The healing touch

09 Jul 2013


A FAMOUS doctor runs a clinic set up in a house in a posh sector of Islamabad. She even carries out surgical procedures on her patients there.

The treatment area is on the first floor and since there are no elevators in the building, patients, usually pregnant women, are made to go through the ordeal of climbing highly uncomfortable stairs to the first floor. This is not the only thing; after surgery, patients are brought down to the ground floor by guards at the gate who lift the chair carrying the patient and climb down the same set of stairs.

It is akin to a tragic scene from a film when a newborn needs oxygen and everybody runs helter-skelter searching for a cylinder; the receptionist finds one somewhere and dusts it with the cloth used for dusting tables at the reception area. The doctor I am referring to is no ordinary soul. She practises in England half the year and her charges are exorbitant.

Exploitative businessmen in the garb of health service providers are no different from the notorious bhatta mafia as both of them ask for considerable amounts to ensure one stays healthy. Under the 18th Amendment, health has become a provincial subject and to ensure better coordination the government has recently formed the Ministry of National Health Services, Regulations and Coordination, but its scope and charter of duties remains sketchy.

The focus seems to be on projects like the Federal Drugs Surveillance Laboratory and the National Maternal, Neonatal and Child Health Programme, which is good, but the regulation of private hospitals is an area nobody seems to be interested in.

A regulatory body should be established under the ambit of this ministry which works with each provincial health ministry to aggressively take up the following three issues which do not require great spending, but strong will.

First and foremost is the lack of infrastructure at private health facilities. These clinics and hospitals are using humans like guinea pigs to carry out procedures without any proper facilities. During my cursory research for this piece I personally visited several private clinics in the Rawalpindi-Islamabad area and found more than 50pc to be lacking in basic facilities like oxygen cylinders, instrument sterilisation etc.

A regulatory body needs to ensure that the minimum requirements are fulfilled before it allows a clinic, where major medical procedures are to be carried out, to operate.

However, care should be taken so that the sole purpose and function of such a regulatory body does not become that of a permit-issuing entity after collecting hefty fees, or less hefty bribes, like so many other regulatory bodies in the country. The purpose should be improvement of standards and not revenue generation.

Secondly, hardly anyone points out the skewed service charges of business ventures that are mostly owned by doctors and investors who earn their money abroad and come to Pakistan to augment their income. They do so because here health laws are so lenient that they can get away with medical murder without anybody even noticing.

There is no proportion in the treatment cost and the charges. What a regulatory body needs to do is to link the charges and cost. There should be a list of standard costs for most procedures. Barring very complicated cases, most medical procedures can be covered in such a list.

The list should take into account the fact that these ventures earn reasonable profits. Also, the hospitals should be categorised based on their infrastructure, quality of human resources, contribution to research, training of employees, compensation of employees etc and charges should be in proportion to that rating.

Linked to the above, another important factor is the exploitative treatment of employees of such medical institutions. So many private hospitals, in order to evade taxes, do not offer a written contract to employees, no medical cover is provided to even the doctors working there and no annual vacations are granted. The pay is meagre and working hours are inhumane.

Health is not just another sector; it is a matter of life and death. Just as the aviation authorities have rules that limit consecutive duty hours for pilots and associated staff, the health sector requires similar measures otherwise deaths can occur. The problem with such deaths is that they do not make the headlines and the problem with us is that we take notice of only the deaths that do.

Lastly, a regulatory body must carry out annual technical audits to assess the hospitals in various categories and recommendations must be made in light of the performance of hospitals (both public and private) in the annual technical audit.

With the same party ruling in the centre and in Punjab, the largest province in terms of population, such a system of checks and balances is not a dream but can be very much a possibility. Other provinces would follow suit.

Allocating huge funds or building government hospitals is appreciable. But a bit of lateral thinking and forthright spirit is also needed to heal the health sector of Pakistan.

The writer is a civil servant.