The Punjab Medical Teaching Institutions Reforms Bill (PMTI) 2019


The Punjab Medical Teaching Institutions
Reforms Bill (PMTI) 2019
Some critical success factors
Dr. Anwaar Ahmad Buqvi*

Health care delivery is an ever expanding and always changing system. It can never remain static and stagnant. It is the basic need of people and must strive to provide health relief to the tax payers of the country. Unfortunately, culture of ‘Safarash’ instead of merit, poor governance, lack of long-term planning, absence of monitoring and evaluation, system of ‘Jaza &’ Saza’ and the population growth @2.4% has overshadowed any improvement in public health sector. One of the shortfalls was excessive control and interference by the non-technical bureaucracy in health secretariat. It a long time when a medical doctor used to be a secretary health of the province.

To address the problem of centralization sometime back The Punjab Medical & Health Ordinance was promulgated in 2002 when Prof. Mahmood Ahmad Chaudhary was Health Minister’ No doubt he was an out spoken, hardworking, honest and enlightened doctor. The 2002 Act was a serious attempt to devolve powers and give self-rule to tertiary level medical institutions for improving health care by solving institutional problems locally. The attempt did not produce desired results and no effort was made to revisit and review the situation by the subsequent authorities both political as well as bureaucratic. It exaggerated the professional problems and enhanced the miseries of patients in public hospitals. As a matter of fact, teachers without proper training proved week and incompetent managers. Appointments of key post were made either on political ‘Safarash’ or on seniority without fitness and without fair competition. Serving professors and sitting medical superintendent were ‘promoted’ and appointed in the same institutions where they were ‘born’. There was no evaluation and monitoring as the failure helped bureaucracy to control and the professors enjoyed their free lunch. Therefore, the problems of the health care system and poor patients remained unresolved. Even our medical press never reported, analyzed or highlighted the ground realities under the 2002 Act. The Act thus lost its identity and became a routine business again. And the lost glory and authority of civil secretariat bureaucracy prevailed. Interestingly with devolution of powers to primary, secondary and tertiary levels, the bureaucracy stole the opportunity and increased the number of seats in civil secretariat!

The present regime after a lapse of one year has now focused on tertiary hospitals. The Punjab Medical Teaching Institutions Reforms Bill (PMTI) 2019 is certainly a step forward. The Act 2019 consists of one Provincial Policy Board (PPB) for overall policy guidelines and supervision and the other multiple Boards of Governors (BOG) for local administration. Presently, the role of PPB lies with the health secretariat.

The success of new bill will depend on some of the following factors:

  1. Evaluation & Impact of previous Act 2002 to get guidelines for future success and avoid failure. If this is not kept in view the new attempt to reform health care system will also meet the same fate.
  2. Members of PPB, BoG must be with clean past record and without tinted reputation. Old and tried faces should not be re selected. Representatives of vested groups should be avoided. Previous experience of members of BoM from elite classes like generals, bureaucracy, judiciary or businessmen proved miserable as these gentlemen were not conversant with the health care system or issues of health institutions or problems of general patients and service providers.
  3. Selection of Deans and Directors of institutions is again a very important aspect for the success of health Reforms. The selection should be on merit and on the basis of previous achievements/contributions. The aspirants from the present lot in Govt. service should be avoided. Only competent professionals from the local market or from abroad should be invited and hired.
  4. MTI must devise its own rules and regulations according to its requirements instead of copying non patient friendly government rules.
  5. Regular monitoring & evaluation as well as clinical audit by a third-party is a must. Every meeting of BoG should examine monthly M & E report and immediate appropriate action/changes should be under taken, subsequently. Such type of message will keep the service providers on their toes and keep the mission of reforms alive.
  6. All the staff including managers and professors should be hired on contract. The Contract System is very useful and is popular throughout the world except Pakistan. During the regime of Ch. Pervaiz Elahi a contract policy was devised by Services Wing of S & GAD. Punjab Bureaucracy was against contract system due to its own apprehensions as later on the sword may not fall upon her. The said policy was distorted by the bureaucracy and the salary of contract staff was drastically reduced. In fact, contract staff with no service protection must be paid double salary but liable to immediate termination on misconduct, corruption or not achieving targets.
  7. Staff from Govt. will continue to enjoy their service rights and can continue in MTI after scrutiny. They must understand the spirit and mission of the new health system. If they don’t believe in change in public health then they should change their place with those who opt for betterment.
  8. New health care system can work if all concerned are motivated and are ready to contribute towards its success. The purpose and mission statement of new Act should be essential part of orientation program for all the staff working in an institution. Therefore discipline, honesty and good conduct for all staff including sanitary workers, ward boys, doctors, nurses, professors and clinicians is strictly and religiously observed.
  9. Private practice should be discouraged and only hospital-based practice be allowed. Professors devoted to academics and research and patient welfare should be appropriately compensated to stop private practice.
  10. General Patient must be protected with maximum facilities at lowest costs and with respect. Previous BoM were never pushed to fight for the cause of patient because they were chosen people and had no knowledge of or sympathy with the deprived ones.

*Ex-Advisor Health Department Punjab
Chief Executive Mansoorah Teaching Hospital, Lahore

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