Of health reforms & woes of poor patients

PESHAWAR: Compared to the previous Pakistan Tehreek-e-Insaf (PTI) provincial government, the incumbent setup seems least bothered to resolve healthcare issues of the people in Khyber Pakhtunkhwa as the health reforms are yet to alleviate the suffering of the poor patients visiting the state-run hospitals.Though the desired results could not be achieved, health and education were the top priority of the Pervez Khattak-led previous PTI provincial government for which maximum funds were allocated.Under the much-trumpeted health reforms introduced through Khyber Pakhtunkhwa Medical Teaching Institution Reforms Act 2015, the government intended to replace old laws by implementing administrative changes in the tertiary care hospitals and medical and dental colleges.A number of new positions were created in the public sector and for the first time in KP doctors and support staff were employed with handsome salary packages.The nomenclature of certain administrative positions was changed. Medical director replaced chief executive and medical superintendent was renamed as hospital director in the teaching hospitals while principal of a medical college is now called dean.In the previous system, a doctor holding administrative position was paid less than Rs130,000 for delivering the same services for which the government is now paying Rs500,000.Dozens of managers and supervisors were employed under the new system and none of them is being paid less than Rs100,000.The prime purpose of the reforms was stated to be providing benefits to the patients and hiring people on merit.Another basic purpose of the reforms was discouraging political interference in these institutions and discouraging their influence in recruitment, particularly in hiring technical staff.The Supreme Court of Pakistan had taken notice of the alleged anomalies and formed a high-level inquiry committee that unearthed massive irregularities in all appointments of key positions including medical and hospital directors and deans.A committee of serving government officials after investigating the issue declared all the appointments as illegal. It termed the hiring process as dubious, partial and against the principles of merit and transparency.The chief secretary had formed the committee having special secretary health, additional secretary finance, additional secretary establishment and chief executive officer of the Post-Graduate Medical Institute (PGMI) as its members.The committee submitted its report but not a single officer was removed from any position.The government rather victimised senior civil servants who implemented orders of the Supreme Court of Pakistan.After implementation of the health reforms in 2015, every institution has formed regulations to better suit their interests.Except the Lady Reading Hospital (LRH), where Dr Nausherwan Burki is chairman of the board of governors (BoG), none of the institutions implemented MTI law in letter and spirit.The board of governors is to give policy to these institutions and oversee the affairs. Many members of the BoGs usually stay overseas and have limited knowledge of their respective institutions. Chairperson of the board is considered to be the real ‘ruler’ of the institution. Critics said the selection of the board chairman in many cases is made on “unannounced written” advice of the government and the appointment is mostly politically-motivated. There is no uniformity in the MTI laws. Every board, dean, medical director and hospital director managed to frame regulations to secure their strength and better serve their interest.Also, every institution has set its own working timings. In LRH, all employees are required to work from 8am to 4pm, though it is not followed by a maximum number of staff.In the rest of the institutions, the staff members are supposed to serve from 8am to 2pm.Except LRH, none of the MTIs have been able to strictly follow the Institution-Based Private Practice (IBP). In the new system, IBP was mandatory for all the newly-appointed doctors. Only LRH has followed this policy and is paying extra salary, though some of the doctors don’t honour their commitment and continue to practice outside the institution.Recently, the LRH administration implemented a strict order to force doctors to follow IBP, but in the past four years it had failed to fulfil the basic requirements of the doctors and patients there.Also, the LRH administration has given a free hand to the IBP doctors to charge patients.It is the only hospital where doctors in IBP are charging their patients high consultation fee. Dr Suleman Khan, assistant professor now made medical director, used to charge Rs2,500 as consultation fee. The BoG chairman reportedly asked him to reduce it up to Rs2,000, still the highest in all the public sector hospitals. In Khyber Teaching Hospital (KTH), IBP has not been started yet but still the proposed consultation fee (Rs600) is the lowest in the province.IBP was also mandatory for the dean and medical director but in some places, people who are mostly surgeons occupying these key positions are yet to start IBP.US-based Dr Nausherwan Burki is the architect of health reforms and is known for his commitment to his work. However, his reforms are yet to be fully implemented to benefit then patients. He would have to bring uniformity in laws of all the institutions and stop political interference to make an impact.

from The News International - Peshawar https://ift.tt/2U7C6r8