Battle for an accountable health system goes on in KP

Islamabad: Chief Justice of Pakistan (CJP) Mian Saqib Nisar’s on-the-spot checking of different institutions around the country, especially in places like mental hospitals, is an eye-opener for many.

It appears no official has ever bothered to visit these hospitals where inmates are being treated worse than animals. Recently, after the CJP’s visit to Khyber Pakhtunkhwa, he made some very pertinent observations about the health system and appeared generally satisfied on many issues, including present arrangements at the Lady Reading Hospital (LRH).

One issue that he raised was that since the public wanted more gates to be operative which had been shut for security concerns, the same should be opened immediately. Later, PTI Chairman Imran Khan held a press conference with his Health Planner in Chief Dr Burki to defend work in the area of medical reforms carried out these past few years.

Imran Khan and Dr Burki face resistance from within the PTI government where reforms are being opposed for different reasons. The battle in the health system in the province is one where changes on the pattern of international health patters like that being followed by Shaukat Khanum Hospital are being implemented. But these are being resisted tooth and nail by those who feel more comfortable with the earlier system where there was no accountability.

Others like Dr Jawad Wasif, President of Insaf Doctors Forum (IDF), traveled to Rawalpindi to speak to The News, and highlighted issues they feel that the Chief Justice should be made aware of. Wasif says as politicians and bureaucrats in Khyber Pakhtunkhwa continue to fight change, like at the Lady Reading Hospital, so it is important also to hear the other side that they represent.

There is no ‘sifarish’ as far as LRH is concerned say doctors there and this has frustrated many, especially politicians, since ‘bhartis’, a lifeline for them cannot be done. “IDF is the wing affiliated with PTI and was established in 2008. Our work is based on welfare activities and working on health policy with the party as a technical and professional wing. It has its cabinets in Punjab, KP, Sindh, Azad Kashmir, Islamabad and the UK. After the PTI came into government, its supportive doctors formed IDF”, says Wasif.

The presentations of LRH, KTH and HMC to the CJ went very well say the doctors and were duly appreciated by the CJ. ”However, we want to put the record straight that the anti-Burki/anti-MTI lobby are against the modern MTI system of autonomy and corporate management with accountability of all employees whether doctors( senior or junior), nurses and paramedics with proper RFID documentation of their attendance, their performance as measured by international parameters like morbidity, mortality, waiting lists etc”, points out Wasif.

The opposition to Burki wants to revert to the old obsolete system of administration of having an administrator appointed by and answerable to bureaucracy, with general cadre doctors instead of professional managers running the hospital who dare not question anyone especially senior faculty about anything.

“Now even senior professors have their attendance marked, and their performance audited. Previously, it was unthinkable to question these uncrowned kings over anything”, adds Wasif. Both politicians and bureaucracy, led by secretary health, want to revert to the old system where they had clout, patronage and influence which they are totally denied in the new system.

“Politicians cannot oblige in recruitments which they thrive on and consider their divine right. Bureaucrats do not have any clout in the hospital. The secretary health has been quoted as saying in the new system all the district hospitals are with DG Health and all the teaching hospitals are autonomous MTIs, then what am I the Secretary of?” said the doctor.

He adds that the IDF has taken a firm stand against the mafias in the hospitals and has supported Dr Burki in bringing modern MTI system through which the powers has been devolved to autonomous board of governors as per vision of PTI chairman Imran khan.

“Before 2013 elections and before MTI law’s introduction, the hospitals remained in the bureaucratic control where no evaluation and monitoring mechanism exist. Political interference was rampant and activists of political parties held administrative positions”, the doctor points out.

Dr. Nausherwan Burki is a Pulmonary Disease Specialist in Farmington, Connecticut, USA, who spearheaded construction of Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) in Lahore and Peshawar.

“Initially, Dr Burki and PTI government faced a lot of resistance from different sectors, while bringing change to the health sector, especially from the doctors who had been stopped from doing private practices. They were against any change and moving courts”, Wasif tells The News.

Doctors have also moved court against the new reforms and court rulings have slowed down the implementation process, but never the less, the government went ahead and increases its health budget from Rs30 billion to Rs80 billion.

At present, say these doctors, the objectives of IDF are to struggle for the implementation of an improved, efficient and effective health delivery system with special focus upon the poor population and to promote Health Education.

“IDF played a pivotal role in implementation of service structure for doctors in KP. IDF also launched medical camps in far areas of KP to give health services to poor people. IDF is also playing a key role in implementation of MTI act and strongly supporting this act. We have also got the support of a lot of doctors and especially Imran khan and PTI”, he adds.