisation (WHO) standards. These initiatives were taken after 22 dog-bite-related deaths last year.
Earlier inquiries had revealed that while ARV was being provided at 371 centres in hospitals, these did not meet WHO guidelines even at tertiary-level hospitals in Sindh. As a result, health department officials concerned were questioned and directed to streamline all matters pertaining to the ARV.
He said that, following detailed findings, 278 ARV units in Sindh now met WHO protocols for such cases. “It was observed during the investigations that if a patient was given the ARV, he or she was not administered RIG, or the wound went unnoticed — leading to mismanagement,” he said.
He said the 278 ARV units include 112 referral centres — one in each taluka — where round-the-clock duty of health staff has been ensured and RIG is administered. These centres were established at secondary healthcare facilities, since administering RIG requires technical staff to inject it into wounds.
For instance, a doctor said, the required protocol was not observed in the case of Rayan Hussain, six, at the LUH. “Rayan, victim of a dog bite, was first taken to Shah Bhitai Hospital in Latifabad, from where he was shifted to the LUH. In addition to the dog-bite wound, he had also suffered a head injury when he was attacked by the dog,” the doctor said.
“Protocol in a dog-bite case demands that every wound be washed. In Rayan’s case, his head injury was treated normally, and the wound was stitched at Bhitai hospital in violation of protocol. When he reached the LUH, he was treated at the Child Life Foundation facility within the hospital, where, again, the boy’s head wound was not re-examined or confirmed as an injury caused by the dog bite,” he said.
Rayan was later discharged, and no information was available on whether he had received the required ARV doses, even though the government’s dashboard had tracked his case.
Similarly, in the case of Ms Begum, she too had sustained a dog-bite wound on her thigh but was not treated accordingly, as the wound was near her private parts.
The ARV has now been included in the Monitoring and Evaluation (M&E) as well as the Provincial Disease Surveillance and Response Unit (PDSRU), which was not the case until recently. The M&E unit normally deals with disease outbreaks in Sindh, and its checklist now includes the ARV.
The purpose of including ARV cases within the domain of the M&E and PDSRU was to ensure that no single case went unnoticed. “This helps us track every case. A dashboard has been created where the ARV protocol schedule is monitored and the record of vials is kept under watch,” an official said. All five mortality cases were analysed, and the analysis revealed gaps in the handling of these cases.
Those suspended included Dr Naveedur Rehman and Dr Ghulam Azhar, medical officers posted in Tando Muhammad Khan district; Farzana Baloch, LHV; Shazia Khadim, midwife; and Dr Paras, medical officer at the Taluka Headquarters Hospital, Tando Ghulam Hyder, Tando Muhammad Khan district; Mohammad Arshad, dispenser at the Sindh Government Shah Bhitai Hospital, Latifabad; and Dr Arbaz Athar Ansari, medical officer at the Anti-Rabies Treatment Centre, Bhitai Hospital, Latifabad.
Explanations have been issued to LUH Medical Superintendent Dr Ershad Hussain Kazmi; Dr Sadiq Ali Khowaja, district health officer of Tando Muhammad Khan; Dr Bashir Ahmed Jamali, director of Shahdadpur Institute of Medical Sciences; Dr Mariyam Rukhsana, medical superintendent of District Headquarters Hospital, Tando Allahyar; Dr Barkat Ali Leghari, medical superintendent of Taluka Hospital, Kotri; Dr Arbaz Athar Ansari, medical officer incharge of the Anti-Rabies Centre at Shah Bhitai Hospital, Latifabad; and Dr Azhar Jagsi, incharge of Taluka Hospital, Tando Ghulam Hyder.
The follow-up meeting, chaired by the chief secretary, was informed that treatment capacity across Sindh had increased by nearly 30 per cent compared with the corresponding period last year. Around 45,000 dog-bite patients had been treated during the past eight months, while 138,000 doses of ARV and 5,000 doses of RIG were administered.
The chief secretary was told that all 278 ARV units had been audited to assess compliance with World Health Organisation (WHO) standards. He directed health authorities to regularly update the digital Anti-Rabies Dashboard to record dog-bite cases, monitor treatment schedules and manage vaccine stocks across the province.
He called for further strengthening of monitoring, and for involving the PDSRU in case-by-case investigations of identified treatment gaps. He also told deputy commissioners that future instances of mismanagement in anti-rabies cases would be treated as administrative failures, and would be reflected in the performance evaluations of the officers concerned.
Published in Dawn, September 9th, 2026.
