Healthcare reform in KP

There are protests once again against the Pakhtunkhwa Medical Teaching Institute (MTI) reform act. The excuse this time is the dissolution of the Post Graduate Medical Institute (PGMI). A small group of physicians has joined hands with the ancillary staff of the hospitals to take yet another stand against reforms.

The KP Assembly passed the MTI act unanimously early last year. The act gave autonomous status to major hospitals under independent boards of governors. Employees were given a choice of becoming employees of the MTIs or continuing as civil servants. Other changes were also introduced – such as new administrative structures and introduction of institution based private practices.

The act alarmed some people; if they remained ‘civil servants’, the institutions could return their services to the government saying they were no longer needed. On the other hand if they opted for the MTI, they would come under the discipline and rules of the MTI itself, jeopardising the hitherto prevalent culture of rights without responsibility. They, therefore, took the matter to the court. The Peshawar High Court stayed implementation of the law.

The government felt frustrated and tried for an out-of-court settlement. However, the court decided in favour of the law. The decision also declared any bargaining between the government and litigants null and void. It also reaffirmed its previous judgements calling healthcare ‘essential services’.

The high court judgement, which in a way expressed the public’s mood against the physicians and the healthcare system, boosted the architects of the reforms. Implementation began at once. In an unprecedented move, a number of deputy medical superintendents were sent back to the government. New managers were hired. Guidelines regarding punctuality and work were issued. It has been a pleasant surprise for many to see the consultants running the out patient clinics or OPD from 8am till 4:30pm.

Another step taken was the dissolution of the PGMI, which was founded in the early 1980s in the particular circumstances of the time. It has since long been past its use by date. Its only significant role has been assigning trainee medical officers (TMOs) to various clinical units and disbursing their stipends.

Unlike elsewhere, where the selection and training of TMOs is a collaborative effort, there was essentially no role of the supervising physicians or departments in the selection of the trainees. Any disciplinary action had to be taken by the PGMI only and not the training facility. This created confusion and a culture where violation of rules and discipline by trainees has been easy to get away with.

The reforms seek to encourage discipline and rules. Therefore, the PGMI was disbanded. In its place, each MTI is to have its own department of graduate medical education. Rather than welcoming the change, some junior doctors have been agitating against it. It seems they want to be trained – but on their own terms and conditions!

Opposition to these reforms can be summarised in three words: fear of accountability. For far too long, the pervasive culture has been of lack of responsibility. There has been little, if any, discipline. They are now afraid that if a system of accountability is set in place, there will be consequences for their actions, negligence and malpractices.

We have heard a number of excuses in opposition to reforms. The most frequent has been that the current compensation structure does not justify a full shift of work. It is true that the compensation has been inadequate for the physicians and needs to be looked at seriously. However, nobody forces them to work in public sector hospitals. They have the option to quit and devote themselves entirely to private hospitals or practices.

The arguments of a few junior doctors against the dissolution of the PGMI are not valid either. Their concern should be getting quality training. The College of Physicians and Surgeons of Pakistan sets the standards of training. It is then for the management of the hospitals to ensure that those standards are met.

The supervising faculty and institution should have a full role in the selection of physicians for training. The selection, like everywhere else, should be made based not only on entrance examinations but other factors such as aptitude and professionalism. The training should comprise medical education as well as ethics and character building.

The role of political parties during this debate on health reform has been disappointing. If they have better ideas, they should come out with them. Healthcare should be spared the usual opposition for the sake of opposition. Let us, for a change, treat meaningful healthcare reform as a consensus national issue.

Perhaps a good start would be an unequivocal joint declaration by all parties stating that government employees should not join political parties or their various wings. Further, if healthcare is not an essential service, what is? Are political parties giving a message to the people that healthcare is a choice and not a necessity? The government should stand firm and not cave in. If these reforms take root, they will be its best legacy ever.

The writer is the former president of the Association of Pakistani Cardiologists of North America. Email: a.rehan@me.com