IN the annals of Pakistan’s administrative failures, the healthcare reforms introduced by the government in Khyber Pakhtun-

khwa (KP) a few years ago will stand out even among the worst. At the centre of this disastrous experiment was the Medical Teaching Institutions (MTI) Reforms Act. Apparently, it was meant to modernise healthcare delivery in KP, but what unfolded was a systematic dismantling of public-sector hospitals, a culture of institutionalised humiliation of senior medical professionals, and the rise of an unaccountable, centralised bureaucracy under the guise of ‘reforms’.

Those behind the move, some of them living abroad, clearly failed to understand the difference between private-sector healthcare models and the realities of public-sector institutions in Pakistan. In a country where millions rely on public healthcare due to poverty and lack of insurance, replicating private-sector efficiencies without ensuring foundational support systems was an invitation to chaos. And chaos is precisely what unfolded.

The MTI Act, passed and enforced without adequate stakeholder consultation, placed extraordinary powers in the hands of Boards of Governors (BoGs) that were handpicked by the KP government.

This legal cover allowed the BoGs to override institutional hierarchies, bypass service rules, and make arbitrary decisions, like assigning the charge of the dean of the Lady Reading Hospital (LRH) in Peshawar to a nursing director, or giving a hospital director the additional role of medical director.

These were not merely administrative faux pas; they were violations of funda-

mental service structures and principles of merit, endangering patient care and the overall quality of medical training.

Once a prestigious training ground for postgraduate medical professionals, LRH was subsequently de-recognised by the College of Physicians and Surgeons Pakistan (CPSP), while Postgraduate Medical Institute (PGMI) associations severed links, citing dysfunction and lack of academic integrity.

All this happened because juniors and political loyalists were elevated to top-tier administrative and clinical roles. Their appointments were based not on qualification or merit, but on allegiance to a particular political narrative.

The outcome was a toxic work environ- ment where senior professionals were sidelined, decision-making became opaque, and corruption reached unprecedented levels.

There are countless anecdotal and documented instances where senior doctors were removed from their positions without cause, humiliated in front of their juniors, or forced into retirement through vague notices. This culture of coercion and fear has driven talented professionals away, and has permanently damaged doctor-patient relationship, institutional trust, and the morale of the workforce.

The MTI Act granted legal protection to BoGs and their decisions. As a result, contracts were issued and revoked at whim, departmental promotions were frozen, and service seniority was frequently ignored. The law was used to shield malpractice, institutional overreach and nepotism.

Moreover, healthcare professionals were promised autonomy, efficiency and dignity under the MTI Act. Instead, they got autocracy, administrative paralysis and widespread demoralisation. Truly, the whole episode would one day be taught in public policy and health administration courses, not as a model of reform, but as a cautionary tale of how ego, political loyalty and misunderstanding of ground realities can destroy entire systems.

It is time to repeal or radically restruc- ture the MTI Act, investigate all the appointments that were made under it, and hold those responsible to account for wilful and systematic destruction of KP’s public health system. Only then can we begin to rebuild what has been broken.

Dr Sahibzada Afsar Ali
Peshawar

Published in Dawn, August 15th, 2025