The decision in March by the Islamabad High Court (IHC) to stop the functioning of the Pakistan Medical Commission (PMC) and order the immediate restoration of the Pakistan Medical and Dental Council (PMDC) is being hailed by many.
The background to this drama is that in October 2019, the PMDC — a statutory regulatory authority that oversees medical and dental colleges in Pakistan since 1962 — was dissolved following a presidential ordinance. It was replaced by the PMC after a powerful lobby realised it could not achieve its goals through the PMDC.
The mushroom growth of medical colleges and universities in Pakistan has been going on for several years now. Despite this, the PMDC had managed to maintain uniform minimum standards of basic and higher qualifications in medicine and dentistry. It did this by controlling entry to the PMDC register and suspending or removing members when necessary.
The PMDC also managed to stop many substandard medical colleges from being registered. The PMDC itself is governed by an all-powerful Council which oversees its functioning and is responsible for all rules and regulations that the PMDC implements.
There has been immense pressure on the PMDC Council to bend certain rules that govern the workings of medical colleges. When the Council, comprising professionals in the field as well as highly regarded academics, resisted the pressure, several ordinances were promulgated to help get things moving.
This included the PM&DC (Amendment) Act 2012, the PM&DC (Amendment) Ordinance 2013, the PM&DC (Amendment) Ordinance 2014 and the PM&DC (Amendment) Ordinance 2015. Most of these ordinances, however, lapsed.
By the time the Pakistan Tehreek-i-Insaf (PTI) came to power, there was a consensus in the medical community that things must be set right at the PMDC. The Prime Minister gave this task to his cousin, Dr Nausherwan Burki.
But instead of things improving, they became worse. A new ordinance called the PMDC Ordinance 2019 was promulgated to help certain vested interests and not the profession. During the six months of the PMDC Ordinance 2019 being in force, all the focus was to bring such changes in PMDC regulations so that staff at the PMDC could be terminated at whim.
Four council members who objected to the methodology of the inspection were de-notified by the Prime Minister without giving cause.
A new practice of inspection of medical and dental colleges was started to accommodate new entities. But this plan could not materialise when the Senate, in September 2019, rejected the ordinance.
The confusion continued, however, when despite the dissolution of the ordinance, the PMDC released the inspection reports without due approval from its Council as per rules. This caused even more heartburn in the profession. Ostensibly, to set things straight, the President of Pakistan promulgated the Pakistan Medical Commission Ordinance 2019, in October 2019.
Through this ordinance, the PMDC was replaced with PMC and all 230 PMDC employees were removed. A council of nine members was nominated with all hailing from Punjab. Of the nine, three were members of civil society.
It may be worth mentioning that prior to the latest ordinance, a meeting of leaders of Private Association of Medical Institutes (PAMI) was arranged in which an exchange of promises was made.
Immediately after the promulgation of the PMC Ordinance 2019, it came as no surprise that favourable policies for private institutions started being introduced. For example, the fee limit was removed, staff and faculty requirements were changed, a new licensing exam was introduced after graduation as well as after completion of the house job and the regulatory role of the PMC was reduced.
During a short period of three months, the PMC accorded recognition to several old and new medical colleges including many of which had earlier not been recognised by the PMDC. While the PMDC wanted to close many substandard colleges, the PMC did the opposite.
It was only after the staff of the dissolved PMDC filed cases against the PMC that the IHC took notice and declared the PMC 2019 ordinance null and void. The IHC also restored the PMDC and all employees. While this is indeed good news, one can only wonder where things will head from here. Such wrangling does not bode well for the medical profession in Pakistan.
Published in The Express Tribune, April 20th, 2020.
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