PESHAWAR: The powers enjoyed by board of governors at medical teaching institutions have been hampering successful enforcement of Medical Teaching Institutions Reforms Act, introduced by government to improve patient care in Khyber Pakhtunkhwa, according to public health experts.

They said that law was also meant to free teaching hospitals and their affiliated medical and dental colleges from political and bureaucratic influence but there was no check on the powers enjoyed by board of governors (BoG).

Since 2015, the government has enforced MTIRA in 11 teaching hospitals, which are now run by their respective BoGs. The members of these boards are nominated by search and nomination council, headed by health minister, from private sector and notified by chief minister.

The MTI-covered hospitals have slipped out of the control of health department and BoG calls the shots. These hospitals get one-line budget from government and utilise the same as per their own requirements. There is no government’s oversight on BoG. The members of MTI-Policy Board, which is supposed to oversee the operations of MTIs and issue them guidelines, are also selected from private sector, according to health experts.

MTIRA architects oppose audit of medical teaching institutions

As per MTIRA, BoG appoints executives, including dean, medical director (MD), hospital director (HD), nursing director (ND) and director finance (DF) for five years to run MTIs. BoG has the powers to remove any of them anytime.

The chairperson of BoG, in case of exigency of service, appoints persons on officiating basis for a period of three months if any of these positions falls vacant before completion of their stints. Last year, an ND was assigned officiating charge of dean at Last Reading Hospital which drew immense criticism.

The architects of MTIRA have incorporated score of amendments to the law further tighten grip over MTIs. According to the law, dean, HD, MD and DF are eligible for re-appointment. Critics of the law say that it is clear temptation as people working on such positions will obey all the directives of BoG to get appointed again for five years.

In recent past, few deans have been re-appointed after completion of their five-year terms without advertising the positions. The law says that BoG members should have no conflict of interest but it hasn’t been elaborated and needs to be explained.

The chairman of BoG is directly appointed by chief minister and enjoys unbridled powers. Recent appointments in many MTIs have brought to spotlight appointments to top as well as lower positions where the role of interview panels has been criticised.

The opponents of the law say that there should be complete audit of MTIs since 2015. So far the architects of MTIRA have opposed the audit, saying they will conduct the audit through third party. Nevertheless, all departments getting public funds from government undergo audit by Auditor General of Pakistan every year.

The Act says that except as otherwise expressly provided in this law, no suit, prosecution or other legal proceedings shall lie against BoG, Policy Board or against any authority, for anything which is, in good faith, done under this Act or the rules or regulations made thereunder.

“It means any financial irregularities/recruitment etc made through policies of board cannot be challenged in the court,” said experts.

The law says that government may vest powers/functions to chairman of Policy Board/BoG under the rules, which are not inconsistent with the Act but the term inconsistent has not been defined in clear legal or technical terms.

It says that BoG may make rules/regulations not inconsistent with Act, which gives an impression that the board can implement harsh policies as it is given powers even to violate the law. Public health experts say that the law should be amended to allow dean, MD, HD and DF to work independently.

Published in Dawn, April 29th, 2026