PESHAWAR, May 13: The NWFP government’s plan to award financial and administrative autonomy to the four teaching hospitals by December 2006 has raised concern among the staff of these hospitals.
The plan was recommended by four consultants hired by the GTZ upon the health department’s request in December 2005. The study was made public in the shape of a 119-page booklet, which recommended financial and administrative autonomy to the Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH), Hayatabad Medical Complex (HMC), Peshawar and Ayub Medical College (AMC), Abbottabad.
The health department has circulated pro forma among the staff of these institutions asking them to offer the option of continuing work either as government employees or within the proposed autonomy plan.
A majority of staff at these hospitals oppose the move and term it a ploy to sell these institutions and deprive them of jobs. Most of the staff, including paramedics, nurses and class IV workers, have opted to stay on with the government, while the doctors have asked the government to further clarify the terms of financial and administrative autonomy and define the nature of their jobs.
“We are not sure about the government’s plan, because no rules have been made so far. It’s beyond our comprehension how the government can implement a scheme first and formulate rules later,” a senior doctor at the LRH said.
According to a report, the government has spent Rs357million per year on the 1,426-bed LRH, which has generated an income of Rs36million. A huge chunk of spending was consumed by salaries of 2,319 staff members. The expenditure on the 1202-bed KTH with 2,075 staff members was Rs308 million against an income of Rs27.161 million per year. The government allocated Rs174.388 million for the 603-bed HMC with 1,065 staff members, while its yearly income stood at Rs26.547 million.
The 1,011-bed AMC with 1,657 staff consumed Rs166.26 million per year, but the quality medical care in the NWFP is still a far cry at these teaching hospitals, the report said.
It said that quality healthcare was hampered by poor referral and drug prescription systems, absence of management training for health professionals and lack of nursing staff and asked the government to introduce a system of incentives and penalties.
It said that patients were directly rushed to tertiary care hospitals for minor ailments, which pushed up medical costs by nine times. Such patients can be provided better treatment at the primary and secondary level hospitals. A large number of patients adversely affected the quality of service and hygiene.
In the four teaching hospitals and some district headquarter hospitals in the province there has been lack of performance, quality, morbidity and mortality, drugs, dedication of staff, unawareness of doctors about the cost of procedures and poor waste disposal mechanism.
It said that paediatric and gynaecological services were insufficient. There is no intensive neo-natal care unit in the province, even though children constitute 40 per cent of the NWFP’s youth population.
“Threats of infectious diseases such as hepatitis stem from the non-availability of isolation rooms. Buildings, infrastructure, water and electricity are not up to the standard,” it said.
In the absence of a prescription strategy, he said, pharmacies are selling drugs for treatment of all diseases. There is no system to decide if a patient is poor. In such circumstances, the rich manage to get free treatment while the poor are forced to pay.
“Most of the senior doctors have their private clinics in the town. Patients are deviated through private practice as well as through private diagnostic facilities such as radiology and laboratories,” it said.
About the scant drug scenario in the province, he said that sales agents of pharmaceutical companies hang around the hospital the whole day, asking doctors to prescribe their products.
“There are incentives for doctors to do so,” it added. The prevalent laws forbid such practices, but they happen on a large scale, it said. There is no committee at the hospital that can look into drug-related affairs, according to the report.
It has recommended formation of drug committees at the hospital level and issuing of special licences for pharmacy shops located outside hospitals. The existing hospitals should be clearly defined as primary, secondary and tertiary care level hospitals and a referral system should be put in place. A campaign must be launched to improve the overall image of the nursing profession and midwives be trained at the teaching hospitals.
The hospitals should develop committees to develop regulations, it added.
