Those opting for employment under MTI shall cease to be Civil Servants

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Punjab Medical Teaching Institutions (Reforms) Ordinance 2019
Those opting for employment under MTI
shall cease to be Civil Servants
Medical Teachers given sixty days to decide about opting
for Institutional practice or practice outside the hospital
Five to Seven member Board of Governors consisting
“reputable members of the society” Technical,
Professional persons to manage these institutions
Management Committee will consist of Hospital
Director, Medical Director, Nursing Director,
Finance Director, two nominees of the Dean

By Shaukat Ali Jawaid

LAHORE: The present PTI Government which is very fond of Governing the country through Ordinances rather than after getting the legislation passed in the Parliament and the Provincial Assemblies after in depth discussions and feedback from members of these houses, has now issued “The Punjab Medical Teaching Institutions (Reforms) Ordinance 2019 on September 02, 2019 which comes into force at once. Earlier a similar ordinance was issued and implemented in Khyber PK. The present Government, it appears, thinks it as Akle-Kull hence does not feel the need to get any advice or suggestions even from its own members what to talk of the opposition. The result is that it is perhaps the first government in the history of Pakistan which has taken a record number of U-Turns, reversed its earlier decisions in such a short span of time. And there seems to be no end to these U-Turns in every field.

Some of the important salient features of this Punjab MTI Ordinance is that these institutions will be run and managed by Five to Seven member Board of Governors which will consist of “reputable members of the society, an eminent technical and professional persons in their respective fields in the areas of law, regulation, fiancé, management, medical services, medical education and patient care”. In case of Medical University, the Vice Chancellor of the University shall be an ex officio member of the Board of Governors.The office of Principal does not figure anywhere and it appears that this coveted post has been dispensed with. This provision allows the rulers to appoint the men of their own choice.

The Provincial Policy Board will have “at least one retired professor of a medical school”. The Management committee will consist of Hospital Director, Medical Director, Nursing Director, Finance Director and two persons nominated by the Board on the recommendation of the Dean. The most important clause under Services of the Medical Teaching Institution sub-section 6 states that “A civil servant, who opts to join the employment of the Medical Teaching Institution shall cease to be civil servant from the date of his notification in the service of the MTI concerned and their seniority, pension and other matters vis a vis employment in the MTI shall be determined in the manner, as may be prescribed.”

Other most important sub-sections 10-13 state that the Provincial Review Board shall be notified by the Government and shall consist of such persons as may be prescribed by Rules to be framed by the Government. Any employee aggrieved by a decision of the Board shall have the right to appeal the decision to the Provincial Review Board for MTIs. In case of a decision of termination by or upheld by the Board shall not be suspended pending decision of the appeal by the Provincial Review Board. All employment disputes as may be pending before any Court shall be transferred with immediate effect to the Review Board established by the Government under the Ordinance and an Appeal against a decision of the Provincial Review Board shall lie to the Supreme Court. It means that no one can appeal in the High Court to get any relief.

The section 23, relating to private practice sates that “ All consultants working in a hospital forming part of the MTI shall be given an option either to do their private practice within the hospital of a MTI or to do their private practice outside the hospital. The option shall be exercised within a period of sixty days and this period may be extended by the Board. The employees who do not opt for private practice within the premises of the hospitals of MTIs shall not be entitled to any increase and adjustment, incentives, bonuses or other ancillary benefits or administrative post, except as may be prescribed by rules.” “Sub-section 6 of private practice clause further states that “The individual consultant shall be held responsible for the most efficient use of the facilities and shall be expected to provide cost and income projections for each new facility, equipment or service request with the support of Hospital Director and Staff. The government has already increase the charges for various services being provided and it may be revised upward further. The consultant’s professional fee for private practice shall not exceed the fees fixed by the Board.”

What is more surprising is the fact that all this is happening while the health portfolio in the provincial government is with an eminent medical teacher Prof. Yasmin Rashid who has throughout his professional life struggled for the improvement of the working conditions in the healthcare facilities, better working environment and facilities for the faculty and upholding all appointments on merit in a transparent manner. If the objective of this Ordinance is to improve the quality of patient care, medical education, ensure discipline and punctuality of the staff including medical teachers and senior consultants, ensure efficient running of these institutions, all this can also be achieved without going for these drastic measures as mentioned in the Ordinance. The Government of Punjab with the help of bureaucracy has been making various experiments in the past without realizing its objectives and one is not sure whether they will succeed this time too. We had earlier also seen the Hospital Management Boards, Board of Governors etc., and as expected the rulers used this to rehabilitate their friends and well wishers once they retire from their government job or please their friends in the business community. This is going to happen once again and the results are not difficult to imagine. MTI no doubt has some very important points but one has to implement such reforms in a phased programme. Decisions taken by part time Pakistani’s who are not aware of the ground realities may not help realize the desired objectives.

If the government decides and shows determination to ensure that all selections, appointments in health services will be on merit, heads of the institutions, Principals, Deans, Vice Chancellors of Medical Universities are selected on merit, starts biometric attendance, makes annual academic and clinical audit of every unit, department in healthcare facilities, medical institutions mandatory which should be linked to their future promotions, incentives etc., it can bring about a revolutionary change. To encourage Research, it can create full time Professorial chairs for Research, those clinicians who do not wish to do private practice should be offered lucrative remuneration, facilities of attending conferences within the country and abroad all paid for by the government. Medical Teachers, Researchers who show exceptional performance and have accomplishments should be publicly honoured and awarded encouraging others to follow their footsteps. Give respect to the office of Principal, Vice Chancellor, and Medical Superintendent. Make sure that some professionals in the field are Chancellor of the medical universities and not the Provincial Governor. The government can learn some lessons from our neighboring country Iran which has one of the best Primary Healthcare set up and for all this one does not have to look towards UK or USA. However, in a country where the Rs. Twelve Lac monthly salary of the renowned Transplant Surgeon looks too much to the authorities who are happy to pay a remuneration of Rs. Twenty eight lacs per month to a Cricketer, we should not expect any miracles. What is going to be the reaction of those who are affected by this Ordinance will be seen with interest by all concerned.

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