Healthcare devolution

A lot is said against the 18th Amendment. However, when asked what is wrong with it no response with substance can be gathered.

I would like to highlight what has been achieved through the 18th Amendment using the devolution of health as a case study, in particular the Jinnah Postgraduate Medical Centre (JPMC) which is one of the leading tertiary care facilities of Pakistan.

The catchment areas of JPMC are not just Karachi but also include patients coming from different districts of Sindh, Balochistan, Punjab, Khyber Pakhtunkhwa, Azad Kashmir and Gilgit-Baltistan. A perusal of data reveals that patients have travelled from 163 cities of Pakistan and 15 countries to avail the facilities offered free of charge, irrespective of nationality, religion or ethnicity, which are otherwise beyond the reach of a regular citizen.

Since its inception, JPMC remained with the federal government and, till its transfer to the government of Sindh in 2011, no additional investment was made to enhance or improve its infrastructure especially after the shifting of the capital from Karachi. However, after its control was assumed by the government of Sindh, its bed capacity has been increased from 1100 to 2200 beds. Its budget was Rs1300 million in 2011; today it stands at Rs4900 million.

To enhance the participatory system of governance, a robust public-private model has been introduced at JPMC which is the best model of Public Private Partnership, with the civil society collaborating with the government to introduce cutting-edge technology for citizens. Cyberknife and Tomotherapy, which offer curative treatment of cancer, are one example. They are not offered free of charge anywhere else on the planet and their charges vary from $50,000 to $90,000 which is certainly beyond the reach of most people. However, this state-of-the-art facility is being provided free of cost thanks to the public private partnership of the government of Sindh and the Patients Aid Foundation (PAF).

Another facility arranged and running in collaboration with the PAF since 2017 is PET-CT and cyclotron for the management of cancer. To date, no other province has such a free facility. More than 15000 PET CT scans have been done so far.

Recently, the government of Sindh, in collaboration with the Patients Aid Foundation, completed a nine-storeyed state-of-the-art new OPD and Surgical Complex at JPMC. This OPD has the capacity to serve 4500 patients daily and has a 550-bed inpatient facility with a dedicated 28-bed SICU. Millions of surgical patients/citizens of Karachi will benefit in the coming decades through this intervention.

All departments of JPMC – including surgical units and its allied specialties like orthopedics, gynae obstetrics, urology, neurosurgery, thoracic surgery, faciomaxillary, ENT, anesthesia, radiologyCT / MRI Doppler etc and all medical units and their allied specialties, pulmonology, neurology, nephrology/dialysis, gastroenterology, psychiatry & behavioral sciences, physiotherapy, occupational therapy,bBlood bank, clinical lab – are also offering exemplary services, and managing millions of patients.

The Accidents and Emergency department at JPMC is one of the largest and busiest emergencies of the country that offers services to millions of patients free of charge. Facilities related to Covid-19 including PCR lab, critical care for Covid and 24/7 vaccination facilities are also playing a due role in meeting the needs of the patient.

This year, the Department of Neuromedicine & Stroke Unit and Department of Psychiatry & Behavioral Sciences will also become operational which will benefit almost 1000-1500 patients daily in their OPDs with admissions to 180 patients of neurological and psychiatric illnesses.

JPMC has grown over the years into an institution that all of us should be proud of. However, instead of championing the cause of health, a tug of war has unfortunately erupted between the government of Sindh and the federal government as a result of a court judgment nullifying the devolution of JPMC to the province.

Though even after the court judgment the federal government has not contributed a single penny in looking after the hospital or its employees or infrastructure development, the government of Sindh, keeping the interest of poor patients paramount, has continued to inject billions every year, which even as per the court judgment the federal government has to repay. In any civilised nation, institutions and citizens champion the cause of success stories and facilitate their further growth, but unfortunately in Pakistan we subject such successes to unnecessary controversies.

Because of the controversy, the employees are not clear about their future and the institution is also unable to hire more doctors and paramedical staff because no one knows what the fate of this hospital will be. It will be in the best interest of the hospital and the hundreds and thousands of patients that the federal government resolves the issue and hands the hospital over to the government of Sindh so that there can be continuity in the development of the institution.

As a citizen, I would like to pay my sincere compliments to the government of Sindh, the Patients Aid Foundation and the team at JPMC who all have contributed to making JPMC an institution that all of us should be proud of. It is time we valued and cherished such success stories which give us hope that, yes, things are possible. Enough of the negativities and the impossibilities. Lastly, all of this would not have been possible without the 18th Amendment which paved the way for the growth and development of JPMC.

The writer is adviser to CM Sindh, and Administrator Karachi.