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‘Politicisation of hospitals to affect patients’

September 11, 2012

KARACHI, Sept 11: Medical experts have apprehended that patient services at the city’s three major hospitals will suffer if their working conditions are politicised following the government move to affiliate them with the newly established Jinnah-Sindh Medical University, which will function with the Sindh governor as its chancellor.

While sharing their views with Dawn about the recent move to affiliate the Jinnah Postgraduate Medical Centre (JPMC), the National Institute of Child Health (NICH) and the National Institute of Cardiovascular Diseases (NICVD) with the newly established university, the experts said that patients having certain ethnic or political backgrounds were already reluctant to visit some hospitals functioning under the provincial or local government since their inception.

In this situation, they said, the JPMC was the best among public-sector hospitals with standard emergency care in the province, providing services to people from different areas and backgrounds.“The city needs more emergency services like this one and it will be very unfortunate if patients are deprived of the only improved emergency care available in the public sector as a result of politicisation that is bound to follow the recent government move,” said Dr Shershah Syed, a senior obstetrician and former member of the Pakistan Medical Dental Council (PMDC) while referring to the conditions of the provincial government-run hospitals.

He agreed with the view that the JPMC was one of the few public sector hospitals in the city where members of all ethnic communities felt safe to get treatment and that was because the institution had remained free from provincial politics to a great extent. He said: “Given the conditions at health facilities under the provincial government, people have genuine concerns over the matter. Having said that, I also believe that the 18th amendment [to the constitution] is a fact of life and there is nothing legally wrong about the move unless the parliament brings another amendment,” he said.

The root cause of the problem, according to Dr Syed, is not decentralisation but the government policy to ignore merit and refuse to allow independent audit of its medical educational institutions and health facilities.

The government had set up a number of universities in recent years but had not taken any step to help these institutions meet the minimum criteria of a university, he said. He also criticised appointments of vice chancellors by the government while ignoring merit.

He said the government had eliminated the role of a regulatory body for medical education by dissolving the council and giving all powers to a committee of hand-picked individuals.

Seconding his opinion, Dr Idrees Adhi, president of the Pakistan Medical Association’s Karachi chapter, said that what aggravated the situation was the fact that currently there was no concept of patient rights or annual evaluation of performance at most hospitals, though a number of methods were being practised in the developed world to achieve these objectives.

“There is no outcome of dozens of meetings between the association and the provincial health authorities for an independent health commission for more than two years. There have been 200,000 deaths in the US alone on account of medical negligence so one could imagine what the situation in Pakistan must be,” he said, adding that such a forum would also help the medical community to register their opinion.On the upgrade of the Sindh Medical College, he said the government should have taken all the stakeholders on board before making any decision involving the three hospitals. “I believe that the government will have to struggle hard not only to maintain the existing standard of hospitals such as the JPMC but also to improve them.”

Dr Qaiser Sajjad, an alumnus of the Sindh Medical College who was on the forefront to upgrade the college to the university level, partially agreed to the views when he said: “The hospital undoubtedly performed comparatively well and that could be because of limited political interference, adequate supply of funds and other factors.”

However, he added, the establishment of the university was the best solution in given circumstances. “Upgrading the SMU will not at all affect the JPMC in a negative way. Instead it would enhance its status. The university has an autonomous status and the SMC alumni will oppose any decision against merit,” Dr Sajjad said.

Speaking to Dawn, JPMC, NICVD and NICH representatives said that none of them were taken on board by the government when it promulgated an ordinance affiliating the institutions with the new university.

“The NICVD is already an autonomous institution being run by a board of trustees. A major chunk of its funds is arranged by the institution itself whereas the government provides a small grant that in no way authorises it to take over the centre,” said an NICVD official.

Opposing the government move, Dr Seemin Jamali, joint executive director of the JPMC, said it should have waited for a court verdict before coming up with an ordinance.

She said: “The government move is a violation of the court order to maintain a status quo till the next hearing. We are fighting for a cause and if we lose it, patients who would be the real sufferers.”

She said it was a longstanding demand of JPMC staff that the institution be awarded a university status as it wasn’t just a hospital but a training institute for higher education. She said: “All paperwork was done to make the JPMC a university and even the Higher Education Commission approved our request in this regard. But somehow the dream couldn’t be materialised.

“The JPMC is like a mother institute that made the Sindh Medical College what it is today and so it couldn’t be brought under it,” she added.

It is worth noting here that a petition challenging the devolution of the JPMC, NICH and NICVD to the provincial government is currently pending with the Sindh High Court.