PESHAWAR: Incorporation of amendments to the Medical Teaching Institutions Reforms Act (MTIRA), 2015, by the government has diluted the law, which was meant to give financial and administrative autonomy to the institutions covered under the law and take independent decisions for improvement in the patient care.

The Khyber Pakhtunkhwa Assembly in December last year had approved the amendments to the MTIRA which included setting up of a policy board and authorising the health minister to issue policy directives to the health institutions.

The previous PTI-led government had passed the law under which the designated teaching hospitals were governed on the advice of the respective board of governors (BoGs) free from health department with a view to free them from political interference.

However, the amendments have paved the way for hybrid health system in which the old system and new one work together benefitting the health department to foray into the institutions that had slipped away from its control when the law was enforced.

Initially, MTIRA was implemented to enable hospitals to work freely

The MTIRA was passed by the KP Assembly in 2015 with a view to give financial and administrative autonomy to the teaching hospitals and enable the institutions to work independently under the board of governors.

However, the health department realised that during enforcement of the law in the past few years its role had been reduced to that of a post office, which only forwarded summaries for the grants required by the hospitals and medical colleges covered under the law and couldn’t interfere about the posting, transfer and appointment of staff.

Amendment in Section 7 sub-section 2 brings in the health minister’s role being the authority to which MTIs are accountable for their performance, but that same sub-section also mentions that there will be a performance monitoring format, which is seemingly not arbitrary. Still, the minister has been assigned a role which can be influenced or misused.

Sub-section 2A is more meaningful as it authorises the minister to give policy and “other” directives, which is against the spirit of MTIRA that was implemented to enable the institutions work freely. Any minister, being elected on votes, would want to seek jobs for the electorates to get re-elected in the next election.

Though the minister’s policy and directives are limited by “performance evaluation” on a monitoring format, all this creates room for the minister to intervene.

Even, these powers of minister are in clash with the powers of “policy board” formed under the newly-added Section 4-A. The powers of the minister are not unbridled, but are limited to sub-section (2) of Section 7 which states these are only for performance evaluation, and that too against a format, and he has no powers of directions regarding appointments, service structure etc.

Additionally, the amendments have created a policy board which shall determine in consultation with the government the base standard for the MTIs and its enhancement from time to time, as and when required and recommend to the government policies for improvement of the MTIs.

Previously, this was done by the respective BoG of each of the MTIs. The new amendments had given an opportunity to the health minister as opposed to the aim of MTIRA under which the institutions were required to work interpedently.

Published in Dawn, February 15th, 2019