n the desert belt of Sindh, where scattered settlements, long travel distances and weak road connectivity shape everyday life, access to timely emergency healthcare remains one of the greatest challenges, particularly for pregnant women facing complications during childbirth.

For thousands of families living across Chachro taluka, Dahli and bordering villages of Umerkot district, the rural health centre (RHC) at Kheensar, is more than just a healthcare facility. It is often the only accessible source of medical care in a vast and underserved desert region.

A recent visit to Tharparkar revealed that the facility is well-managed, functional and trusted by surrounding communities. Despite its remote location, the RHC provides a broad range of essential primary healthcare services, including outpatient care, maternal and child healthcare, immunisation, laboratory services and dental care. The facility also has portable X-ray and autoclave services.

The community’s growing reliance on the facility reflects both its operational strength and the lack of quality healthcare options in the surrounding areas. Although other health facilities exist nearby, people continue to travel long distances to RHC Kheensar due to the better quality of care, functional services and availability of staff.

RHC Kheensar manages 4,000-4,500 outpatient visits daily. It also manages 80-85 normal deliveries every month. Patients come not only from nearby villages but also from some remote settlements, including Mehndre Jo Par and Khokhrapar.

Despite these strengths, a critical, life-saving service remains unavailable: emergency cesarean section (C-section) care.

For pregnant women experiencing obstructed labour, haemorrhage, fetal distress or other obstetric complications, the absence of surgical obstetric services can quickly become a matter of life and death.

Currently, all complicated delivery cases requiring C-sections are referred to Umerkot, 85 kilometres away. 10-15 women every month must undertake this difficult referral journey.

In a desert environment marked by poor roads, limited transportation, extreme weather and poverty, such delays can prove fatal. Every hour lost during emergency labour increases the risk of maternal and newborn complications. For many families, the journey becomes a race against time.

Kishore Meghwar, a local citizen, described the situation with deep concern. “the government has done an excellent job by bringing essential healthcare services to this desert area. This is why so many people depend on this facility. But when a woman requires a C-section, there is no facility here, not even in Chachro taluka. Families are then forced to travel nearly 85 kilometres to Umerkot. In such situations, we face a triple burden: the risk to the lives of mother and child, severe financial pressure and psychological stress.”

In Sindh’s desert belt, where poverty, climate vulnerability, geographic isolation and weak infrastructure continue to intersect, the absence of emergency maternal care is not simply a service gap; it is a survival risk carried by women and families.

Beyond the immediate medical risks, these referrals impose an overwhelming financial and emotional burden on already vulnerable households. Families are often forced to arrange costly private transport on short notice, manage fuel expenses and incur additional costs for attendants, food and temporary accommodation in Umerkot.

For low-income families and daily wage earners, such emergencies can push households deeper into poverty.

The absence of emergency obstetric services at RHC Kheensar stands in sharp contrast to progress made elsewhere in Tharparkar. During discussions with the facility staff, it was highlighted that PPHI Sindh has already demonstrated that expanding emergency maternal healthcare in remote desert settings is both feasible and impactful through the establishment of C-section services at RHC Islamkot.

Establishing C-section services at RHC Kheensar will not only benefit local communities but could also strengthen the referral network across the desert region. Nearby health facilities that currently lack surgical obstetric services will then be able to refer complicated delivery cases to RHC Kheensar instead of sending all such patients to distant hospitals in Umerkot. This will significantly reduce referral time, improve emergency response and improve the chances of survival for mothers and newborns.

The situation at RHC Kheensar highlights a systemic challenge in rural healthcare delivery: while primary healthcare access has improved in many remote regions, life-saving emergency maternal services remain unevenly distributed.

Strengthening RHC Kheensar with comprehensive emergency obstetric and newborn care, including C-section capability, surgical staff, anaesthesia services, blood storage support and functional referral transport could dramatically improve maternal and neonatal outcomes across this underserved desert region.

This investment will not only save lives but also reduce preventable suffering, lower catastrophic healthcare expenditures for poor families and promote greater health equity for marginalised rural populations.

In Sindh’s desert belt, where poverty, climate vulnerability, geographic isolation and weak infrastructure continue to intersect, the absence of emergency maternal care is not simply a service gap; it is a daily survival risk carried by women and families.

The author, a gender and development professional and an advocate for women’s empowerment can be reached at [email protected]