LAHORE: The standoff between the young doctors and the Shahbaz Sharif government continues to affect healthcare services across Punjab. The stopgap arrangement — induction of new medics, asking a few hundred senior doctors to work overtime and deployment of some 150 army doctors, etc — in public hospitals has had only a small impact, given that the province is faced with the absence of some 22,000 striking doctors.

The government imposed the Essential Services Act followed by the Sunday-night swoop on a YDA meeting in Lahore. Many young doctors were arrested which only exacerbated the situation.

Young Doctors’ Association (YDA), which is fighting for a service structure and better pay and is the force behind the two-week strike at the hospitals, seems determined. It asks the government to release the arrested doctors, withdraw cases and apologise publicly for its action before doctors return to their jobs to “provide emergency services only”.

A complete end to the strike is conditioned on the government’s acceptance of YDA’s ‘minimum demands’: future induction of medical officers in BPS-18 instead of BPS-17, enhancement of the stipend for postgraduate residents and increase in the doctors’ health professional allowance. The total cost of these demands is estimated to be Rs4 billion a year.

Caught between the government and the striking doctors are the poor users of the public healthcare facilities. Many deaths have been blamed on a lack of proper treatment in the wake of the strike. While their repeated strikes – it is the eighth major strike call by the YDA since its formation in 2008 – have cost the young doctors public support, the government also has drawn flak for its poor handling of the situation.

The YDA came into existence in 2008 following the suspension by the chief minister of some women doctors of Mayo Hospital, Lahore, over alleged negligence. A group of young doctors protested the order and got their suspended colleagues reinstated.

This emboldened the young doctors: they could force the government to bow before them by using their street power.

Since then the YDA has led a series of strikes. In October 2008, the YDA Punjab launched a province-wide strike for a week for a raise. The monthly salary of a house officer then was Rs12,000 and that of a postgraduate resident Rs15,000. The demand was accepted and salaries doubled. Then last year’s 37-day strike forced the government to again raise their pay.

The salary of a doctor in BPS-17 was enhanced to Rs42,000 to Rs44,000 and in BPS-18 to Rs52,000 to Rs54,000. A committee was also formed to look into the demand for a service structure, transfer and time-scale promotion to senior grades. But no progress was made on the issues – doctors say because of opposition from the bureaucracy.

Service structure

In April this year, the transfer of 691 young doctors to the district level health facilities was seen by the YDA as part of a plan to weaken it. Yet another agitation ensued. The YDA said it was not opposed to transfers but these should have been done under a formal service structure which was being denied to them. The order was reversed after a week-long strike and another committee set up on May 7 with Khwaja Salman Rafique, the special assistant to the chief minister on health, as its chairperson.

The service structure proposed by the committee for all cadres of doctors was rejected by the health bureaucracy. Objections were raised against the demands for a universal one-scale upgrading, provision of official residence and cars for doctors in BPS-20 and 21 and increase in health professional allowance and stipend for house officers, medical officers and postgraduate residents because of a “massive financial impact of Rs423bn a year”. In response, the YDA first scaled down its demands to a point where it would cost Rs33bn and then the price tag was reduced to Rs6.2bn.

The scale upgrading remained a divisive issue and the health ministry objected, prompting the YDA to call another province-wide strike last month.

The strike began on June 18 but the doctors continued to provide emergency and critical care services. The government, however, told the YDA to call off the strike unconditionally before a dialogue could be initiated and launched a media campaign that dubbed the striking doctors as murderers and highlighted incentives given to them over the past four years.

There are an estimated 14,000 posts of BPS-17 doctors, 7,200 of BPS-18, 2,600 of BPS-19, around 600 of BPS-20 and 7 posts for BPS-21 doctors in Punjab. The bureaucracy says that after one-scale upgrading, the health department would have 2,600 posts in BPS-20 and 600 posts in BPS-21, posing a serious threat to the existing health hierarchy in the province. The health department’s top post (health secretary) is in BPS- 21, while usually an official of BPS-20 is appointed as secretary. In the existing situation the demand for BPS-22 for the doctors was not acceptable to the health department. The district management group (DMG) officials in other departments also endorsed this view which is suspected to have played a big role in preventing a deal between doctors and the government.

Legal hitches

“They have made a habit of agitating every two months,” says Khwaja Salman Rafique. “We have promoted 600 doctors, increased the number of posts to remove the backlog of stalled promotions, raised their salary bill to Rs24bn a year from Rs8bn in 2008. How can we keep increasing their pay? There are hundreds of thousands of other government employees. They would demand the same.”

Besides, he says, there are some legal hitches in the acceptance of some of the demands like one-scale-upgrading. “This simply cannot be done,” he says and urges strikers to resume work unconditionally.

Dr Aftab Ashraf, the Punjab YDA press secretary, argues: “Is it a crime if we are asking for a service structure to govern our appointments, transfers and promotions? Today if you do not have the right connections you are stuck in BPS-17 for 20 years in a remote area. There have been doctors who were appointed in BPS-17 and retired in the same grade after spending a lifetime in the service. Our fate lies in the hands of a BPS-16 section officer.”He says the YDA in its meeting with senior doctors sent by the chief minister on Sunday had agreed to scale down the demands to a point where these would not cost the government more than Rs4bn.

“The same night the police attacked our meeting and arrested our people. We are not going to call off the strike unless our demands are met, arrested doctors released and those terminated from services reinstated,” he says.

Dr Izhar Ahmed Chaudhry, a leader of the Pakistan Medical Association, says it is wrong to compare doctors with other government employees.

“We are on call 24 hours a day and work under stressful conditions,” he says. “The federal government has already accepted this and allowed special grades for doctors working in its institutions.”

60-year-old demand

Medical Teachers Association (Punjab) general secretary Dr Tehseen Riaz says the young doctors are fighting for a 60-year-old demand of medical professionals. “The government has money for distributing free laptops and for sasti roti schemes. It has no money, no service structure for doctors. The government could not break the resolve of the striking doctors but instead it has shattered the entire public healthcare system.

Dr Hasan Askari Rizvi, a Lahore-based political analyst, is also not amused by the way the chief minister has handled the issue: “A good administrator always anticipates the consequences (of his actions). When the Punjab government let the police loose on the striking doctors it thought the action would scare them and they would return to work. That hasn’t happened and the government doesn’t have a long-term strategy to cope with the emerging situation.”

According to a senior doctor considered close to the PML-N: “Instead of talking to the striking doctors, the Sharif government chose to threaten them and ran a media campaign to demonise them.

“This is not the way of a political government. Last year, ultimately the chief minister sat with the doctors and the matter was resolved in 15 minutes. I guess he will do it again but only after more lives have been lost and the patients have suffered much more.”