THE Pakistan Medical and Dental Council (PMDC) is once again in the limelight, unfortunately for negative reasons. An ordinance signed last week by the president (himself a dentist by profession), who should have understood its implications better, provides for the constitution of a 17-member council to run its affairs. The PMA, the body that represents the doctors, has rejected the ordinance on the grounds that it is ‘undemocratic’.
The document provides for members of the PMDC being nominated by the prime minister, the chief ministers of the four provinces, the College of Physicians and Surgeons Pakistan (CPSP) and the armed forces. Its tenure will be for three years and it will elect its own president. Its composition is diverse with some laypersons also being included to represent the public in addition to the medical professionals. The sceptical response from some quarters is understandable. It is feared that the ordinance will allow some vested interests to monopolise control of the PMDC for their own advantage.
The fact is that the PMDC has had a controversial history from the start. It was introduced by the Ayub regime in 1962 through an ordinance and since then has mostly depended on ordinances for its existence. On some occasions, the government of the day (the PPP in 2012 and the PML-N in 2014) brought the PMDC issue before parliament for enacting a law but that was jettisoned by a subsequent ordinance. The approach has basically been an ad hoc one.
The PMDC has had a controversial history from the start.
This is an indicator of the scant public interest in social welfare issues and the tendency to abdicate responsibility to the powers that be. Previously, no one seemed to care what was happening in the health and education sectors in Pakistan. It is only in the last few decades that the PMDC has started receiving greater attention than before. This is the period when medical education in the country came to be privatised in a big way.
As is the wont in Pakistan, privatisation brought with it the curse of commercialisation. The PMDC, being the regulatory body for medical education (and which also certifies doctors), came to play a pivotal role in deciding how medical education should be organised. In other words, it determines which medical universities fulfil the criteria that have been spelt out to ensure quality education for the students. In the process, it was also discovered that medical education could be made a source of lucrative income if one turned a blind eye to quality and cut corners to produce quick results.
Bizarre measures were taken by the PMDC, such as recognising medical universities without an attached teaching hospital, a full-time highly qualified faculty or proper laboratories. Over and above this, the fee was pitched high. There followed an influx of students whose parents had the wealth but they themselves did not have the qualifications to gain admission in the proper course. Thus standards were lowered. At one time, there was an attempt to introduce afternoon shifts in universities to increase enrolment. But this move was scuttled. If it wanted, the PMDC could have pre-empted this attack on medical education in Pakistan. It did not for obvious reasons, and allegedly became a party in these shady deals.
Small wonder then that control of the PMDC has become a coveted goal of those seeking lucrative returns from medical education. Thus this regulatory-cum-licensing body has come in the eye of the storm. The standard of medical education in Pakistan, with some exceptions, has declined while malpractices by doctors have been on the rise.
The new ordinance has been issued ostensibly to strengthen the PMDC and thus to enable it to check these ills. Will it? Experience shows that when a body is democratically constituted, the concentration of power is not possible and misuse of power by its members is checked. In the present case, five of the members will be nominated by the prime minister, one each by the armed forces and the CPSP and 10 by the four chief ministers. They will represent civil society, basic and medical scientists from the public sector and the private universities. The PMA and family physicians, who form the backbone of the health sector in Pakistan, will not be represented at all.
If this ordinance survives the parliamentary challenges it is bound to face, time alone will indicated the vested interests that stand to gain from such a nominated body. It is apparent, the troublemakers — the PMA being the main one — have been kept out to allow the vested interests to have a free hand.
It is important that the government should consult all shades of opinion in such technical matters so that everyone stands to gain. For the last year or so, an interim body has been managing the PMDC’s functions. The new one does not give the appearance of being a permanent solution.
Published in Dawn, January 18th, 2019