Pak healthcare system in crisis

ISLAMABAD: A medical college was illegally built on a church property seven years ago. It’s been annually enrolling hundreds of students for medical studies. The college administration still continues to expand its operations. But perusal of its official record showed that institution was built on an encroached church property which, as per a superior court’s order that the college has had no right to construct its building.

“It [college] was a case of fraud,” revealed a special report prepared by a commission formed by the Islamabad High Court (IHC) to investigate the Pakistan Medical and Dental Council’s (PMDC) issues in 2014. This PMDC was dissolved by the country’s top court on January 12, 2018.

Hashmat Medical and Dental College Gujrat, which never responded queries despite reminders sent to its administration by this correspondent, is one of around three dozen medical institutions where allegedly rampant fraud, cheating, dubious documentation, illegal registration, etc. alarmingly left Pakistan’s healthcare system in serious crisis. Implications of this apparently broken medical-education system are being felt from Karachi to Peshawar and even abroad.

Future of over 5,000 medical students was at stake. More than three dozen medical and dental colleges, which perhaps did not qualify for No Objection Certificates (NoC), were operating under the nose of now a dissolved statutory regulatory authority — PMDC that maintains an official register of medical institutions/practitioners.

Official document and report of the commission Geo News have had accessed to, revealed that 19 medical and dental colleges, despite PMDC’s public warning, gave admission to around 4,000 fresh students in 2015 to 2017. As many as 15 medical institutions did not fulfill even basic criterion of PMDC but they got registration in past eight years. Around 4,500 medical students were studying in these colleges. The cases of around a dozen colleges were still pending with different courts. Currently, around 156 medical, dental and medicine colleges were registered with the PMDC. Some 55 institutions are from public sector while 101 are from private sector. As many as 30 public and private health sector universities and 37 postgraduate health institutes are operating in the country. Some 22 medical institutions started working in past three years. Pakistan is among top five countries competing for a place in the global strategy. India leads with 450 colleges, followed by Brazil with 259, China with 187 colleges, US with 186 and Pakistan is in fifth place with 156 colleges, officials associated with this field said. Currently, Pakistan alone requires 0.5 million doctors and has only got 168,491 registered doctors and out of these only 40,167 were specialists and even out of these, 25,000 are working abroad. Around 15,217 dentists are practicing accordingly. Pakistan requires 0.5 million hospital beds and has only got approximately 0.1 million beds currently and even out ofthese hospital beds, 80 percent is being provided by private medical and dental colleges.

Some 20 medical institutions asked to stop admission processing but they never followed PMDC order. These were named as Avicenna Medical College (Dental Station Lahore), HBS Medical and Dental College (Dental Section) Islamabad, Wapda Medical College Lahore, Al-Aleem Medical College Lahore, Hashmat Medical and Dental College Gujrat, Niazi Medical and Dental College Sargodha, CMH Kharian Medical College Kharian, Bilawal Medical College for Boys Jamshoro, HITEC Institute of Medical Science (Dental College) Taxila Cantt, Abwa Medical College, Faisalabad, Swat Medical College Malakand and Dental College Matta Swat, Muhammad Medical College (Dental College) Mirpurkhas, Shahida Islam Medical Complex (Dental College) Lodhran, Abu Umara Medical and Dental College, Lahore, Bahawalpur Medical and Dental College, Bahawalpur, Watim Medical College Rawalpindi, Cantonment Board Institute of Medical Sciences (Dental College) Peshawar, Rashid Latif Dental College Lahore and Jehlum Medical College Jehlum, revealed the commission report prepared by Dr Syed Fazle Hadi, Dr Sania Nishtar and Ejaz Rahim.

It further revealed that PMDC illegally recommended Ziauddin Medical College of Dr Asim Hussain for 150 seats. Forgery in inspection was noted by the audit team where signatures of two inspectors were declared as suspect and doubtful, revealed the report. Rawal Institute of Health Sciences, Islamabad had “defective ownership record and there is no record of university affiliation showing a glaring case of misuse of inspectors’ powers.” Its matter is still under litigation, report continued to reveal. Aziz Fatima Medical and Dental College, Faisalabad had “no university affiliation record, no nursing college and no daycare center.

It did not meet land requirement and leased and with unregistered deed in contravention of ownership provision criteria.” Nafees Medical College, Islamabad met financial irregularities in a report recorded in April 2013. No endowment fund (yet 37 marks given), evidence of fabrication in part VII of Audit observation.

Total marks were actually 554 but inflated to 828 (750 are minimum requirement). No faculty proof or details available (but marks: 58 for physiology department, 35 for pathology). Pakistan Red Crescent Medical and Dental College Lahore has no faculty facilities yet (but 15 marks awarded), no hospital facilities, only 250 marks in all yet inspection team recommended training for 100 MBBS students. Case of Rahber Medical and Dental College, Lahore was still under litigation, Amina Inayat Medical College, Lahore has no lab, no endowment, no working record and no hospital bed facilities but allowed training to 100 MBBS students although 669 marks as against minimum of 750 marks required. Muhammad Bin Qasim Medical and Dental College, Karachi had no land ownership record, 422 marks obtained, not recommended, only two faculty members and no endowment fund record but recognised. Pakistan Medical College/Ali Tibri Medical College had no endowment fund or working capital. In pathology department deficiency of nine faculty and only two assistant professors were available.

For anatomy, only non-medical PhDs available and surgery pediatrics deficient and RHC, based hospital, was not purposefully built and having a very difficult approach. Yet, it was registered. Al Razi Medical College, Peshawar issue is in litigation and there was a complaint against owner of Islamabad Medical and Dental College as donation worth Rs1 million was being extracted from each student.

This was not investigated and faculty was missing but PMDC had allowed its recognition in 2009. Registration of Healer Educational Society was not available and till June 2012. Abbottabad International Medical College and Jinnah Medical College, Peshawar were asked by the council to close operation but they are still operating.

The committee gave 705/750 marks on Dec 2011 to MBBS Medical College, Mirpur but 50 students admission recommended and later council raised it further to 100 admissions after a few weeks. Record of Rashid Latif Medical College Lahore showed no legal registered lease documents violating Ch IV, CI. 17 of 2009 regulation (ownership or 33 years lease).

Inspection teams’ reports, according to commission report, revealed that rented building of Yusra Medical and Dental College, Islamabad has no space to develop pharmacology, psychology, community medicine and forensic medicine and not recommended by inspection team but the then PMDC head Dr Asim Hussain illegally approved the college for recognition.

Executive Development Center of Gandhara University Peshawar introduced Masters in Public Health without PMDC’s recognition. No action was taken by PMDC management which despite several reminders did not respond to Geo News. No representatives of said colleges talked to this correspondent despite repeated requests as according to them the case was being taken by the apex court.

Some 11 private colleges failed consistently to comply with 150 bedded hospital requirements, yet students were allowed to be registered by PMDC. These colleges are: Women Medical College, Peshawar Medical College, Yusra medical College, Muhammad Medical College Mirpurkhas, Mohidduin Islamic Medical College, Continental Medical College, Central Park Medical College, Multan Medical and Dental College, Jinnah Medical College Peshawar.

Dr Sania Nishtar says report’s recommendations were never implemented. “Really Pakistan medical system seems in crisis,” she observed adding that the PMDC suffered from one of the worst forms of regulatory capture in recent history. “Our committee noted with concern the allegations of corruption. Since we do not have the capacity to conduct financial forensic investigations, the council should develop appropriate mechanisms to investigate and engage appropriate authorities.”