In the previous issues of Cutting Edge (April 16-30, 2021), the higher education crisis in the country and groupings in the sector’s regulatory body, the Higher Education Commission of Pakistan (HECP), were discussed. Regrettably, the crisis is also afflicting one of the most important professional fields of Pakistan, medical education and the healthcare delivery system.
A long-drawn tussle among different centres of power in medical education as well as the healthcare profession in the country resulted in the dissolution of the over 50-year-old regulatory body, Pakistan Medical and Dental Council (PMDC), in 2019. President Dr. Arif Alvi promulgated an ordinance in October 2019, dissolving the PMDC and paving the way for the establishment of a new body, Pakistan Medial Commission (PMC). The ordinance, titled “PMDC Ordinance 2019”, suggested that a 17-member council would deal with the issues related to medical colleges, attached hospitals and health professionals.
The Ministry of National Health Services (NHS) released a press statement, saying that an ordinance had been signed by the President. “Implementation of the new ordinance requires the dissolution of the current PMDC. (The newly established regulatory body) PMC shall be a body corporate consisting of: (1) The Medical and Dental Council; (2) The National Medical and Dental Academic Board; and (3) The National Medical Authority, which will act as the Secretariat of the Commission,” the statement added.
The move was severely criticised by doctors’ representative body, Pakistan Medical Association (PMA), which termed the decision undemocratic and detrimental to medical education and the healthcare delivery system. “The government should have tabled a bill in the Parliament so that all stakeholders would have given their input. If it was necessary to promulgate an ordinance, the government should have abolished the PMDC 1962 Ordinance, as the new ordinance is also in violation of the 1962 ordinance, which states that the Council shall be established through elected representatives from the medical fraternity,” a news release issued by the body said.
There is no denying the fact that the PMDC had been facing a number of issues during the past two decades. The proliferation of medical colleges and universities (run like businesses), from 34 to about 144, dangerously compromised the quality of medical graduates. The PMA alleged in an earlier statement that the PMDC had been taken over by vested interest groups, and dozens of medical institutions of compromised quality opened all over the country in a short span of time.
In 2015, the Supreme Court of Pakistan intervened as a result of a petition filed by the PMA to rectify the situation, and an ordinance was introduced by the then President Mamnoon Hussain, dissolving the Pakistan Medical and Dental Council and ordering new elections for its new office holders. After the PMDC elections, a 35-member executive body was elected to manage the PMDC. The ordinance was passed by the National Assembly, but deferred by the Senate to the Council of Common Interests. Later, on another petition, the apex court dissolved the executive body on January 12, 2018, and appointed a nine-member ad hoc council to run the affairs of the PMDC.
However, the issues could not be resolved and the medical education and health delivery system kept suffering at the hands of vested interests in the sector. In a telephonic conversation, an official of the PMA in Lahore expressed his dismay over the current situation in medical education as well as the health system. He regretted that medical education and health centres had been converted into a thriving business in the country and government authorities appeared least interested in regulating the sector.
He said, “In the near past, we have seen a price tag to get a licence to open a medical college. We have 144 medical colleges in our country. Do we have 144 professors or associate/ assistant professors for each subject, as per the guidelines of the dissolved PMDC,” he questioned. He said that the country was churning out more than 15,000 doctors a year. “But how many of them are competent? There is a severe compromise on quality,” he claimed.
The PMA representative believes that there should be one body in the country to regulate medical education. “If there are some faults with the body, they should be removed. We demand the government consult the provincial governments and all other stakeholders to run the regulatory body effectively. If the government’s attitude does not change, then it will be a disaster and the provinces would have their own bodies, like higher education commissions of the provinces,” he explains.
Deteriorating medical education standards are not a matter of concern for the PMA only, but also for medical academia, who have nothing to do with politics. Prof. Nasreen Javaid, former professor of pharmacology, Fatima Jinnah Medical University, Lahore, believes that the standard of present-day doctors has gone down in all aspects, like ability, efficiency, knowledge and human values, etc.
In a talk with Cutting Edge, she regretted that with the passage of time, there had been deterioration in our society; and many vices gradually crept into the medical profession, including dishonesty, greed, selfishness, callousness, and lack of commitment. Giving reasons, she said that a major factor was the establishment of private medical colleges and their mushrooming growth. “The colleges charge a very high fee; so those, who can afford but do not have merit for admission to government medical colleges, get admission there. The colleges offer very lucrative salaries to their staff. Teachers of government medical colleges join them; some take leave, others leave before retirement, when their abilities are at their peak. The result is government colleges lose their experienced and capable teachers, creating shortages of staff. Sometimes, a demonstrator, with hardly any teaching and administrative experience, becomes the head of a department. Consequently, teaching and clinical training suffer badly,” she added.
Prof. Nasreen Javaid is also critical of medical teachers’ role. “Discipline is difficult to maintain as most teachers have come for a higher salary, and they lack dedication. If another private medical college offers more salary, they go for it. The syllabus remains unfinished, as it may take time to get their replacement. The hospitals attached to the colleges mostly do not fulfil the requirements as the number of beds, departments, and equipment, etc.,” believes the professor.
The FJMU former teacher says another major issue is the formation of larger groups for clinical and practical training in hospitals. “The student-teacher ratio does not meet the requirement, and students’ knowledge remains mainly theoretical, and not practical.” She also finds the process of admission to medical college faulty. She believes that the entry test is not enough, and there should be a proper interview by experts of various fields, including a psychologist, and they should try to judge whether the student has the ability, interest, temperament and capacity to work hard to study and practice medicine or not.
However, the Pakistan Medical Commission believes all issues related to the medical academia and healthcare system would be streamlined soon, with the dissolution of the politics-afflicted PMDC and the formation of a new neutral body as the first step. In a telephonic talk with Cutting Edge, a spokesperson for the Pakistan Medical Commission, said a number of reforms had been made for the betterment of medical education.
Not disclosing his name, he told this writer that 43,198 licences of doctors and dentists had been renewed, 6,685 new licences issued and 1,986 applications for the registration of postgraduate clinical qualification processed during the last eight months. He said that 3,876 foreign medical students were granted a provisional licence to practise and 1,699 foreign medical students were granted a full licence to practise in Pakistan.
Since the establishment of the PMC in September last year, it directed the private medical institutions to disclose their entire fee structure for the programme prior to admissions. The PMC enhanced 550 seats in the public sector medical colleges and introduced a policy for foreign medical graduates to get a licence to practise in Pakistan. He said that an online portal had been introduced through which stakeholders could access services. The National Medical Scholarship Fund has been established for deserving students with an initial commitment of Rs250 million, he added.
He said the National Assembly Standing Committee on NHS had also sought suggestions from the opposition members for the “The Federal Medical Teaching Institute Bill 2020,” so that it would sail through the parliament without any hurdle. He believes that within a few months, various chronic issues causing troubles in medical education as well as the healthcare delivery system would be sorted out amicably.