Such an initiative is essential for accountability and restoring
public trust in charitable healthcare institutions
ISLAMABAD: A comprehensive audit and critical examination of all Trust Hospitals that received free land from the Government of Pakistan or philanthropists—along with numerous other benefits such as exemptions from duties and taxes on imported medical equipment, instruments, and laboratory materials—is long overdue.
Some of these institutions have failed to honor their commitments to provide free or highly subsidized treatment to underprivileged segments of society. Instead, they have increasingly operated as commercial entities, generating significant revenue. It is imperative that a committee comprising healthcare professionals of unquestionable integrity and intellectual credibility be established to investigate this matter thoroughly.
Currently, a large number of Trust Hospitals and NGOs are operating in Pakistan in the fields of health and education. Among them, a few stand out for their commendable service and transparency, thereby attracting generous donations and funding from both the government and philanthropists within Pakistan and abroad. Notable examples include:
• Sindh Institute of Urology and Transplantation (SIUT), Karachi
• Indus Hospital Health Network, which manages numerous healthcare facilities nationwide
• Ghurki Trust Hospital, Lahore, which has also established a world-class trauma and spinal surgery unit
While a handful of other Trusts are performing reasonably well, the functioning of many others leaves much to be desired.
The proposed committee should thoroughly examine the disparity between the commitments made by these institutions and the actual services provided on the ground. Specifically, the committee must review:
• The original intent and policy under which free or subsidized land and other facilities were granted
• The terms of Trust Deeds and MOUs signed by these institutions
• The percentage of beds or services reserved for free or subsidized treatment
• Whether the promised services are being communicated to eligible patients and whether proper records of beneficiaries are maintained
• The findings of any previous audits, and whether any recommendations or concerns were addressed
Another important aspect is the accessibility of these institutions to the poor. The committee should evaluate whether:
• These hospitals coordinate with government institutions or other NGOs
• Allegations of refusing treatment to poor patients are substantiated
• The use of land and other benefits aligns with the stated goals in the Trust Deeds and MOUs
• Any of these hospitals have shifted toward a purely commercial model, including the establishment of medical or dental colleges
If any financial irregularities have been reported in the past, the committee should investigate the actions taken in response. Furthermore, the governance structure of these institutions must be scrutinized. Key questions include:
• Who controls and manages these hospitals?
• Are the trustees or board members accountable to any public authority?
• Are there safeguards in place to prevent political or corporate interests from influencing decision-making?
The committee should also assess whether a system exists for receiving and addressing public or patient complaints and whether these grievances are documented and resolved appropriately.
In cases where serious violations of lease agreements or trust deeds are identified, the institutions should be issued show-cause notices. Failure to provide satisfactory explanations could result in penalties or even revocation of their land or benefits. Ethical considerations must remain central during this audit to ensure that charitable resources are not diverted for personal or commercial gain. Investigators may need to clearly distinguish between the charitable and commercial operations of these Trusts.
Finally, the committee or commission entrusted with this responsibility should:
• Draft a comprehensive set of recommendations and improvements for regulatory oversight
• Suggest mechanisms such as social audits, periodic surprise inspections, and community feedback systems
• Propose terms and conditions for any future allocation of state land or government grants to Trusts in the health and education sectors
• Recommend penalties or cancellation of agreements for institutions failing to comply with clearly defined regulations
Such an initiative is not only necessary for accountability but also critical for restoring public trust in charitable healthcare institutions.
