PESHAWAR, April 30: The NWFP Assembly unanimously adopted on Wednesday its special committee report doing away with the controversial institutional-based practice (IBP). The report, however, did not mention the fate of doctors who had resigned in protest over the IBP.
The committee, which was headed by Anwar Kamal Khan and included besides 10 other MPAs the minister for health, in its signed report said the IBP had delivered no goods to the poor patients, rather it had increased the difficulties of the masses. Therefore, the report added, it was appropriate that it should be discontinued and the old system of private practice be allowed.
The IBP announced and implemented by the previous government under Governor Lt-Gen Syed Iftikhar Hussain Shah (retired) in February last year had caused consternation among government doctors who were required to close down their clinics in the wake of a blanket ban on private practice.
Several senior doctors had resigned in protest, others sought retirement on one or the other ground.
Governor Iftikhar, who had stuck to his guns in the wake of protests by doctors community, last week publicly voiced his concern over reports that the government planned to scrap the IBP.
The committee in its report, however, recommended to the government to allow private practice but at the same time devise a mechanism to curb malpractice in this noble profession in the interest of general public.
It advised that private practice should be properly documented for all purposes, including collection of taxes, etc., and consultation fee should be rationalised to the paying capacity of public and categorised for different grades of doctors like professors, associate professors, assistant professors, district specialists, registrar and medical officers.
It further recommended that the consultation fee should not be more than Rs300. It said all fees, including those for various diagnostic tests, should be fixed at reasonable rates keeping in view the poverty basis of general public.
It said the health regulatory authority under the NWFP Medical Health Institutions and Regulation of Health Care Services Ordinance 2002, should be established at the provincial level as well as at the district level that included elected representatives.
It said only qualified pathologists, radiologists and any other qualified person should be allowed to run or have share in private laboratories or X-rays, etc.
Importantly, it said, consultants should not be allowed to perform procedures in their clinics unless adequate facilities were available.
In addition to the morning OPD, it said, the system of evening OPD shift should be re-started and the government should ensure that specialists were available during the two shifts by rotation in the hospitals.
The committee said health budget should be increased mainly for supply of medicine and other facilities for general public and non-practising allowance for such doctors who were not doing private practice should also be increased.
The special committee, however, did not mention anything about the fate of several senior doctors who had resigned in protest, refusing to accept the IBP.
It simply refers to a statement by the additional law secretary, who, with regard to the re-instatement in service of doctors who had resigned or proceeded on retirement, said there was no question of withdrawing a resignation accepted and communicated to the individual concerned.
Moreover, he said, cases of officers retired on medical grounds and declared as permanently incapacitated, were considered closed for all intents and purposes.
He, however, left a way out for doctors who had resigned over the IBP, saying that if established beyond any shadow of doubt that the application of resignation was obtained through coercion and circumstances beyond his control, then that could become a valid ground for allowing the withdrawal of resignation. In this case, the additional secretary said, the period of absence would be treated as leave of the kind.
The special committee during the course of its deliberations recorded the statements of director-general health, widely regarded as the main mover behind the IBP, doctors and government officials.
Interestingly, while the secretary health and director-general health opposed the scrapping of the IBP and called for bringing in improvements, the minister for health suggested that the IBP should be done away with.
Giving details of the net income from the IBP during the nine months of its operation, the director-general said Rs213.18 million had been earned through the IBP, part of which had been utilised on the upgradation of curative and diagnostic facilities for poor patients. Rs149.22 million, the lion share of the income, he said, went to the doctors as their share in fee, Rs7.461 million went to the treasury as taxes, the paramedics got Rs21.31 as their share, while the hospitals received Rs42.63 million.
Another interesting information that was brought before the committee was regarding clinicians owning laboratories. Dr Khan Nawaz, assistant professor pathology, Hayatabad Medical Complex told the committee that a certain laboratory in Peshawar was run by a consortium of 26 clinicians while two other laboratories were run by 17 and 27 other doctors.
He said under the rules, the doctors could not send any sample or test to any private laboratories if such a facility was available in the hospital.