PESHAWAR: The government teaching hospitals where Medical Teaching Institution Reforms Act, 2015 was imposed over half a year ago are yet to show any tangible improvement with regard to patients’ care owing to obstacles posed by status quo forces, court cases and established dominancy of the teaching staff.

The situation with regard to enforcement of the law is 50:50 because of infrastructural and human resource development and procurement of new equipment, but except Lady Reading Hospital others are yet to start institution-based practice (IBP), a basic concept of MTI to generate income for the institutions.

Construction of new casualty building at Hayatabad Medical and new Intensive Care Unit with motorised beds at LRH, are some good indications but patients’ care remains the same as it was prior to enforcement of the new law, mainly owing to administrative problems.

Despite deployment of managers for bed, casualty, quality assurance and promotions and hiring consultants for casualty and new equipment and a permanent medical director, Khyber Teaching Hospital doesn’t have services of director finance, procurement manager and secretary of Board of Governors.

People hold administrative posts which don’t exist under the MTI, reminding one of putting old wine in a new bottle.

The law allows only four top positions including medical director, hospital director, finance director and nursing director.

Four of the hospital directors hired from open market through a competitive process have resigned, citing personal reasons but they decided to quit owing to tremendous pressure from the top to deliver.

The hospital directors were surrounded by old people of the same institutions, who prevented them from taking action against striking employees.

In one of the teaching hospitals, a competent individual left his Rs500,000 monthly salary when he saw himself unfit in the system. In three other teaching hospitals, the hospital directors resigned owing to lack of cooperation by other tiers of the administration.

In another teaching hospital, the hospital director was held responsible for the strike of employees but support wasn’t extended to him as if he alone was responsible for it.

The hospital directors have to take care of human resources, house-keeping and all financial and administrative matters of their respective medical teaching institutions but they were neither allowed to take action against striking employees nor were supported by administrative hierarchy in other matters falling under their domain.

The imposing presence of teaching staff in teaching hospital is old and unending.

They have been the administrators, chief executives and now medical directors of the medical teaching institutions.

The medical directors, who are professors at the same institutions for years, have been instrumental in health delivery. This dominancy is unchanged.

The professors teach at the affiliated medical colleges governed by the MTI and head wards, radiology, pathology and other departments.

Legal obstacle in the shape of cases filed in courts has also slowed down progress on transition of the old system to a new one outlined in MTI.

There are also stances of challenging new law in the court and applying for posts advertised under the MTIs.

Some had challenged the law but were able to stick to important positions.

The LRH has full-fledged IBP where senior consultants examine patients in afternoon. The HMC is expanding OPD to start it. The KTH is unlikely to start it in near future.

The system of promotion of doctors and other employees has sped up and employees don’t wait for approval of directorate and secretariat for leaves and other official matters. The MTIs take decisions locally.

Published in Dawn January 17th, 2017