It’s happening all over again: the doctors might loiter on the streets of Punjab; the unrest in the province might prevail, and the disarray in public hospitals might carry the day. On 10th March 2020, the doctors in Lahore held a strike, once again and not surprisingly, in the aftermath of Medical Teaching Institutions Reform Act 2019 (MTI) being presented to the assembly by the incumbent Government.
On the eve of 11th March 2020, during the meeting of Grand Health Alliance (GHA) at the Services Hospital Lahore, the Punjab Assembly approved the bill. The GHA meeting was organized to pursue further action and it decided to knock the judicial door of Lahore High Court. On 12th March 2020, Justice Jawad Hassan heard the case and said that “the Government cannot pass the bill without proper consultation, it’s unconstitutional.” The court dismissed the hearing for a day.
The MTI act 2019, basically, intends to revamp the administrative structure of the public health sector. The act was promulgated earlier in KPK, and presently, the Government has aimed to implement this act across the country, Punjab being the second stop before it reaches the final destination. Mainly, the act gives complete autonomy to the Board of Governors (BoGs) and public hospitals over budgets and administrative measures.
To summarize, the act comprises of five major components, 1) Search and Nomination Committee: The Chief Minister will constitute the committee, and the Health Minister will be the chairman along with other Government and non-government members; the task of the committee will be to recommend the members for Provincial Policy Board, 2) Provincial Policy Board: the Government appointed members will structure and make policies and supervise the functionality of medical teaching institutes, 3) Board of Governors: the members of this board will also be appointed by the Search and Nomination Committee of Government. It will be responsible for budget, employees, making rules and structuring of the management, 4) Management Committee: the committee will consist of several directors such as hospital director, medical director, finance director, law director, and nursing director and the main task of this force will be to implement what BoG will advise; they will be answerable to BoG, and 5) Employees: the civil servants (government employees) will no longer remain civil servants after accepting the terms and conditions of MTI act 2019. Those negating the act will get transferred to the non-teaching medical institutes.
However, the act has created a lot of noise in the KPK over the years. In 2018, the KPK MTI Reforms act 2015 was tried in the supreme court due to the unlawful decisions and poor administration by the BoGs, hence, the supreme court dissolved all BoGs of KPK. Moreover, the Peshawar High Court also termed this act as a “strange law.” There are several primary and consequential complications in the act that could lead to further inconvenience in the system.
First of all, the political interference and politicization of the BoGs could stimulate the personal agenda in the system and cause deterioration of the administration – the favorable appointments and nepotism.
Secondly, in KPK, when a department did not achieve the target revenue as recommended by the BoG, the department was forced to shut down, leaving the patients to deprive of the treatment; the patients had to seek some other hospital for the treatment. This falls under the total institutional autonomy. The prices will also increase following the autonomy factor if it fails to complete the required revenue.
Thirdly, the fundamental proposition of any government institution, promotions based on seniority, would deteriorate. Under this law, a junior officer can be appointed to a higher position than his senior, which will result in disturbance within the sector. For instance, in KPK, the majority of senior doctors resigned from their posts because of the replacement by juniors.
Nevertheless, another primary purpose of giving autonomy to the BoGs was monitoring the performances of the staff in accordance with the MTI rules and regulations. Undoubtedly, there is continuous grafting in the field, and senior doctors take advantage of the unlawful privileges; the BoG would put an end to this if it gets depoliticized and free of political interference.
Furthermore, any person from private sectors could be appointed in BoG, under the act, such as a lawyer or a finance professional. The GHA demands that the board should only comprise members from its doctors’ community, which is fair given the standards of other institutions in Pakistan. Additionally, the doctors can continue private practice within the hospital premises for additional bonuses and an increase in salary, and there will be checks and balances on them, which is crucial given the inclination towards money more than health.
However, the doctors are most likely to erupt a new wave of protests if their demands are not met and 2019 has been the year of protests for the doctors over the MTI act, and that is what incited them to make Grand Health Alliance of doctors, nurses, and paramedics in the first place. The state requires a binding approach to tackle this matter before it gets out of hands. According to the official reports, only one doctor is available for every 6,325 people in Pakistan; hence, the empty public hospitals amid the protests would deprive people of necessary health facilities.
The need for healthy debates and negotiations to achieve the central goal is required. Thus, it is essential for both parties, GHA and the Government, to discuss this matter in conscientious way under law rather than taking it to the streets. History never repeats itself the same way, hence, it is immature to think that this new, expected, the wave of protests will, more or less, result in the same manners and intensities it did the last time. It could get worse or better; on that account, it would lead to probabilities that might create more chaos.