Healthcare reforms

September 20, 2019


HEALTHCARE delivery is an ever-expanding and always changing system. Unfortunately, poor governance, lack of long-term planning, absence of monitoring and evaluation and population growth at the rate of 2.4 per cent has overshadowed any improvement in public health sector.

The Punjab Medical and Health Ordinance was promulgated in 2002 when Prof Mahmood Ahmad Chaudhary was health minister. It was a serious attempt to devolve powers and give self-rule to tertiary level medical institutions for improving healthcare. The attempt did not produce desired results.

The present government after a lapse of one year has now focused on tertiary hospitals. The Punjab Medical Teaching Institutions Reforms Bill 2019 is a step forward. It consists of one Provincial Policy Board (PPB) for overall supervision and the other multiple boards of governors (BoGs) for local administration. Presently, the role of PPB lies with the health secretariat.

The success of the new bill will depend on some of the following factors: PPB and BoG members must have a clean record. Representatives of vested groups should be avoided. Previous experience of members of BoG failed as most of them were from elite classes like generals, bureaucracy, judiciary or businessmen. They were not conversant with the healthcare system or problems of health institution or patients and service providers.

The selection of directors of the institution should be on merit and on previous achievements. The aspirants from the present lot in service should be avoided. Only competent professionals from the local market or from abroad should be hired.

There should be regular monitoring and evaluation and clinical audit by a third party followed by an appropriate action.

The contract system is popular throughout the world, except Pakistan. It was distorted by the bureaucracy when the salary of contract staff was reduced. In fact, contract staff with no service protection must be paid higher wages but liable to immediate termination on misconduct, corruption or failure to achieve targets.

Genuinely poor patients must be protected with maximum facilities at lowest costs and with respect.

Dr Anwaar Ahmad Bugvi

Published in Dawn, September 20th, 2019