Political Parties should stop playing politics with Health and Medical Education


Political Parties should stop playing politics
with Health and Medical Education
We need long term sustainable policies finding cost
effective indigenous solutions to our problems

By Shaukat Ali Jawaid

KARACHI: Political Parties of Pakistan should stop playing politics with Health and Medical Education. We need long term sustainable policies finding cost effective indigenous solutions to our problems benefitting from the advice and suggestions of those healthcare professionals and medical educationists who have served in this country for decades and are fully aware of ground realities. They alone can come up with a prescription which can guarantee positive outcome and achieve the noble objectives which the Government has in mind to improve medical education and healthcare.

However, at present lot of confusion prevails in the medical profession these days and no one is certain as to what is going to be the final outcome of various measures being introduced by the government in the health sector. During the last five decades of my professional career I have never seen the medical profession so helpless, depressed and frustrated as one sees these days. What is more frightening is the fact that no one is prepared to stand up and tell the authorities the disastrous consequences which will follow. Neglect of public healthcare facilities will be a very costly experiment. It will encourage the private health sector which as usual will exploit the situation. Medical Education and Health Care has already become an industry rather than profession. Entry of business and real estate tycoons in these fields has made the situation worse.

The Prime Minister’s surprising declaration at a function in Lahore recently that District Headquarters Hospitals are lying deserted because of lack of doctors, hence, “why should the Government spend money on them if doctors are not going to DHQ Hospitals to serve the masses” has sent alarm bells ringing. Are we going to do away with DHQ and THQs hospitals? This is no doubt a very short sighted policy and it also reflects the lack of proper planning by the party in power. Provision of primary healthcare is the government responsibility and it should not abdicate it under any circumstances. The much talked about Sehat Sahulat Card is a good idea but the way it is planning to be implemented will ruin everything and the authorities would be well advised not to indulge in this experiment. Sehat Card should be reserved for only those families who have no income at all or very meagre income. Otherwise if the bulk of the funds meant for health are passed on to the insurance companies, what will be left for improvement, expansion of public healthcare facilities? A spokesperson of the Federal Government has recently stated that Sehat Card is a very revolutionary idea which is not even available to public in United States of America? Does it mean that we are even far ahead of USA the richest and most advanced country in the world? It is bound to lead to lot of malpractices.

Instead of destroying the DHQ hospitals for lack of specialists, the authorities should advertise posts specifically meant for these District and Tehsil Hospitals. Hence only those will apply who will be willing to serve in those areas and the bureaucracy will not disturb them by frequent transfers. A former Vice Chancellor of a medical university pointed out that when they discussed these issues with the health officials, they said, there was lot of pressure from IMF as our Pension bill is increasing very fast. But the question arises why to opt for adhoc appointments and contract appointments of medical teachers and healthcare professionals alone? Are they the only government servants eligible for pension benefits and why they are being singled out for this special treatment? Let the government adopt a uniform policy and appoint bureaucrats, police, revenue officials and all other government employees on contract basis if the pension is the main issue.

Pakistan Medial Commission has already made a mess of medical education. MDCAT exam was a disaster. Sindh has already allowed admission to medical and dental colleges with 50% marks as against 60% recommended by PMC. How the students of Baluchistan and interior Sindh can compete with students of big cities. PMC is reported to have threatened not to register those students and Sindh has planned to establish its own Medical and Dental Council for their registration. Baluchistan might follow suit. Britain has already withdrawn the exemption granted to FCPS holders thanks to the PMC.

The idea of Institutional Practice is good and so is the concept of monitoring, accountability, clinical audit and ensuring punctuality but before implementing IP in medical institutions, the authorities should improve the basic infrastructure. Once it is done, many doctors will be more than willing to opt for institutional practice. MTI was introduced in KPK many years ago and the concept of institutional practice could not be implemented fully. A large number of consultants resigned which has adversely affected the teaching, training and health care. Now the government of KPK is also handing over some healthcare facilities in far flung areas to private parties through public-private partnership. An attempt is also being made to enforce MTI in Punjab but according to reports, there is lot of resistance and if the authorities tried to implement it with force, many faculty members are prepared to resign. Though the government might find new untrained and inexperienced people to replace them but the damage it will bring to these institutions, medical education, teaching and training as well as healthcare, is not difficult to imagine. Introduction of full time faculty through a gradual phased programme and implementing it in case of all new inductions, appointments would have been a much better strategy. Doing away with public healthcare facilities are going to bring more misery and problems for the poor, under privileged population. It is not the government alone which is responsible for the present mess but the members of the medical profession which lack leadership with vision is equally responsible for it. Is it not a matter of shame for HCPs that someone not from their ranks is calling the shots and dictating them what to do. Let us hope that the authorities have another look at its policies and refrain from destroying whatever was built over the last few decades.

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