FeaturedNationalVOLUME 15 ISSUE # 15

Punjab health reforms

The Punjab government has introduced the Punjab Medical Teaching Institutes Act to reform the health sector. Doctors and paramedics have started protests against the initiative and the tussle is expected to intensify in coming days as doctors believe all hospitals will be privatised and their services would be deregularized, but the government claims it will bridge the administrative gap that is draining massive public resources but offering poor healthcare services to patients.

Health and police reforms top the Pakistan Tehreek-i-Insaf (PTI) manifesto. The provincial government has failed to reform the police but it has come up with a plan to revamp hospitals and medical teaching institutes after the party’s successful experience in Khyber Pakhtunkhwa province. It is a fact that hospitals badly need reforms because patients are not satisfied with the facilities. According to the Punjab government, it is spending Rs4.5m annually on each hospital bed in the teaching institutions and Rs3.5m on each bed in primary and secondary healthcare facilities. Despite spending the massive amount, no patient is satisfied with the performance of the doctors and hospitals. The health department has 49,000 beds at its healthcare facilities, with Rs230b non-development and Rs45b development budget.

Under the new law, the government has envisioned complete financial and administrative autonomy to medical teaching institutions and the audit of every employee’s performance. The government will nominate a board of governors (BoG) and a hospital committee that would ensure the availability of all training facilities in teaching hospitals. The teaching hospitals would be given one-line budget so that the BoG could ensure up-to-date facilities. The BoG’s performance would be audited by a third party thrice a year and a final financial audit by the accountant general and each institution’s performance audit report would be presented to the Punjab Assembly.

The chief minister would have powers to disband a BoG, if it does not perform at its optimum level. The employees of the health department will remain government servants but a medical institution would monitor whether they are performing well or not. The BoGs will also have powers to appoint administration officials to key slots and senior faculty members. The post of principal will be converted into dean, who would be appointed by the BoG for a period of five years. Every hospital will have a management committee, consisting of a hospital director, medical director, nursing and finance directors and two members nominated by the BoG. Headed by a dean, the management committee shall have powers to terminate any or all employees of the institution in accordance with the rules and regulations. “The civil servant status of all government employees shall stand abolished besides no role of the health department in the state-run medical teaching institutions. The employees would be given a choice to either continue work for the institution in private capacity under the MTI Ordinance. In case, they want to work as civil servants, their services will be placed on the disposal of the health department for further posting in any other state-run institution,” the ordinance says.

Under the new law, if a hospital needs a machine or equipment, it will have its own budget and can buy it within a day. Earlier, hospitals would request the secretary for any kind of equipment or budget and then after days or weeks of delay, the request was processed and the equipment was provided to the hospital, while patients suffered in the process.

The salary package of doctors and paramedics will be doubled and doctors would be allowed private practice in hospitals. However, doctors practicing outside the hospital will have to forego professional medical allowances from the salary package. The third party audit of hospitals will help improve their performance immensely. For example, when Peshawar’s leading and one of the biggest public hospitals, Lady Reading Hospital’s Cardiac Surgery ward was audited under the MTI Act, it found the mortality rate was 36pc. It meant one out of three patients died at the ward, which is against international standards. When the doctors were asked for an explanation, they complained of shortage of required equipment and supplies, which were provided to them. The law will also ensure the accountability of doctors, which is a new concept in Pakistan.

Rejecting the new law, the Young Doctors Association (YDA) and the Grand Health Alliance (GHA) have announced resisting its implementation at all levels. They say it is huge injustice to run public hospitals, established on taxpayers’ money, in a private manner. The government has stripped thousands of doctors, nurses, paramedics and allied health professionals of their civil servant status with a stroke of pen. The government has privatized the healthcare services, which will deprive poor patients of their basic right to health free of cost, they claim.

Fearing resistance from the opposition in the Punjab Assembly and protests from medics during the legislation process, the government had to implement the health reforms through an ordinance. As a precaution, the government banned political activities and gatherings in hospitals and educational institutions. The PTI government has recruited 14,000 doctors in the first year of its rule in the province, besides inducting 600 medical teachers, 1,100 consultants, 4,000 nurses, 5,000 paramedical staff and as many pharmacists. The government also plans to set up 12 new nursing colleges to meet the shortage of nurses.

Though the services of the doctors have not been deregularized, yet they can be sacked by the BOGs for poor performance. It is hoped the new law will improve the performance of the doctors and hospitals. It will be for the first time in Pakistan’s history that doctors could be held accountable for their negligence.