July 17, 2008	Thursday	Rajab 13, 1429

KARACHI, July 16: The boards of governors installed over the past few years in four teaching hospitals being run by the provincial government were dissolved on Wednesday when the government withdrew a relevant notification with immediate effect.

Three boards of governors, which managed the affairs of four hospitals — Lyari General Hospital, Civil Hospital Karachi, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, and Ghulam Mohammad Maher Hospital, Sukkur — for around three years, stood dissolved with no legal standing under the latest notification issued by Sindh government’s health department.

According to the notification issued on July 16, an ordinance, which authorised a board of governors to act as the principal governing body of a government health institution and its administration and management, stands lapsed now. “With the approval of the competent authority, the chief minister of Sindh, this department’s (earlier) notification – dated June 16, 2005 – to constitute the boards of governors in all teaching hospitals of Sindh government is hereby de-notified with immediate effect.”

After developing consensus among the high-ups, an ordinance titled, “The Sindh Health Institutions (Establishment and Management) Ordinance, 2005”, was promulgated by Sindh Governor Dr Ishratul Ibad Khan on August 1, 2005. The ordinance aimed at giving autonomy to the health institutions in Sindh for provision of quality and affordable health care to all sections of society.

However, it took the government about six months to install the first board of governors (BoG), headed by a chairman selected from a list of retired personnel of the bureaucracy and judiciary, at the Civil Hospital Karachi and Lyari General Hospital. The delay in appointment of a highly paid chairman and a finance director for each of the BoG, according to the health department’s insiders, could be attributed to the traditional hassles in the bureaucracy and lobbying on the political fronts. The government was yet to install a BoG at the other two teaching hospitals in the province, said a source.

Subject to control and directions of the government, each board of governors was supposed to act on the administrative and managerial fronts in the shape of a chairman to be appointed by the chief minister and government officials and private sector representatives as its member, as provided under the ordinance that was promulgated last time for another six months on December 27, 2007 with a retrospective effect from October 24, 2007.

However, the idea of constituting a board of governors to minimize the government’s influence in the working of health care institutions while ensuring marked improvement in the efficiency of employees and transparent utilization of funds and other resources available with them did not work accordingly.

The boards failed to perform either due to lack of commitment of their chairpersons and members to the cause of public health or because of the indifferent attitude of the then existing hierarchy at the government hospitals, the source said, adding that even a former health minister, at one stage, had to say that the boards of governors were doing nothing practical.

Before the installation of the BoGs, the teaching hospitals were authorised to procure 25 per cent of the required medicines while 75 per cent drugs for the hospitals were procured by the health department. However, in wake of the BoGs and their formal functioning, the entire government funds meant for the procurement of medicines and utilization for other purposes were completely given at the disposal of hospital management.

In view of the latest government notification, some quarters have expressed concerns that there is a likelihood that the government’s policy of devolution and “measures taken, so far, for the improvement of the hospitals’ working will be hampered”. However, there is a general feeling that the BoGs were not delivering despite being in a position to approve the overall plans, policies, programmes as well as development and non-development budget of the institutions in relation to the approved government policy. The boards were empowered to examine and approve the annual and evaluation reports of their respective institution for submission to the government, consult the national academic bodies and other relevant statutory bodies or the government, where necessary, and ensure that government servants are provided treatment according to their entitlement.

A source privy to the process of annulment of the 2005 notification regarding the board of governors said the health minister was concerned over the affairs of the boards in general, and the CHK’s and LGH’s in particular. The minister is of the view that if the BoGs had shown interests in addressing the grievances of patients and their attendants by executing the renovation, improvements of the existing facilities and execution of the much emphasized federal government funded trauma and emergency centre the things would have stood changed remarkably at the civil hospital.

Referring to the CHK affairs, the source said that there were differences even within the ranks of its board of governors.

A group of private members in the CHK’s and LGH’s board of governors, addressing a press conference in March 2008, had said that the board was unable to perform up to the mark and act as per the related government charter due to ‘unfavourable conditions’.

The group had stated that the board could not attain the status of a true autonomous body because both the doctors and the bureaucracy on occasions did not accept the board wholeheartedly.

“We felt that there was a dire need of getting hundreds of sanitation, security and nursing staff on a contract basis against various vacant posts, but failed to do anything positive as were told by the BoG’s chairman to toe the policy practised by the Sindh government only.

“Had there been initiatives and sincere follow-ups on the decisions and resolutions reached at various meetings of the BoG the things would have stood better and could save us from embarrassment for a ‘failed-like situation’,” the members had reiterated, indicating that if corrective measures were not taken, they might dissociate themselves from the board.

Commenting on the government’s latest decision, a senior health official said the forum was introduced under political expediencies though there remained very little chances of its revalidation, as all the top government hierarchies and political quarters had been consulted before reaching to the disbandment decision.

Minister’s views

Sindh Health Minister Dr Sagheer Ahmad told Dawn that the decision was part of a government strategy to get the health care delivery system improved in the real sense and provide practical relief to the ailing masses.

In reply to a question about any alternative to the BoG system and teaching hospitals’ future, Dr Ahmad said the terms of business at the CHK and the three other hospitals would remain as they were before the installation of the boards of governors. However, he said, he would ensure that some sort of monitoring remained in place in the shape of some advisory team comprising honorary members only. “We may also think over the matter that the overall control, direction and supervision of the affairs of the hospital should vest in a medical superintendent or some new mode of delivery of services be developed,” he added.

Sindh Health Secretary Shafiq A. Khoso said the BoGs running the affairs of teaching hospitals would cease to function and the hospital management would be reverted to the medical superintendents of the hospital concerned and the Sindh health department from July 17. “The chairmen or the members of the BoGs will not intervene further in the affairs of the hospitals,” he added.