February 7, 2006	Tuesday	Muharram 8, 1427

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PESHAWAR, Feb 6: Foreign health experts have said that misunderstandings about autonomy and lack of commitment on the part of stakeholders are hindering the process of granting autonomous status to hospitals despite legislation.

“Doctors are technically well trained, but the overall human resource management is poor,” said a report released by Austria-based gynaecologist Dr Andreas Ruth, who along with two other co-consultants, conducted a study on hospitals’ autonomy in the NWFP.

Invited by the German Technical Agency (GTZ), the experts visited the Lady Reading Hospital, Khyber Teaching Hospital and Hayatabad Medical Complex in Peshawar and Ayub Teaching Hospital in Abbottabad to assess the scope of extending autonomy to selected hospitals.

The report said that allowing a hospital to develop its own vision, its own culture and its own ways of working and being held to account for its performance within an agreed framework of roles and performance indicators within the province’s overall health policy was called autonomy.

It said that the health management information system needed to be upgraded. The problems facing the health system would get worse if something was not done to address them on urgent basis. The role and system capacity building of districts needed attention before giving autonomy, the report said.

Discussions about autonomy had a long history in Pakistan, which had been recommended time again and sometimes implemented, it said, adding that the purpose of autonomy was a sustainable healthcare system of appropriate quality for all of the people of the NWFP.

It said that the dilapidated health condition in the healthcare delivery system was the outcome of the existing faulty system, because Pakistanis work very effectively in international and private organizations.

The present system had been designed many years ago for a very different population, but at present people’s needs had increased and technologies expanded. Too many transfers of senior staff in health department had incapacitated them to have time to learn the realities or to make a difference.

“Files, records maintained by clerks can be lost. Old decisions can be neglected or overturned. Situation is marred by general uncertainty,” it said.

It said that too much money went into salaries of the staff and one-line budget was to the day treated as government money with application of standing financial procedures. Moreover, allocation of money and decision-making with regard to repairs and other heads was extremely slow and budgets were not sufficiently fungible.

Lack of continuity was another big problem, because individuals may or may not continue the work of their predecessors.

The report pointed out that wrong numbers, wrong skills, wrong disciplines, wrong levels and wrong places had adversely affected the human resource system. Emphasis on seniority and examination result for selection and promotion than competency and annual confidential reports (ACRs) were powerful tool singed by wrong people.

The report had recommended registration of health institutions as non-profit organizations under the 1984 Companies Act and setting realistic fee level, because the current fee did not cover even marginal cost of tests and treatment.