Daily Times

A vast majority of doctors are in junior ranks, mostly serving in government-run hospitals. In the teaching hospitals, the junior doctors are selected only if they are doing their post-graduation and are called trainee doctors. They have been grossly underpaid and overworked. In the private sector, the pay and scales are almost similar but chances of post-graduation are only in private medical colleges. The recent proud remark by Shahbaz Sharif at a police function that with the new pay rise a constable was getting more pay than a doctor did not go down well with the junior doctors. On March 2, 2011, the doctors’ movement for better pay and working environment started in Punjab and continues till today. This has been the longest strike by doctors.

Health was and still is not a priority with just 0.5 percent GDP allocation to this sector. Starting in the 1980s, the private sector in Punjab began to pick up. Today the private sector accounts for 30 percent of curative services. However, for the poor who are in the majority, government health services are the only facilities open.

Historically, doctors have been treated as second class government servants who were not given the same pay and perks as the elite government servants in other departments. In 1976, the doctors finally received equivalence in pay but again were not given the same perks as other civil servants. These perks are worth more than four times the salary. By 1980, the wages of the junior doctors were not liveable and they started private practice after working hours, which according to rules was illegal. Just teachers (assistant and associate professors and professors) are allowed private practice but only at their residence. This rule has been openly flouted and teachers not only visit private clinics, some have even opened hospitals. Some junior doctors have drifted into the stock market and real estate. Today, with the huge inflation suffered by Pakistan over the past number of years, the present wages have become insufficient for survival. The buying power of the Rs 100 note of the early 1980s is now equal to Rs 1,000.

The main body of doctors belongs to the Pakistan Medical Association (PMA), which is a national organisation. There are other splinter smaller branches like Young Doctors Association (YDA) of junior doctors and Medical Teachers Association (MTA) of teachers in medical colleges. Besides these organisations, each speciality has its own association, which is mainly academic. The YDA and MTA are event-specific and are resurrected according to local issues. Today, the YDA is not subservient to PMA to ensure that their interests are not compromised. The PMA finally made an attempt to act as a bridge between YDA and the government, but without any support from YDA. In many teaching hospitals the teachers also expressed support for the strike and gave the Punjab government a deadline for the resolution of doctors’ issues.

The Punjab government had agreed to a pay raise five months ago but it is alleged that the government was facing a financial crunch and hence could not implement the agreement. Senior Advisor to Punjab CM Sardar Zulfiqar Khosa in a meeting with YDA had agreed to the pay rise on March 31. However, the government refused to honour the agreement on pay rise claiming that the government did not have the requisite funds (Rs 27 billion). The stance on both sides is hardening as time goes by, with no solution in sight.

The junior doctors also want a service structure, workplace security and better working conditions in the hospitals. Presently, a large numbers of doctors have been waiting for promotion for decades. This was the result of service structure experimentation over the years. The YDA took out protest processions, which were met by the usual police brutality. Initially, the doctors were working in makeshift out patient facilities and in the emergency but with the hardening of the Punjab government’s stance, the YDA decided on the extreme action of leaving government-run hospitals and some also submitted their resignations. According to YDA sources, 3,000 doctors have tendered their resignations in Lahore alone while the total number of doctors ready to resign in Punjab is 10,000, but these have not been handed to the government as yet.

On April 1 the Essential Services (Maintenance) Act 1958 was invoked in Punjab under which the offender can be jailed for up to one year and also fined. The principals and medical superintendents were given powers to hire and fire any doctor.

The government action to thwart strike action has been to give TV reports regarding the plight of neglected patients and deaths due to non-availability of doctors in the government hospitals. An English daily reported on April 4 that the president of YDA and 60 other doctors were sacked and 84 were to be served notices after a 24 hour period. The doctors on strike were to be replaced by government doctors working in peripheral institutions. The government’s arm-twisting mechanism is to dismiss selected doctors. It has recruited 465 doctors to run the hospitals. This is an unwise step since most of these doctors have been pulled out of rural areas or have been out of work for years and are not trained to function in a different environment. Doctors in Islamabad who had been on strike for more than 24 days called off the strike after an assurance from the Federal Health Secretary Nargis Sethi on April 5.

There is no doubt that doctors have never been given a living wage. On the other hand, financial inputs are not the only determinant of better health facilities to the people. We need reforms in our government health system. We have to evolve a better system based on the existing realities of Pakistan rather than what works in other countries.

The doctors’ protest has been badly handled by the Punjab government. Punjab Secretary Health Fawad Hassan Fawad, detested by the doctors for his arrogant behaviour, has taken a hardline approach. In a situation of dialogue it is imperative that an escape hatch for the opposition is left open, which the Punjab government has closed. The perception of being cornered often leads to abnormal response. As the government starts to show its muscle, things are going to get worse. The senior doctors are already supporting and would join the striking doctors. Doctors in other provinces shall also come out in support of the Punjab doctors. This is not going to be a pleasant affair for the government and soon we may hear: ‘Go Shahbaz, Go’.

The writer is a leading urologist