Healthcare systems is a top priority for any developing or developed countries in the world. IT is universally accepted that to improve a health sector, all tiers of healthcare system including policy makers, governing bodies, doctors, administrators, nurses, paramedics, pharmacists, laboratory personnel etc have to play important and collective role. Unfortunately, Pakistan’s healthcare system has failed to deliver effectively to the masses in past few decades and it has continued to decline due to many reasons including but not limited to political interference in the system, lack of autonomy to hospitals, centralization of power at secretariat level.
The ruling party Pakistan Tehreek-e-Insaf’s manifesto included revamping health system as one of its top agendas to improve delivery of quality healthcare to public. PTI’s health reforms includes many initiatives but one of the core constituents of these reforms is Medical Teaching Institution act.
It has been a hot debate in medical fraternity in past few months now in Punjab and it led to few healthcare provider’s organizations to protest strongly against the act and on the other hand government is firm to implement these reforms.
What is MTI act? And If government has the mandate to implement its policy and if it is largely in interest of the patients and all healthcare providers, then why is it a continuous debate at the moment? What are the concerns that have raised this resistance to much awaited reforms in health sector? We will try to find answers:
Medical teaching Institution is an act’s core idea is to decentralize powers from secretariat and provide administrative and financial autonomy to the medical teaching institutions and their affiliated hospitals and healthcare centers across Punjab. After implementation of this act, each teaching institution will be governed by the Board of Governors to be nominated by Search and Nomination Council. This act largely aims to enhance the professional capacity of the public hospitals making them free from any political influence, bringing in the process of performance-based evaluation, and ensure the availability of 24hrs emergency services, improve salary structures of doctors and all healthcare providers. It brings the concept of Institution-Based Practice for doctors to perform private practice within the public hospitals.
The question that If government has the mandate to implement its policies and if it is largely in benefit of the patients and all healthcare providers, then why is it a continuous debate at the moment and what are the concerns that have raised this resistance to much awaited reforms in health sector?
The first and foremost concern by certain organization and forums of healthcare providers is that this act is probably going to privatize the state-owned institutions This seems to be a misconception as government continues to stress in black and white that these are government owned institutions and will continue to remain so, receiving single line budget from the government, governed by people nominated by the government and overseen by the government. Health minister, chief minister office and beaurocrats will be a part of Search and nomination council, provincial Board and will be involved in nominations of experts in medical profession, acting an retired vice chancellors of medical universities and notable professionals from legal and finance departments to run as board of governors.
Another concern of the resistant factions of the community is that it may provide opportunity to the Board to victimize or will increase nepotism in the system which is not a wrong concern looking at the history of our political interference and biased attitude of the management
The second concern is Job security and the idea that it will end the regular jobs of doctors and paramedical staff and will be put on contract which is a valid concern considering the lack of opportunities for the doctors for a long time now. However, government is adamant in expressing that there is no such thing as termination of regular jobs and employees will not be put on any length of the contract, rather it is introducing a system of performance based evaluation after every 2-3 years and if good performers will be rewarded according to policy devised by the institution and in case of underperformance, that particular individual will be provided with a period of 6 months to improve the output and get himself above the threshold line to continue to provide effective care to the patients.
Another concern of the resistant factions of the community is that it may provide opportunity to the Board to victimize or will increase nepotism in the system which is not a wrong concern looking at the history of our political interference and biased attitude of the management. However government is of the view that nobody in any tier of the management will have no right to victimize any individual and if any employee of the institution feels that there has been impartial attitude towards him, he will have the right to appeal before three forums subsequently i.e. Board of Governors, Provincial board and ultimately to supreme court of Pakistan.
The other important concerns include expensive treatments for the masses who cannot afford private medical facilities. Health department is spreading its massage loudly that all services, investigations and medicines will remain free for the patients and introduction of Insaf Health Card is going to be the backbone to uplift the delivery of quality healthcare services to the public.
Insaf Doctors Forum believes that Medical Teaching Institution act is the way forward in the long run as it is the universally accepted system and current complexities in the healthcare system have failed to deliver for a long period of time. However, the real challenge is not the introduction of this act, but it lies in the successful implementation of this reform in its true spirit.
Insafdoctors forum will continue to play its part in stressing government to make sure the smooth implementation of MTI, continue to keep on board all stake holders, on merit appointment of board of governors, regular third party audits, continuous re-evaluation of the program, parallel capacity building of the institutions for institutional based practice and introduce necessary amendments to overcome the deficiencies with period of time.
At the same time Insaf Doctors Forum urges all organizations and forums of doctors, paramedics, nurses and allied health professionals to play their role and work in harmony in line with government to continue to improve healthcare services to people of Punjab and also continue to improve ourselves as healthcare providers.
The writer is Health Policy Incharge at IDF, Punjab