Dr. Zafar Mirza’s departure from Federal Cabinet was expected since long

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It has nothing to do with competence, expertize or corrupt practices
Dr. Zafar Mirza’s departure from 
Federal Cabinet was expected since long
Pakistan’s Health Train is being pulled by various
Engines by different Drivers with varying expertize
towards different directions
Pharma industry opts for downsizing, slashes
salaries of senior executives, puts on hold further
investment, expansion and modernization of
drug manufacturing facilities

By Shaukat Ali Jawaid

ISLAMABAD: Dr. Zafar Mirza’s departure from the Federal Cabinet was expected since long as he was misfit in the set up from the very first day. Even I had told one of his colleagues in WHO EMRO long time ago that he will be a failure due to various reasons. Firstly, since he no longer lives in Pakistan for the last many years, he is not aware of the ground realities and has no contact with the healthcare professionals. Situation has changed a lot since he used to live in Pakistan and work for Network an NGO in Islamabad before he decided to leave for Malaysia and then onward joining the WHO. Pakistan’s Health Train is being pulled by different engines by various drivers with varying ability and experience in different directions that is why it is not moving further.

Health sector in Pakistan is faced with numerous problems and they keep on multiplying with the passage of every year irrespective of the colour and shape of the government whether it is Pakistan People’s Party, Pakistan Muslim League Nawaz or the one led by military dictators. No one has ever tried to seriously study and identify the problems so as to find some indigenous cost effective solutions. To have a good efficient primary health care and giving preference to prevention of diseases is extremely important and so is to have a National Formulary with Essential Drugs List benefitting from the WHO’s Essential Drugs concept, but it has seldom attracted the ruler’s attention. A sincere attempt was once made by the PPP Government led by late Mr. Z. A. Bhutto when the then Director General of Health Prof. Naseer Sheikh did introduce some far reaching reforms. It was the PPP Government in 70s that introduced the concept of Basic Health Units, Rural Health Centers and they were supposed to be interlinked with secondary and tertiary care centers which unfortunately could not happen.

Again it was Prof. Naseer Sheikh as DG Health who for the first time introduced the concept of Drug Registration, Licensing of the Drug Manufacturing Units, created the posts of Associate Professors in medical education. It was planned that each professorial unit will be provided a Secretary to help documentation and promote research culture which too could not be implemented as Martial Law was declared by General Ziaul Haque. The civilian governments which followed have been making different experiments without any success.

It will be worthwhile to add here that frustration and discontentment among the healthcare professionals have been increasing over the years. They were and continue to be badly treated by the bureaucracy. To quote late Prof. Iftikhar Ahmad, in Pakistan it is the Lassi which rules over the Cream. The situation became so bad that when the young doctors under the leadership of Pakistan Doctors Organization headed by Dr. Eice Muhammad went on strike in 1974 and paralyzed the country’s health services, even the popular government of Mr. Z.A.Bhutto had to negotiate. As a result 40% of the doctors in general cadre were promoted to Grade 18 and they were also promised a proper service structure - a promise which remains unfulfilled till today. Later the PDO again went on strike, its entire leadership was jailed by the Zia regime, Dr. Eice Mohammad and few other leaders were sentenced by Military Courts. However, the government had to eventually agree for one of the basic demands of the young doctors i.e. provision of hundred percent paid house jobs. PPP Government led by Benazir Bhutto introduced Peoples Health Scheme and also published a National Formulary containing essential drugs but it could never be implemented.

During the last decade and a half, the authorities tried with the concept of Board of Trustees, Board of Governors for the public sector hospitals bringing in non-medical personnel as well but nothing has worked so far. However, the authorities agreed to enhance the remuneration of House Job doctors as well as postgraduate trainees substantially. When the PTI Government came in and formed the Government in KPK, it started experimenting with the Medical Teaching Institutions (MTI) Ordinance under the guidance of Prof. Naushewan Khan Burki. Now the PTI has been in government in KPK for the last over seven years but has it made any difference as regards performance of healthcare facilities is debatable. On the contrary a large number of consultants have resigned and left government jobs and patient satisfaction has suffered a great deal. However, since it introduced lucrative pay packages, most of the well trained nursing staff and paramedics serving in private hospitals joined the public sector hospitals which has happened for the first time in Pakistan. The Government desire to ensure discipline among staff, punctuality, clinical and academic audit of all departments, consultants are all praiseworthy steps but the method adopted for its accomplishment were faulty hence it has failed to make any impact. There has to be some difference while dealing with the labour and dealing with the educated elite in the society.

Now after the 2018 elections, the selectors facilitated PTI to form the Government in Punjab as well. It has also managed to rush through the controversial MTI Ordinance and get it approved by the provincial assembly but can it be implemented in its letter and spirit looks highly impossible. In KPK the government has made certain amendments to the MTI but it falls too short of the expectations by the healthcare professionals who are struggling for better working conditions. Added to it was the so called brilliant idea of Pakistan Medical Commission replacing the PM&DC? The PMC Ordinance was rejected by the Islamabad High Court which restored the PM&DC to the great embarrassment of PTI Government though there are reports that yet another attempt will be made to do away with the PM&DC. PM&DC no doubt is a den of corruption, its functioning is erratic and it needs complete overhauling but all this has to be done in a way that the corrupt elements are chopped of painlessly and reforms are introduced gradually going for automation by making use of the information technology. It goes to the credit of PTI government that for the first time in PM&DC’s history, it had organized an inspection of medical and dental colleges using the experts in different fields which was very much appreciated by the faculty and all those who are interested to ensure standards of medical education. The government could have used similar measures through the PM&DC by making necessary arrangements instead of antagonizing the medical profession through dissolution of PM&DC. It needs to be made really autonomous and independent body working under people whose intellectual integrity is not questionable. It is not difficult to find few such people in Pakistan provided the intentions are good and objective is to reform and not to provide lucrative jobs and rehabilitate the party loyalists.

Drug prices is yet another highly sensitive issue. If no policy is framed after meaningful consultation with all the stake holders, the pharma industry will be reluctant to make any further investment, modernization of its plants will be withheld, there will be no expansion, drugs export which has a great potential will suffer, some of the drugs which are not economical to produce will remain in short supply or disappear from the market and eventually we will have to resort to imports which is not at all in the national interest. When the government cannot control prices of essential items like wheat, Flour, Sugar which are produced in the country in abundance and has to resort to their imports, how it can control and freeze drug prices for which we have to import most of the raw material from overseas when our currency has been devalued by almost 35-40%.

Infected with the COVID19 Pandemic and the prevailing circumstances in the country due to political instability, Pharmaceutical companies who believe and practice ethical marketing are struggling to survive, finding it difficult to pay for the staff salaries. Some units have opted for downsizing, slashed the salaries of their senior executives, put on hold further investment, expansion and modernization of drug manufacturing facilities for the time being till the situation improves and becomes conducive for business. Pakistan which was making good progress in drugs exports and many companies had ambitious plans to enter different markets overseas, but now all this is going to be adversely affected.

While on one hand the PTI has failed to show good performance in every sector, health sector being no exception, it also has the unique privilege and honour that it was in its tenure that a tertiary care hospital, Punjab Institute of Cardiology was ransacked by a mob which marched to the PIC parading on the main roads of Lahore for over two hours. Emergency, ICU and CCU were badly damaged. Some patients died, many others including the healthcare professionals saved their life by running out of the hospital which closed its service which remained shut for couple of days. This all happened when the province was being administered by Chief Minister Buzdar who should have been shown the door but unfortunately he is still the chief executive of the province. Such an unfortunate incident has never happened in the history of Pakistan before and it will continue to haunt the PTI for many years to come.

In view of the above, it does not make any difference who is in charge at the Federal Health Ministry, the problems are so acute that it needs both short term and long term planning, finding an indigenous cost effective solutions. Unfortunately in Pakistan, final decisions about health related issues are also taken by the politicians and not professional experts. Those at the helm of affairs must remember the frustration in the healthcare professionals which is increasing might become uncontrollable. If any force is used to get the new rules implemented which at present means those who opt for MTI rules and regulations will cease to be government servants which is in other words privatization of the health services. A new Eice Muhammad might emerge on the scene one day from the ranks of Grand Health Alliance or the Young Doctors Association to lead the struggle afresh. Hence, people like Dr. Zafar Mirza who was one of the non-elected members in the Cabinet along with over a dozen other Advisors, Assistants does not figure anywhere. If he was corrupt, he should have been punished rather than allowing him to resign. One of the officials in the WHO EMRO where Dr. Zafar Mirza was working before joining the Pakistan’s federal cabinet remarked that “Dr. Zafar Mirza’s departure is in fact failure of Imran Khan”. It has nothing to do with the competence, ability or rumors of corrupt practices which are making rounds in the print, electronic and social media. There are various groups within the cabinet since the government is made of people brought from different political parties who have their own view point on various issues. Majority of elected members hate the presence of non-elected people enjoying important positions in the cabinet. Hence, one feels sorry for Dr. Zafar Mirza who had to leave in an un-ceremonial manner. However, one of his failures was his inability to interact with those who could have given him some useful suggestions to grapple with the issues related to health sector. Unless there is some qualitative change in the method the decisions related to health issue are taken any new comer is also likely to face enormous problems. The idea of recalling the above all is just to enlighten the authorities that they should keep these historical facts in mind before making any plans in the health sector.

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