Annual Appraisal & Re-certification of healthcare professionals needs to be started-Ghulam Rasool Mufti


 Panel discussion on Healthcare challenges in South Asia at FMH
Annual Appraisal & Re-certification of healthcare
professionals needs to be started-Ghulam Rasool Mufti
Establishment of Care Quality Commission in UK
has helped improve quality of healthcare
Absence of Primary Healthcare and lack of funding
are main issues in Pakistan

LAHORE: One of the important scientific highlight of the FHM International conference on General Medicine Update was panel discussion on “Healthcare Challenges in South Asia”. Dr. Ghulam Rasool Mufti Consultant Urological Surgeon and Fitness to Practice Tribunal Member from UK was the main speaker in this session. Other members of the panel included Dr. Shaukat Ashai from USA, Prof. Khalid Masood Gondal VC KEMU, Prof. Amir Zaman Khan VC FJMU, Prof. Javed Akram VC UHS Lahore, Prof. Jamshed Nasir Principal Fatima Memorial Medical and Dental College, Atia Mubarak, Dr. Tariq Mian who represented Pakistan Academy of Family Medicine, Ms. Kausar Director General Nursing Punjab while Prof. Yasmin Rashid Punjab Health Minister also later joined the panelists.

Dr. Ghulam Rasool started the programme with a brief presentation on what he said were his own impressions on the subject. He described the historical background to the introduction of Allopathic Western Healthcare in British India before 1947. It consisted of Churches who practices Heal and Preach, British Indian Government provided state funding while Rajas and Maharajas also provided some funding for healthcare. British left in 1948. It was Aneurin Bevan and the Labour Government in UK which introduced National Health Service in 1960 despite resistance by the leaders of the medical profession. It was decided that every citizen will be provided treatment by the GPs. There will be one hospital for a population of 1, 25,000 and till 1980s it was the golden era of National Health Service. Many doctors from India and Pakistan joined NHS in UK. Then there was a movement which demanded that the medical profession must be regulated. Those doing good job should be rewarded and those who did harm to the patients should be fined. The issues which were faced included how to govern and how to spend the money. Escalating costs of healthcare needed more money. Funds were increased every year and the Government spent almost one hundred fifty billion Pounds on healthcare every year. UK spends almost 9% of its GDP on health but Germany spends much more. NHS still remains under funded. It was felt that quality of care needs to be improved. The regulation journey of healthcare professionals is still going on.

Prof. Rakhshanda Rehman alongwith Mrs. Shahima Rehman, Dr. Atif Munir presenting a
memento to Dr. Shaukat Ashai during the International Conference organized by  FMH last
month. Also seen in the picture on left are Dr. Ghulam Rasool Mufti and Prof. Nighat Mir.

General Medical Council Dr. Mufti stated, started self-regulation while public also demanded regulation of the profession. This lead to annual appraisal of professionals and revalidation. Care Quality Commission was formed that is how the healthcare regulation started in UK. Its mandate was to see how safe is the hospital and how good is the leadership. The healthcare providers were graded as Outstanding, Good, those which required some improvement while the fourth grade was those which were found inadequate.

Talking about the South Asia, Dr. Mufti said that Pakistan has the highest infant mortality, very high under five mortality and very high maternal mortality. In fact Pakistan’s health indicators are worse in the region. Sri Lanka has an outstanding healthcare. It has a very good record of immunization and very high life expectancy in the region. They achieved it by reorganizing their Primary Healthcare and it is a success story. In fact Sri Lanka is ahead of time in healthcare and they keep on improving with time. The challenges in Pakistan include Finance and Good Governance. India spends 4.7% of GDP on Health, Pakistan 2.6%, UK 9.1%. While on one hand it is the meager funding for healthcare, on the other hand there is too much corruption and lot of public funding for healthcare is wasted with the result that the end user gets very little.

During the last few decades private health sector has mushroomed in Indo Pak subcontinent. Private health sector caters to almost 65% population in Pakistan and 70% population in India while in Sri Lanka private health sector caters to just 20% of population while 80% is looked after by the public sector. There is no dialogue between the public and private sector which is happening in Bangladesh but not in India and Pakistan. Private sector is focused on sickness, it is commercially focused and its focus is also on tertiary care and not primary healthcare. Speaking about regulation of health sector in India and Pakistan Dr. Ghulam Rasool said that in India some departments were de-recognized but no action was taken against the chair of the department. In Pakistan it is the PMDC which regulates the medical profession. In India the Indian Medical Council has been dissolved in 2018 and some new arrangements will be made to regulate the doctors and healthcare providers. In Pakistan, there is CPSP, PMDC, provincial and federal governments which are all involved in regulation of doctors. There is absence of primary care and lack of funding. Population explosion is yet another challenge. Poor governance and poor regulation has made the situation worse. Illness and diseases are rampant, there are communicable diseases, Non-communicable diseases, increasing road traffic accidents. What Pakistan needs is Good Doctors and Good System. A Bad Doctor will spoil even a good system. It is the wisest and the stupid who never change, he added.

Participating in the discussion Prof. Yasmin Rashid said that funding is the most important issue. In Pakistan public sector takes care of 35% of the population. Our main focus is primary healthcare. This year the Government of Punjab had allocated 16% of its annual budget for health services but most of its goes in salaries of the staff and other infrastructure, services and only 35 billion rupees was left for providing services. There are three hundred thousand employees who have to be paid salaries and we cannot work without human resource. We have floated Sehat Card scheme and this year seventy two lac cards will be distributed to the poor families who will be entitled to avail health services up to seven lac twenty thousand per family. They do not have to come to the public hospitals but avail services offered by private sector as well. We have started with the most deprived areas of Punjab. We will further increase this budget and this insurance scheme will cover 35-40% of the population. How to check Corruption is our major problem. We are trying our best but the moral fabric of the society as a whole has become corrupt, she remarked.

Dr. Ghulam Rasool Mufti and Mrs. Shahima Rehman speaking at the International
Conference organized by Fatima Memorial System at FMH  last month.

Dr. Ghulam Rasool Mufti pointed out that in UK waiting list for various procedures in NHS is too long and patients have to wait for months. Hence the NHS buys these services from the private sector. The various NHS Trusts negotiates with private health sector and avails the most cost effective services.

Dr. Tariq Mian stated that there are over one lac forty thousand family physicians and only forty thousand specialists. The government has so far completely ignored the family physicians and their main focus is on Basic Health Units to provide primary health care. Moreover, those who settle in general practice have no training in this discipline and they are not capable of providing the much needed care for the common diseases which they see in actual practice. Family Physician are not at all involved in primary healthcare. We have no prevention programme and no referral system at all. Now UHS has started a pilot project in Gujranwala district and once it is successful, it will be introduced in other districts as well.

Prof. Khalid Masood Gondal said that training is required for all professionals at all level CPSP has started Fellowship in Family Medicine. Dr. Shaukat Ashai remarked that similar issues were confronted in UK and USA in the beginning. Later Residency programme was started in Family Medicine in USA. MRCGP programme was started in UK.

Prof. Javed Akram stated that UHS has now started Masters Programme in Family Medicine. We also intend to establish College of General Practitioners at our new campus. At present GPs are not integrated in health services but they run a parallel system. All the private medical colleges by law are required to have 50% beds in their affiliated teaching hospitals free and we intend to utilize those beds for referral system in the days to come. However our main problem is the population explosion. Our resources does not match with our population. We need to set our priorities and spend the budget judiciously. The gap between resources and our needs is huge. Population control should be our No.1 priority. We need to work on integration of public and private sector and introduce curriculum reforms Dr. Shaukat Ashai remarked that Pakistan has more medical colleges and few nursing schools but it should have been the other way round.

Prof. Yasmin Rashid Punjab Health Minister alongwith Prof. Rakhshanda Rehman and
Mrs. Shahima Rehman presenting mementoes to Prof. Javed Akram VC UHS, Prof. Khalid
Masood Gondal VC KEMU and Dr. Tariq Mian at the International Conference on General
Medical Updates organized by Fatima Memorial System at FMH last month.

Prof. Amir Zaman Khan said that we have made changes in the curriculum and it will have a good impact. We have included subjects of Medical Ethics, there is emphasis on patient centered teaching and training, the curriculum is competency skills outcome based and we do take care of the global challenges. However, he agreed that the implementation was not as perfect and it was lacking. Prof. Amir Zaman Khan further stated that in the last few years we had almost twenty councils of PMDC. There exist some grey areas as regards PM&DC and the CPSP.

Prof. Jamshed Nasir opined that public sector was in fact looking after 50% of the population and was doing a commendable job despite lot of hardships. Sri Lanka has better primary healthcare because they have a very high literacy rate which is not the case with Pakistan. CPSP was doing a good job in postgraduate medical education. We have too many undergraduate medical colleges but their problem is that there is no standardization. We need more slots of postgraduate training.

Ms. Kausar DG Nursing stated that nurses are regulated by Pakistan Nursing Council but there is no re-validation. We are short of faculty. We have MSc programme in nursing but no PhD programme in nursing.

Prof. Yasmin Rashid remarked that Government is working in all those areas which have been pointed out during the discussion. New PM&DC set will ensure quality in doctors. We certainly need more nurses and more medical technicians. She agreed that medical students needs to be exposed to the global challenges. Pakistan is producing too many doctors and many of them are exported and similarly a large number of nurses leave the country. Medical students must benefit from the wisdom, knowledge and experience of such distinguished visiting faculty. They must come back more frequently and contribute whatever they can to improve health services. She further stated that while she was coming back from UK after doing MRCOG, she was told by her consultant that take care of thalassemia but we were never told about it when we were medical students. On return I saw that we had a huge problem of thalassemia and AFIP was doing some work in this area. We must modify our curriculum and find indigenous solutions to our problems, she added.

Mrs. Shahima Rehman participating in the discussion said that we at FMH had promoted the discipline of Family Medicine. The discipline of Rheumatology got birth here and we are the pioneer in this area. Government cannot do everything. Fatima Memorial Hospital is a gift of people for the people of Pakistan. We wish to create a favorable environment so that our doctors can come back to serve their countrymen in Pakistan.