Health system needs a revamp

Good governance is the aspiration of every citizen, yearning to have good things of life and to enjoy fundamental rights through better service delivery. Knowing well the sentiments of the people, the political parties, international organisations and non-governmental organisations also highlight “good governance” as their first priority.

In the same flow, the main focus of the PTI during and before the election had been to provide good governance and achieve the goals of sustainable development, with a focus on human and social development. Therefore, their repeated emphasis was on not to believe in raising mega projects like motorways, metro bus services or other super structures which were considered a source of corruption — ridiculing the PML-N government. In contrast the emphasis was on setting the system right to the satisfaction of all. In this context, the correction of health, education, police and patwari systems remained high on the agenda.

Attracted with its manifesto and slogans, quite a sizable population dreaming of a better tomorrow voted for PTI.

On assuming power, the Prime Minister and his team gave a 10-year plan, setting the direction for human development. A surge of expectation occurred among the people, hoping the remodeling of the system with efficient service delivery would be the hallmark.

The party all along trumpeted of the reforms in the health sector in Khyber-Pakhtunkhwa by restructuring the whole system with new legislation in the form of the Medical Teaching Reforms Act and health insurance system. However, mere legislation for improving the system is not enough, unless the human resource is taken into confidence, motivated and properly trained to do an assigned task efficiently. Over two years have passed, while seven in K-P, the longest any party could have spent so far in that province, but the situation on ground is not up to mark — a fact admitted by the Prime Minister when saying at a recent event that he and his team were not prepared for governance.

In the words of Ahmad Faraz, ‘meray khwaab raiza raiza’, all our dreams of having a better health system were shattered with the often repeated news of resignations of senior doctors in tertiary hospitals, in particular, Lady Reading Hospital. The real test of the system is always during challenges and emergencies. Things going wrong are usually brushed under the carpet, thus they remain hidden from the public gaze. People in Pakistan generally consider a civil wrong or negligence attracting penal offence or suit for damages as a consequence of fate, as if it was destined and therefore avoid raising the issue or claiming damages.

The previous maladministration of the Khyber Hospital, causing scores of deaths due to a short supply of oxygen, amplified the inadequacies of the various tiers of governance to deal with emergencies. The most unfortunate part in our governance is that we wait for tragedies to occur, respond, remain active for a few days, and then forget about it only for business as usual to continue, till another heart-wrenching event takes place.

The wounds and scars of the deaths at KTH have not yet healed, when another patient died due to the breakdown of an oxygen cylinder at Ayub Teaching Hospital, Abbottabad.

These tragedies have brought the whole health management system to the fore in K-P amidst many question marks.

An analytical survey carried out in Peshawar cited criminal negligence, inefficiency and non-adherence to procedures and protocols as well as an inactive Secretary Health as among the major causes of maladministration. In this context majority of the doctors blamed the Medical Teaching Reforms Act, 2015 as a major problem, turning the whole system topsy-turvy. The new act was introduced without taking the main stakeholders — the doctors and health workers — into confidence. With the employees finding themselves in a quandary about their terms and conditions, running helter-skelter between the hospital administration and the health department to find a solution, no improvement can be expected. Issues of promotions, leaves, pensions and other ancillary matters cropped up due to new terms and conditions, causing anxiety among the health workers.

Another fault-line in the system is the diarchical regime in the hospital with the creation of posts of Director Medical and Director Administration overseen by the Board of Directors headed by a chairman. Things might not have gone so bad had the board not been stuffed with persons sitting abroad or outside Peshawar or the respective city. To add insult to injury, one of the board directors started micromanagement, by appointing juniors as heads of departments over senior professors, causing despondency and demotivation. Therefore, due to non-conducive conditions, a number of senior doctors resigned as they had no other option. One can well imagine how a system with a demotivated human resource can deliver.

In this connection, the other fault-line is the holding of so many offices and private practice by the same doctor. There are always human limitations; therefore, such a person cannot do justice to his or her job. Any doctor desirous of hold the position of vice chancellor, dean or principal or any other position of administrative nature should give an undertaking to not assume private practice, and the health regulatory authority should ensure that he or she does not violate this undertaking.

While coming back to Covid-19 management, the study also established that around 100 out of 2,000 beds have been spared for the treatment of Covid-19 patients at LRH. These 100 beds are not in use at the optimum level. But, the worry is that all is being done at the cost of services of the remaining 1,900 beds. Although the Covid-19 pandemic emerged a year ago, the health personnel have not been imparted training to deal with the situation. As a result, the mortality rate on ventilators in LRH is the highest.

The situation requires third party validation as well as a study by a working group consisting of members of society including the stakeholders. Rhetoric alone does not serve the people, these are practical steps that change the destiny and life of the people. In short, the whole health system needs a revamp.

Published in The Express Tribune, December 30^th, 2020.

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