The Hippocratic Oath requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. These include the principles of medical confidentiality and non-maleficence. “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” It is a statement that certainly encompasses the rights of a patient in a critical condition fighting for his or her life. Nishwa, the little girl, who was administered a wrong injection at Karachi’s Darul Sehat Hospital passed away a week ago. The hospital has only been fined Rs 500,000. One Sobia, is accused of filling the injection that had no labelling, and giving it to a male nurse, Agha Moeez. On April 14, a nine-month-old girl had become paralysed allegedly after being administered a ‘wrong injection’ by ‘untrained nursing staff’ at the Darul Sehat Hospital situated in Karachi’s Gulistan-e-Jauhar area. Nishwa’s father Qaiser Ali told the media that police had told him to withdraw the case and threatened him. The government could have send Nishwa abroad for treatment but did not. Ali said he would approach every forum to seek justice for his daughter so that others were spared a similar fate. There is no effective regulatory framework to govern the health sector in Pakistan. The markets are incomplete (there are no doctors for the elderly) and there are large information asymmetries (so that it is not always clear that what is being prescribed is in the patient’s best interest). Regulation is therefore very important. Otherwise, the temptation to take patients for a ride becomes too much. Even if some doctors and hospitals do not indulge in unethical practices, it becomes hard for the lay man to differentiate between those and the less scrupulous ones. Word of mouth is not enough to make clear distinctions. The doctor is not the most important thing; a well-funded, well-organised and centralised form of healthcare is But there is more to it than that. When one visits a specialist, they order a number of tests before they will even start talking about treatment. Hospitalisation is sometimes the only option if you want a team of doctors to examine the patient holistically. Even that is not easy. Getting admitted to a private hospital is costly and once you are placed in the care of a particular doctor, it may not be easy to get other specialists to visit the patient. Even if they do, they still write their diagnoses and prescriptions in isolation. There is no primary doctor to coordinate with other specialists or look at issues of medicinal interactions, the effects of one treatment on another, and so on. It comes down to the patient himself/herself or to the family of the patient to coordinate between doctors. Most of the time they have no way of knowing medicinal or treatment interactions. One hears of too many cases where mistakes have been made by doctors and care providers. This it highlights the lack of an effective regulatory structure. Our Judicial institutions must also be quick to dispense justice that will allow for a remedy against malpractice. Generally hospitals have strong internal peer group-based quality audit systems. There is a need for a strong inspection and oversight mechanism that includes government, prefereably a local government, imposing a strong external quality assurance audit on hospitals, medical practices and doctors, and a strict licensing requirement. The medical profession has membership requirements, standards, checks and balances, which can vary across societies. Nonetheless, almost all checks and regulatory structures are in place in most societies. In some countries there are insurance companies and other intermediaries coming in on behalf of patients. We have none of those in Pakistan. It is no wonder medical markets are lucrative in Pakistan but provide, on the whole, terrible service. A medical research study in the US has shown that 30 per cent of all deaths in the US happen because of a medical mistake or negligence. The most important thing is not the doctor. It is having a well-funded, well-organised and centralised form of healthcare. An oath does not improve healthcare, a system does (for example, the Scandinavian health model). In Pakistan a junior doctor in the public sector works like a mule. Most hospitals are under-equipped, under-staffed and over-burdened. As a developing country, Pakistan has always struggled with healthcare issues. A World Health Organization report places us 122nd among 190 countries. There is a need to increase the health budget. The number of government hospitals and doctors is not enough to cater to the large population. The private hospitals are out of reach for lower or middle class patients. Pakistan was ranked 149th out of 179 countries in 2015 on the Maternal Mortality Ratio Index. New healthcare blueprint needs increased funding and efficient cross-sector linkages. According to Unicef, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among countries when it comes to infant and neonatal mortality. There is a need for strong institutions. The three-tier healthcare approach should be replaced with a four-tier one, the fourth pillar being preventive healthcare. There should be strict penalties for wrongdoing. A clear procedure should be laid out for investigation in such cases and punishment should be meted out transparently. Every person in a medical service must have defined duties. This includes doctor, pharmacists and parameds. The Pakistan Medical and Dental Council and the Drug Regulatory Agency of Paksitan must wake up from their slumber. Standard operating procedures must be followed so that cases like Nishwa’s can be prevented. The writer is doctor