The Government of Punjab has introduced a new modus operandi to manage the health affairs in tertiary care hospitals of Punjab in the form of Medical teaching Institutions Act 2019 or MTI act 2019. MTI was enacted in Punjab as an ordinance signed by Punjab’s Governor Chaudhry M. Sarwar last month. Fearful of strong resistance by the opposition in assembly and medical staff of Punjab’s hospitals, Health ministry avoided presenting the bill in the assembly for an open debate. Punjab’s MTI act, a carbon copy of KPK’s MTI act, was designed and implemented by Prime Minister Imran Khan’s cousin Dr Nousherwan Barki in KPK previously keeping in view the model of Shaukat Khanum Cancer Hospital.
PTI’s Government, who declared Shaukat Khanum Cancer Hospital as avant-garde in Punjab’s health system, decided to follow the footsteps of it to revolutionize the healthcare delivery system in Punjab. But the policy makers in Punjab didn’t realize the difference of needs of a NGO-run charity hospital backed by a star-cricketer and a government hospital that is being managed by budget allocated by the provincial government.
Shaukat Khanum Cancer Hospital is a small setup with 195 beds and 13 billion rupees annual approximate budget as compared to Jinnah hospital Lahore that is a 1500 beds hospital but gets only 5-6 billion rupees annually by the Punjab Government.
Shaukat Khanum Cancer Hospital provides medical care to only first and second stage cancers and it refuses any patient who may have 3rd and 4th stage disease with lower chances of a better outcome. On the other hand Jinnah hospital and all tertiary care hospitals in Punjab treat each and every kind of disease presented at any stage from any part of the world. Punjab’s government tertiary care hospitals receive patients not only from Punjab but from all four provinces and the neighboring countries such as Afghanistan as well.
Government tertiary care hospitals do not refuse to provide palliative care and admits those patients as well who have been refused by Shaukat Khanum Cancer Hospital. The question is that can Imran Khan’s NGO-run 200 bed hospital that gets the largest amount of donation in Pakistan be a torchbearer for the rest of healthcare setup of Punjab which has altogether different challenges to face!
Punjab’s government without any second thought followed the model of Shaukat Khanum Cancer Hospital and enacted MTI in the form of MTI act that has faced severe resistance by the staff working in tertiary care hospitals in both provinces and has brought the Doctors and paramedical staff on roads in both provinces where PTI is in power.
MTI act has dissolved all the powers and control that the Provincial Secretariat had had on tertiary care hospitals in Punjab. Instead the Board of Governors (BoG) has been introduced that will include members from different fields of life responsible to manage the hospital, generate income and spend on patients with little financial support from the provincial government. Jinnah hospital, where I work, will have a female PTI stalwart, a retired judge, a retired professor of surgery and a business tycoon as its BoG members. Similarly a BoG will be formed at provincial level that will have the provincial minister for health, Secretary health and some other notables as members.
Since all tertiary care hospitals are semi autonomous after this act, they have full authority to generate income for hospital, acquire or remove staff on ad-hoc basis, allow private and institutionalized practice to senior doctors in evening and enact any new policy at their level with the consent of the Board. Government of Punjab has also offered all current employees of medical teaching health to either continue their jobs as employees of the institution or attach themselves with the the Punjab Secretariat at the dispense of provincial government.
The doctors and paramedical staff who have called it “Privatization” of the hospitals and started a movement against it have deliberately ignored the fine line that distinguishes a semi autonomous body from a private organization. Semi autonomous body is not tantamount to a private body and it cannot be called “Privatization”. Semi autonomous bodies have proved to be better governed with positive outcomes as compared to the government bodies. Divisional public schools in Punjab, for example, are semiautonomous schools with BOG being responsible for everything. DPS have also delivered better results than the government schools in Punjab in last decade.
A very large number of doctors in Tertiary care hospitals have already accepted MTI and are not part of the resistance. The protests that include most of the nurses and paramedical staff with only representatives of doctors associations have failed to create any mayhem. However the paramedical staff looks more anxious than the doctors. Lack of job security and accountability has made the paramedical staff anxious. MTI provides a clear modus operandi for accountability of everyone and this fear of accountability has created a robust resistance in paramedical staff in Punjab.
MTI act also empowers an institution to halt the free service delivery of healthcare to everyone all the time. It will categorize the patients in 4 stratums. Upon visit to a tertiary care hospital, patients will be divided in 4 categories; the deserving, the entitled, the insured and the affording. However the Government and the tertiary care health department has not shared any data of how the hospital will treat these patients in a different way. What I assume is that the deserving will get most of the facilities free of cost to some extent, the insured will be covered by their insurance schemes, the entitled will also avail free services being Government employees and the self-affording will only pay for their stay in a hospital. Though the government has not announced any criteria for such division to this moment and it is suspected to end up in increased prices of all blood tests and surgeries in hospital that are free of cost at the moment.
In relevance to free treatment and massive health insurance plans, Government of Punjab has also launched Sehat insaf card, a health insurance scheme that will provide free insurance up to 0.7 million rupees to lower class of Punjab. It will shift the burden of patients from tertiary care hospitals to private hospitals. This is a marvelous step which has opened the doors of private hospitals for the poor. But this scheme will benefit only those 20 percent of Punjab’s population who visit Government tertiary care hospitals. The rest of 80 percent population of Punjab that avail private health facilities will have nowhere to go since they may not fall neither in the “deserving ” category of the hospital nor eligible for sehat insaf card.
However MTI would have been much better if the government had constructed new tertiary care hospitals, consulted the stake holder organizations of doctors and paramedics and improved the current situation of tertiary care hospital services before enforcing MTI in Punjab.