Political parties should stop playing politics with Health & Medical Education in the country

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Political parties should stop playing
politics with Health & Medical
Education in the country
Preference to prevention of diseases, free availability
of all essential drugs at public hospitals and no
privatization of public healthcare facilities 
under any pretext should be the cornerstone
of any National Health Plan

From our correspondent

ISLAMABAD: Previously it was Pakistan People’s Party and Pakistan Muslim League (N) which had failed to resolve their differences as regards Health services and medical education in the country and now Pakistan Tahreek-e-Insaf has also joined this group. All these major political parties continue to play politics thereby destroying the healthcare as well as medical education in the country. Entry test for admission to the medical and dental colleges remain controversial, functioning of the regulatory bodies leave much to be desired. Now there are voices of establishing Provincial Medical & Dental Councils and this demand is being supported by Pakistan Medical Association as well. In fact it is not only the political parties but the members of the medical profession themselves are also to be blamed to a great extent for the present sad state of affairs.

To begin with medical profession lacks honest, sincere, dedicated leadership with representative character. Professional bodies lack democratic character and do not enjoy good credibility. Medical profession has constantly failed to identify black sheep among its ranks, it failed to take any action against those involved in unethical practices which has gone a long way in destroying its image in the public. Uncalled for and most often unwarranted criticism by the media without any solid evidence, continuing with a malicious campaign against the medical profession and healthcare facilities has also added to the present crisis. Had the PPP and PML ( N ) leadership resolved their differences and restored Pakistan Medical & Dental Council making it independent, autonomous regulatory body and it too had performed its functions honestly we may not have seen the present days. On the contrary, the PM&DC leadership encouraged corruption, turned it into Private Medical & Dental Colleges Council, allowed increase in seats, opening of new medical and dental colleges without adequate inspection and ensuring that those setting up these institutions had proper functioning teaching hospitals, teaching and training facilities, faculty which matters most.

When PTI formed the government it started playing with the PM&DC and eventually replaced it with Pakistan Medical Commission. They also gave too much authority, went out of their way to please the private medical and dental colleges and all this effectively made it a lucrative business to make quick money. They first implemented Medical Teaching Institutions Act in KPK and now has also got it passed in Punjab but are reluctant to implement it in major cities and institutions knowing fully well that these measures will not be accepted by the healthcare professionals. Attempts to introduce MTI in PIMS Islamabad are being opposed by the staff and faculty which is supported by Grand Health Alliance. MTI it is alleged is an attempt to privatize the public healthcare facilities which remain the last hope for millions of patients who visit them daily and benefit from their services. MTI was implemented in Khyber PK seven years ago and if it has helped improve medical education or healthcare, it should be highlighted and the results shared with the medical profession as well as public at large. One does not see any worthwhile study published in the medical literature in Pakistan or overseas which highlights its positive outcome and impact so far.

There is no denying the fact that we do need meaningful reforms in health sector as well as medical education but they need to be introduced gradually in a phased programme. For example start of institutional practice is something good which needs to be encouraged but before getting it implemented, government needs to invest in providing and upgrading the needed infrastructure. Do our public hospitals have proper seating arrangements, facilities, and facilities of rest rooms for the patients and attendants in these hospitals? It is essential that first these much needed facilities should be made available. Secondly the authorities can plan to have a separate cadre of consultants in all teaching hospitals and all those appointed to these posts should have separate pay scales with no facility of pension etc. They should know it when they are joining service and should not enjoy the title of Assistant, Associate or Professor. Yet another step could be that the Heads of the Department in all teaching hospitals, major healthcare facilities should be made full time and non-practicing. They should be only allowed institutional practice but they must be paid well and their perks and privileges should be revised appropriately so that they can live a decent, Honourable living. These are all long term plans which needs to be implemented in a phased programme after meaningful consultation with not only the medical profession but also representatives of the other major political parties for which there should be meaningful debate in the National Assembly and Senate before these plans are approved and implemented. Any attempt to implement these measures with force will backfire and might prove counterproductive. Americanization of our health services is a sure prescription for disaster.

Investment on prevention of diseases, strengthening the Basic Health Units, Rural Health Centers, Tehsil and District Headquarter Hospitals and having some referral system will reduce the rush and burden on teaching hospitals as well. A country like Pakistan can ill afford to provide curative services free to the entire population and the much publicized Sehat Card is not an ideal solution without proper monitoring. Otherwise it will only benefit the insurance companies and the private hospitals. In the coming days we might see mega corruption cases due to misuse of Sehat Card and business interests of private hospitals. There must be a proper monitoring system in place. Provision of Sehat Care should be restricted to the highly downtrodden families with no or very little income while all others should seek healthcare at the public healthcare facilities where all essential drugs should be available free of cost including the essential investigations. Private Wards, Wings can be established at these hospitals for those who can afford to generate funds. Health Insurance could be a solution provided it is properly worked out. We need to develop and strengthen our primary, secondary healthcare set up in particular. Similarly the funds earmarked for EHSAS programme should also be used judiciously. It is of no use distributing money. At least 50% of the funds allocated for EHSAS programme should be used to set up small scale cottage industries in the suburbs of cities to provide job opportunities so that people can start earning, come out of the poverty group and it will also create lot of job opportunities.

Similarly the regulatory bodies should not be imposed. They should be elected from among the medical profession with 30-40% membership which can consist of non-medical personnel but not politicians under any circumstances. It should represent the Trusts, Foundations and other entities working in the field of Medical Education and Health who enjoy good reputation and have earned credibility and trust of the society. It is not at all difficult to find out about a dozen such people provided the rulers are not interested to rehabilitate and provide lucrative jobs to party loyalists and professional praise singers. The selection should be based on merit, competence and their ability. We need to establish more nursing schools and institutions for training of Allied Health Professionals. The mushroom growth of private medical and dental colleges also needs to be checked and if standards are maintained, before getting permission they establish hospitals providing required faculty, teaching and training facilities, ensuring no compromise on quality, these measures can take care of the quality of medical education. However, it is extremely important to ensure transparency at every level and offering incentives, facilities to those who set up these institutions in small towns or rural areas. They can also be asked to serve the adjacent areas as regards provision of primary healthcare for which they must get some incentives. At present everything seems to be in a mess and any reforms introduced with force, may not get approval of the new government while opposition by the healthcare professionals themselves will further complicate the whole situation. Let us hope that those in the power corridors act with wisdom and foresight so that we can introduce some meaningful reforms in both medical education and health services.