The country at large and the health sector in particular are facing one of the worst health-related crises currently in the face of the novel coronavirus pandemic. However, a series of dramatic occurrences at the health education scene have also attracted the attention of all concerned lately. The Pakistan Medical and Dental Council (PMDC), the statutory regulatory authority that oversees medical and dental colleges, medical education and professionals in the country, remained at the heart of some activities during the past six months. The body was dissolved about five months ago through a Presidential ordinance, and then restored by the Islamabad High Court on March 30, 2020. However, the issue is too large to be summed up in only a paragraph, hence some digging into the crisis and some further details.
Pakistan has produced great health professionals due to its medical colleges and universities, being run under the supervision of the PMDC. The professionals are not only running the national healthcare system successfully but also bringing name and fame to the country through their competence and services abroad. Even in developed countries, like the US, the UK, Germany etc., Pakistani medical professionals have their own standing, and they are recognised as competent professionals by the governments as well as people of the countries.
However, medical education and institutions have started becoming the centre stage of controversies, serious allegations, rifts and tussles for the last decade or so. Behind the scene, a tug-of-war amongst various players must have been going on for long, but the first surprising episode coming to the fore on October 20, 2019, was the dissolution of almost half-a-century old PMDC by the President of Pakistan through an ordinance, paving the way for the establishment of the proposed Pakistan Medical Commission (PMC).
The reaction from the medical fraternity, especially PMDC employees, was swift and strong. A writ petition was filed in the Islamabad High Court (IHC) against the action and discussions started on the social media, particularly Twitter and Facebook, and PMDC employees as well as Young Doctors Association (YDA) members started holding protest demonstrations in various cities of the country.
A member of the council believes that a deep conspiracy against the PMDC was hatched by vested interests, including the owners of private medical colleges in the country, to get rid of the council. He says fears were rife among medical professionals that the new body could give in to pressure from private medical universities, which make up a powerful lobby and agree to fee increases, which the PMDC had been opposing.
The PMDC has also been cracking down on medical colleges in the private sector which were not properly equipped with laboratories and other facilities. Therefore, he adds, owners of private colleges saw the PMDC as a big hurdle to the way of their money-making plans, and therefore, its dissolution had become crucial for them. He relates a specific incident of October 2019, the month the council was sent packing through an ordinance. “An unspecified number of representatives of private colleges met in Lahore to discus the idea of bringing in a new body to regulate medical colleges in Pakistan, and a personality from the United States participated in it through Skype,” he told Cutting Edge.
The meeting decided, in principle, that soon a new ordinance would be promulgated to place the PMDC under a new regulatory body for medical colleges. The new body would not have powers to decide about private medical colleges’ fee or faculty strength and the colleges would be free to set their own criterion of admission and every college would be allowed to choose the university of its choice, etc.
And only after a few weeks, the President of Pakistan signed the ordinance titled “Pakistan Medical Commission Ordinance, 2019.” The ordinance was aimed at regulating and controlling the medical profession by establishing uniform minimum standards of medical education and training and recognising qualifications in medicine and dentistry.
“The implementation of the new ordinance requires dissolution of the current PMDC. The government of Pakistan hence directed the temporary shutting down of the offices of the council,” an official order from the Ministry of National Health Services said. “The 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 a Secretariat of the Commission,” the notification said. Following the issuance of the ordinance on Sunday, the weekly day-off, the PMDC offices were shut down on the same day in a coup-like situation. The government said the move was aimed to ensure the safety and security of the council’s record.
PMDC Registrar Brig (retired) Dr Hafizuddin Ahmed Siddiqui, who was appointed in July last year for a term of three years, said that even he was not aware that the ministry had decided to take over the building. “I am very much concerned about the secrecy and protection of the record of the council. Moreover, I am also concerned about the future of 220 employees of the council as they earn bread and butter for their families from the institution and I suggest that employees should not be sacked,” he said.
However, Special Assistant to the Prime Minister on Health Dr Zafar Mirza termed the new ordinance the need of the hour. “The world has progressed but we are still following decades-old methods for our medical education. We need to liberalise our medical education and for it practices of other countries would be followed,” he told the media.
An influential health practitioner from Khyber Pakhtunkhwa also has a complete charge-sheet against the PMDC. In a telephonic talk with Cutting Edge, he vociferously rejected the charge that the council was dissolved on the pressure of private colleges. He said in fact the case was vice versa and the PMDC had been very lenient with a number of private colleges. “The colleges had been overcharging students under the nose of the council, and it took no action against them,” he alleged.
Requesting anonymity, he said that commercial interests of the PMDC led the body to recognise low-standard colleges without an attached teaching hospital or properly qualified staff and standardised laboratories. Reports of double shifts in private colleges to increase enrolment of students surfaced, but no action was taken against them at all, he alleged. However, all the blames and counter-blames aside, the PMC Ordinance was among 11 Presidential ordinances, which the government passed in the form of bills from the National Assembly in a controversial manner, amid ruckus by the opposition members on November 7, 2019.
Later, the bill was introduced in the Senate, and referred to the standing committee. Meanwhile, the Senate sub-committee on health met on August 9, 2019, and took serious notice of the interference of the College of Physicians & Surgeons Pakistan (CPSP) in the working of the PMDC. The committee held that the PMDC had been hijacked by the CPSP through its president, Dr Zafarullah Chaudhry, member from Khyber Pakhtunkhwa, Prof. Dr. Amer Bilal, and member on the seat of philanthropy, Ali Raza. Both members are close associates of National Health Task Force Chairman Dr. Nausherwan K. Burki, a cousin of Prime Minister Imran Khan.
Finally on August 26, the standing committee passed the bill. However, Pakistan People’s Party parliamentary leader Sherry Rehman, on August 29, tabled a resolution for the disapproval of the “PMDC Bill 2019” which was passed.
Meanwhile, The Islamabad High Court, after almost five months’ hearing of the case, ordered the federal government on March 30, 2020, to restore the PMDC immediately by opening its offices, and declared the formation of the Pakistan Medical Commission illegal. The court noted that the manner the PMDC was dissolved was illegal, and took note of the fears expressed by the petitioners that the new body could induct people into contractual positions, making it impossible for previous PMDC employees with years of experience to serve the council. The court stopped the PMC from registering new doctors and allowed PMDC Registrar Brig (retd) Dr Hafizuddin Ahmed Siddiqui to sit in his office. The court remarked that the registrar could approve the new registration of doctors which were still pending.
In a telephonic conversation with Cutting Edge on April 10, 2020, an official in the PMDC registrar office said that despite the court order, working could not be resumed fully at the council. Besides, because of the lockdown in the wake of the Covid-19 pandemic, the council was still to restore the database to its original form as the proposed PMC had taken it over earlier. He hoped that the council would be able to resume work soon.
However, it is hard to believe that the powers that have made so many efforts to get the PMDC dissolved will accept the court decision with an open heart and would not make another attempt to achieve their goals.