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| June 7, 2005 | Tuesday | Rabi-us-Sani 29, 1426 |
Autonomy to hospitals: system fails to deliver
RAWALPINDI, June 6: The autonomy given to teaching hospitals a couple of years back has failed to improve their working as both the doctors and the patients report a steep decline in the hospitals’ services. “The system of autonomy currently practised in the teaching hospitals of the province is on ventilator, taking its last breaths and one does not need to be an expert to determine its prognosis”, said Dr Tariq Niazi, Vice-President, Pakistan Medical Association, Punjab chapter.
He believed that the biggest fault with the system was that those people, whose interests were likely to be hit, have been assigned the task to exercise the autonomy.
A former health minister had some times back described them as “merchant doctors”.
The failure of the system to address the basic problems afflicting these institutions could be gauged from one example: the C.T. scan facility is at Rawalpindi General Hospital and the neurosurgery facility in District Headquarters Hospital.
The patients, therefore, have to be shifted from one hospital to another for examination and treatment causing inconvenience and waste of time to seriously injured patients.
The basic essence of autonomy was to decentralize the decision-making and to allow an individual hospital or set of hospitals to make decisions that can improve their functioning and facilitate the patients.
This objective, it appears, has never been the priority of the health managers.
The answer to all this is a single administrative system.
There are other reasons which need immediate attention of the health administrators.
“The condition of hospitals, their equipment and discipline have deteriorated; patient care and cleanliness standards declined; treatment expenses gone up, political interference in recruitment and other affairs has increased; and the basic purpose to check private practice of senior doctors has remained an unrealised dream”, Dr Niazi said.
The patients complained about unavailability of medicines, patronage of specific pharmaceutical companies, rud attitude of the doctors, absence of consultants and professors, lack of a patient-friendly atmosphere, neglect of outdoor patients in connection with admission or surgery.
“The same patient if consults a doctor privately gets immediate admission or an early surgery appointment”, one patient said.
Some of the patients said that getting proper treatment without reference from someone, who matters is a big ask.
The State Bank Governor, Dr Ishrat Hussain, had voiced similar concerns about the health system at the launch of Human Development Report in Islamabad the other day.
He said that the rationing of access to health services is done according to the status of the patient. “The system favours the elite”, he added.
The doctors told Dawn that they were not at ease with this system. The junior doctors are more frustrated because of an insecure future. There hasn’t been any recruitment of doctors by the provincial public service commission for the past over 10 years and those hired on contract are working under pathetic conditions. Many young doctors are leaving the country or are even leaving the profession. Just imagine the loss being caused to the country that spends about Rs1.15 million to prepare just one doctor.
The medical superintendents of the hospitals defended their performance saying that they are unjustifiably held responsible for the poor showing, as they don’t have the authority to redress people’s grievances.
They said maintained that most of the complaints of the public concern the professors, who are administratively not under their control.
Complaining about political interference in the hospitals’ affairs, the medical superintendents said, “they can’t transfer a wardboy what to think of taking action against a doctor.
The consultants justifying the continuation of their private practice said the hospitals did not have adequate infrastructure for starting institution-based private practice.
The government, they maintained, before doing its home work prematurely allowed institution-based private practice.
Dr Niazi held the policy-makers responsible for the failure of the system meant to serve the patients and improving the working conditions of the doctors.
He said the claims made by government functionaries from time to time raise people’s expectations, but when they (people) are encountered with ground realities they get frustrated and lose confidence in the health system.
“This situation is perfectly conducive for promoting private practice,” he believes.
He said, in 1997 the planner imposed unqualified and inexperienced people lacking the decision-making power on the hospitals in the first version of autonomy, but after its failure a new system in the name of ‘board of governors’ was put in place that too failed.
The BoGs were replaced by the current boards of management.
Dr Niazi is quite confident that this system too is at the verge of collapse, thanks to an ineffective and incompetent lot appointed by the health planners to run the affairs.
The SBP governor had also substantiated this claim saying inexperienced and unqualified persons are aspiring for the administrative functions in health setup for perks and privileges.
Since they lack the potential to run these institutions they turn to clerks and others for support to run the affairs.
Another important aspect of the poor state of delivery of health services in Punjab is non-utilization of funds allocated for health sector.
The allocation is not fully and properly utilised because of rampant corruption in the administration, complex system of audit and lack of vision of the administrators.
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