Critical analysis, evaluation of Federal, Provincial Govts. about their performance in Health Sector

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 Federal, Provincial Governments fail to check unethical
practices by Physicians & Pharma industry

Critical analysis, evaluation of Federal, Provincial Govts. about their performance in Health Sector

Punjab seems to be ahead in overall development
as well as developments in health sector

KPK Govt. can take pride in introducing Medical Teaching
Institutions Reforms,
 selecting VCs of universities on merit

Sindh Govt. should be pleased with the performance,
functioning of NICVD
 

By Shaukat Ali Jawaid

KARACHI: It is heartening to note that despite the Dharnas, intrigues, conspiracies, working overtime by the disgruntled politicians and nefarious activities of Jokers who visit Pakistan from time to time, we have the second Parliament and provincial assemblies which have completed their five year term. It is not less than a miracle in a country where democracy has never been allowed to flourish. Credit for this goes not only to the Government which had to work under very difficult circumstances some of which have come to the surface while a lot still remains hidden but the Opposition as well. The role played by Syed Khurshid Shah, Leader of the opposition in the Parliament, Chairman Senate Mr. Raza Rabbani, Speaker National Assembly Sardar Ayaz Sadiq besides Makhdoom Javed Hashmi deserve to be commended as it was their foresight and vision above all love for the democracy that saved the country from any major disaster.

Selection of the caretaker Prime Minister Justice (R) Nasirul Mulk by consensus is also heartening, CJP and Chief Election Commissioner’s resolve to hold the elections on schedule i.e. July 25th in free transparent manner are all the positive developments which show that we are on the right track and if all goes well, we will reach our destination one day. Free and Fair elections, undiluted democracy is as important for the country as quality drugs for a patient. Engineered elections, promoting artificially created political leadership is like a poison. Now when the new elections schedule has been announced, it also gives us an opportunity to critically analyze the performance of Federal as well as all the provincial governments in the health sector which falls under the domain of the medical press. All the major political parties were in Government either in the Centre or in the provinces and people should look at their performance as to how far they have been able to deliver and fulfill the promises they made at the time of last elections.

Federal Government

Let us first start with the Federal Government. After the 18th Constitutional Amendment, Health and Education both have gone to the provinces, hence the Federal Government has very little say in these areas except policy making and giving guidelines while it is up to the provincial Governments to plan, and implement interventions in Health as well as Education sectors. However, the Federal Government still has an important role to play in medical education and health sector particularly as regards the performance of Pakistan Medical & Dental Council as well as Drug Regulatory Authority of Pakistan. Since the ruling party PML-N did not have majority in the Senate, it could not pass the Ordinance related to the PM&DC. PPP continued to play politics but little did it realized that at the end of the day they are going to lose everything. That is exactly what happened. The Supreme Court appointed an adhoc set up headed by former Supreme Court Judge Mr. Justice Shakirullah Jan which is busy in streamlining the working of the PM&DC. It has already taken some effective measures and plans to introduce some radical interventions in its set up to improve its functioning. Had it not been better if both Government and Opposition could have agreed on certain reforms and introduced it themselves rather than providing an opportunity to the Courts to intervene and take important decisions? This again shows that the politicians have not yet learnt any lesson from their mistakes and they keep on playing politics even on important issues.

Soon after formation of the Government, I personally handed over a copy of Guidelines by the National Bioethics Committee regarding Physicians Interaction with the Pharmaceutical Trade and Industry to Federal Minister of State for Health Regulation Mrs. Saira Afzal Tarrar at the Psychiatric Conference at Lahore with a request to read it carefully. I had further suggested her that most of the recommendations can be implemented without any financial burden as it just required administrative measures. I will be too glad to talk to you again once you have read it and if implemented it will take care of most of the unethical medical practices by the medical profession and unethical marketing practices by the pharma trade and industry. I have my doubt whether she ever read it or she even knows and remembers that something like National Bioethics Committee exists in Pakistan. Most of the time she was busy tackling the PM&DC affairs or was occupied with the issues related to DRAP where too the courts had to eventually intervene and issue certain directives. The Federal Government also failed to resolve the PIMS and SZABMU affairs, the problem created by the former PPP Government which announced the establishing of this university on its last day of Government without any homework about its feasibility. What a pity. The result was that no efforts were taken to check the unethical medical practices by the healthcare professionals as well as unethical marketing practices by the pharmaceutical trade & industry.

Once Ms Saira Afzal Tarrar was invited to chair the conference of Family Physicians at a Five Star Hotel in Lahore where the issue of quackery was highlighted by the family physician’s leadership. I wish she had the courage to tell them that the menace of quackery cannot be eliminated by making speeches at conferences organized at Five Star Hotels. On the contrary quackery can be successfully checked if the Family Physicians who are common man’s doctors whom the patients consult first, ensure accessible, affordable primary healthcare in the country. The Billions of Rupees which the medical profession including the Family Physicians and different associations, organizations of the medical profession collect from Pharma Trade and Industry every year, if used properly instead of wasting this money on lunches and dinners at five star hotels and family & social get together, they can do a lot. Let the Family Physicians start examining patients free one day a month or fix some time every week, help their colleagues establish small clinics in urban slums, small cities and towns with these funding so that they can provide affordable primary care to the patients. Once services by qualified physicians are accessible and affordable for the common man, they won’t go to the Quacks and quackery will die its own death. But to suggest all this one needs foresight and vision which she lacks. The problem with the politicians is that they are ignorant about many technical things for which they need to consult professionals but they are not interested to learn either, hence they end up making mess of everything. That is exactly what we are observing in Pakistan year after year.

The Federal Government also failed to compile and finalize Essential Drugs List. However, Ms. Saira Afzal Tarrar remained humble, was not at all involved in any corruption scandal and her overall performance could be termed as below average or just average.

Government of Punjab

Provincial Government of Punjab headed by Chief Minister Mian Shahbaz Sharif has accomplished numerous development projects in the province including those in the Health Sector. Improvement of primary health care by streamlining the working of Basic Health Units and Rural Health Centre’s, upgrading and expanding services at Tehsil Hospitals and DHQ Hospitals, establishment of new medical colleges at Sargodha, Sialkot, Gujrat, Gujranwala, Sahiwal, Dera Ghazi Khan, Most modern Tayyab Ergdon Hospital at Muzzafargarh in South Punjab, Institutes of Cardiology at Faisalabad and Rawalpindi, Kidney Center at Multan, improvement of numerous teaching hospitals, ensuring free supply of drugs in the Emergency Departments, successful campaign against Dengue, establishing new medical universities at Faisalabad, Rawalpindi and Multan, Drug Testing Laboratory, Forensic Laboratory, effective use of Health Information Management System, commissioning State of the Art Surgical Tower at Mayo Hospital Lahore with most modern Operation Theaters and Burns Ward with an Intensive Care Unit, setting up Children Hospitals in various parts of the province are just some of the accomplishments by the provincial government. In addition the most modern State of the art Pakistan Kidney and Liver Institute (PKLI) at Lahore is yet another project which is going to play a vital role in provision of quality healthcare. At present a large number of our patients are visiting India for Liver Transplant which is not only expensive but also a matter of great embarrassment for the country and lot of inconvenience for the patients and their attendants. We need to check this traffic and institutions like PKLI is expected to play an important role in this regard. We need to develop a number of such centers in other parts of the country as well. PKLI has already established a network of Hepatitis Screening and Management Clinics in most of the districts of the province. It must also be remembered that it is not only the buildings but the consultants and other healthcare professional which work there which matter the most. Hence, when one selects the best staff, they also have to be paid the salaries and other privileges at the market value so that they can concentrate and work with devotion and dedication. Hence no one should grudge their salaries and other benefits which are being offered to these talented people. Till such time that we can improve the culture in Government departments, Private-Public Partnership in health sector is the way forward. It ensures discipline, punctuality, monitoring and accountability. Hence, the results are much better.

The government has also announced to establish a few more medical colleges, one of them has already been announced which will be located in District Vehari. Punjab Health Care Commission has been very active and it has initiated a campaign to check the menace of quackery, done lot of good work in starting registration of healthcare facilities and laboratories, framed Minimum Health Care Standards. Not only that it is helping other provinces also in establishing and improving the functioning of their Provincial Health Care Commission’s which have been constituted only few months ago.

Having said all that, the provincial government had its share of failures as well. It did made some major blunders. The search committee formed to interview, short list potential candidates for appointment as Vice Chancellors could have been much better. Its failure to appoint Vice Chancellors at King Edward Medical University and University of Health sciences in time is a sin which cannot be forgiven. If that was not enough, appointment of a physician who had earlier destroyed the KEMU as acting VC of UHS was yet another major blunder. It just showed that the Government was not aware of the ground realities. The Chief Minister was surrounded by some Sycophants and praise singers who had his ear all the time and they successfully misguided him. The provincial health department also cannot escape blame because either those sitting in the coveted positions in the department were not aware of the reputation of certain physicians or they did not had the courage to tell the Chief Minister what are the feelings within the medical profession. Hence, the Chief Minister and the provincial Government had to face a very embarrassing situation when few others appointed as Vice Chancellors at various medical universities had to resign. Under directive of the Supreme Court, the provincial government has now constituted a new Search Committee and interviews for the potential candidates for the VCs posts in Faisalabad, Nishtar, FJMU and Rawalpindi Medical University have been announced. These incidents unfortunately overshadowed the excellent performance of the provincial government in health sector and it has to blame itself for this fiasco. All this could have been avoided had the provincial government consulted people like Prof. Kh. Saadiq Hussain and Prof. Mahmood Ali Malik. These are some of the medical personalities who do not run after the bureaucracy or people in the power corridor. They have to be invited, given due respect and asked to give their input in such sensitive matters where merit and merit alone should prevail. Provincial Health Department however deserves a pat on the back for courageously tackling the issues of indiscipline and rowdy behaviour among the junior doctors. Some of those found guilty after an independent enquiry were also punished. Mayo Hospital and Services Hospital in Lahore in particular had earned lot of bad name due to the activities of junior doctors which tarnished the image of the entire medical profession. Such incidents of indiscipline should never be tolerated and the department must come up with a mechanism to redress the complaints, grievances of patients as well as the healthcare professionals. One only hopes that those sitting in the provincial health departments as well as Mian Shahbaz Sharif has learnt some lesson from such stupid mistakes. They certainly need to enlarge their consultation group and take help and guidance from professionals who enjoy not only good reputation but also have a track record of accomplishments to their credit.

Government of KPK

Pakistan Tehreek-e-Insaf leadership wasted a golden opportunity of proving itself to be a mature political party by concentrating on development work in Khyber PK where it had formed the Government. However, PTI leadership spent most of the time in Sit-Ins more commonly known as Dharna, accusations and allegations against its political opponents particularly the Sharif Family. It was hoping for the “lifting of the Umpire’s finger” to topple the Government but it did not happen, thanks to Makhdoom Javed Hashmi and the sensible, constructive role played by the Opposition Pakistan People’s Party which condemned the attack on Parliament and other important Government buildings, stood like a rock to safeguard Democracy and democratic order. PTI leadership was also at odds with the Election Commission, former Chief Justice of Pakistan Iftikhar Chaudhry, former Caretaker Chief Minister of Punjab Najam Sethi and many others but could not prove any allegation and accusation. It severely criticized the Metro Bus project by the Government of Punjab terming it as a “Jungla Bus” saying that this project was initiated just to make money. It kept on harping this for almost four years and then suddenly it realized that it is for the benefit for the common man who are happy. Hence it came up with its own Rapid Bus Project, started working but it was too late. It could not complete the project. All this shows lack of political maturity in the PTI leadership.

However, in the health sector, it can take pride in setting up a highly powerful Search Committee to interview, short list candidates for the post of Vice Chancellors of various universities in the province. The Search Committee which consisted of eminent personalities did a commendable job and all the Vice Chancellors were selected and appointed on merit. Prof. Nosherwan Burki an eminent specialist in Pulmonary Medicine working in United States came to their help and worked out, implemented Medical Teaching Institutions reforms. Though these are not liked by a section of the medical profession but on the whole it is a good initiative and an important step in the right direction. Pay structure of the healthcare professional’s i.e. medical teachers, consultants, Registrars and trainee doctors besides nurses and technicians, paramedics has been increased tremendously. Discipline, regular attendance by the healthcare professionals has been ensured which has improved the working of these public healthcare facilities to a great extent. The remuneration offered to even the paramedics, nurses and technicians is so lucrative that a large number of those working in private hospitals have joined the public hospitals. It is undertaking reforms, expanding services at the teaching hospitals as well as all other healthcare facilities. Their preference was for sustaining the reforms introduced rather than taking up new projects. Other provinces have a lot to learn from the reforms introduced by the KPK Government in health sector. Had the PTI leadership concentrated whole heartedly on development work in the province rather than continuing with the agitation politics, it could have done much better.

Government of Sindh

The city of Karachi in particular in the province of Sindh has remained a victim of deteriorating law and order situation for the last many years. It also had something to do with the appeasement policy of the PPP. The provincial government was most often occupied with tackling the law and order situation, facing terrorist activities which did affect the performance of the provincial government to some extent as regards the development work, health sector being no exception. However, the government seems to be allergic to Merit when it comes to appointing people on coveted posts in the health sector including Vice Chancellors of the Medical Universities. For a long time it had to work with a Governor who seldom listened to the provincial government. It reluctantly agreed to the appointment of Prof. Saeed Qureshi as Vice Chancellor of Dow University of Health Sciences who was selected on Merit. He has done a commendable job as Medical Superintendent of Civil Hospital Karachi, is a humble, quiet person not at all interested in medical politics. The provincial government has tried to improve and expands the facilities available at various medical institutions, also established new medical universities as well as some medical colleges. Teaching and training facilities at Liaquat University of Medical and Health Sciences at Jamshoro Hyderabad, People’s Medical University at Nawabshah and SMBBMU Larkana, BBSU university at Lyarai at Karachi are also being improved but the pace of development work is very slow for reasons which are very well known. However, ghost workers in the health services remain a major problem which need a strong political commitment to tackle this issue.

Government of Sind should be proud of the National Institute of Cardiovascular Diseases (NICVD) which under the leadership of Prof. Nadeem Qamar and his team has made tremendous progress. It has extended its working throughout the province, established its sub-centers in many important cities besides opening a few Chest Pain units in Karachi. It has offered lucrative remuneration to its staff, introduced institutional practice. Anybody coming to the NICVD with Acute Myocardial Infarction is managed immediately, facilities of round the clock primary angioplasty are available and it has performed a record number of primary angioplasties at one center. Lot of expansion work is under way, the facilities available has been improved, enhanced, there is no more waiting period for echocardiography and many other important tests. The entire working of the NICVD has been computerized which has not only improved its performance, increased patient satisfaction but also checked financial corruption. It also shows that cordial friendly relationship by the heads of the institutions with the provincial government can be used for the benefit of the common man and thus help the society at large. Efficient functioning of the NICVD is indeed commendable and it offers lessons to many other similar institutions if they are interested to learn and improve their working.

Government of Baluchistan

During the last five years, the provincial government has tried to improve the working of teaching institutions, healthcare facilities but without much success. It also established some new medical colleges providing an opportunity to the talented youth to join medical profession. However, Baluchistan has its peculiar problems, the differences between Sardars belonging to various tribes, political horse trading, and terrorist activities, unstable Government does not provide an ideal environment for development. Hence, there is not much to report at present. Education of the masses, creating political awareness, allowing free atmosphere to the political parties to function will help improve the situation. CPEC offers a great opportunity and once this project is fully completed and implemented, it will benefit the country a lot and the province of Baluchistan in particular.

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