Pakistan is not a failing state, but the prediction is certainly true about many of its institutions. The decline in education and health sectors is an example. There has been a wilful neglect by successive governments to cater for the increasing demands of the students and the vacuum has been filled by unbridled growth of commercial enterprises in primary up to higher education levels. Medical education offered an even more lucrative field with fabulous tuition fees from the local students and more than thrice the amount from overseas Pakistanis and foreigners. It has become a billion rupee industry attracting unscrupulous entrepreneurs whose sole purpose is to make easy money. The Aga Khan University had created an excellent role model, but it has not been emulated.
A mushroom growth of private medical and dental colleges has taken place in the country. Most of them have makeshift buildings, poorly equipped labs and equally impoverished affiliated hospitals lacking the required number of beds and other teaching facilities. Some without a hospital of their own acquire beds on rental basis at considerable distances from the college premises. The arrangements are entirely unsatisfactory. The public sector too has lately opened up colleges in every other town affiliating the District Headquarters hospitals without upgrading their infrastructure. The establishment of more institutions was, indeed, a requirement, but it should not have been done without proper projections and certainly not at the cost of quality.
The rot in the once internationally acclaimed standard of medical education in Pakistan was initiated by the opening of seven unplanned medical colleges with one stroke and simultaneous manifold increase in admissions in the old as well as the new colleges during the seventies. It was compounded by political gimmicks like 50 percent option permitted in the professional exams by the then Governor Ghulam Mustafa Khan as the Chancellor of Punjab University, which was immediately followed by suspension of recognition of our degrees by the UK General Medical Council.
The overwhelming indulgence of medical teachers in private practice was an additional factor. The collapse has been completed by the glut of new colleges. Surprisingly, the results of the University of Health Sciences as well as universities elsewhere consistently show pass percentages of more than 90 percent in the examinations held by them. The quality of the bulk production of graduates by these factories was bound to be poor.
The overall blame for the predicament lies squarely on the shoulders of the Pakistan Medical and Dental Council (PMDC). The Council is a statutory body having the sole mandate of regulation of medical education in the country has utterly failed to carry out the task and its credibility has become highly controversial. It has granted recognition to more than a hundred new colleges without instituting a mechanism for quality assurance.
Most of them are substandard, not fulfilling even the minimal criteria for accreditation. It is being blamed for incompetence, mismanagement and, above all, for financial corruption. There is no transparency and allegations of shady deals keep circulating. Its inspection teams turn a blind eye to glaring deficiencies, conniving at fictitious figures presented to them and acquiescing to the irregularities being perpetrated by both the private and public sectors.
Similar malpractices are said to be prevalent in the registration of fresh graduates, eligibility certifications and examinations for equivalence of foreign diplomas. Several functionaries, including its secretaries and registrars, have been arraigned and arrested on charges of misconduct.
The PMDC has become dysfunctional, as an institution and is irrelevant to the modern challenges in its present format. Its membership is unwieldy and disproportionate. It is totally dominated by the private mafia and has lost the capability to enforce its rules and regulations. Its future vision of “becoming the world’s leading medical regulatory authority” is certainly no more than a pipedream. The disenchantment with its performance has led to demands in Punjab and Sindh for setting up provincial regulatory authorities and proposals for its bifurcation into separate bodies for medical education and registration. Incidentally, the Indian Medical Council was in a similar mess a few years ago when its President was sent to jail on charges of taking bribes for recognition of private colleges. The body was promptly revamped under new legislation.
The warnings of saner elements in the profession have gone unheeded, allowing the situation to drift to an alarmingly low level. The moratorium imposed a couple of years ago is not enough. The cases of all newly-recognised colleges shall have to be re-examined in a transparent manner and the officials involved be made accountable for their misdeeds.
The PMDC requires fundamental changes in its statute under a radically revised charter. The main plank of the agenda is downsizing and proportionate representation in its composition. The total number should be reduced to a third of its present size consisting of 30 percent each from the public and private undergrad medical colleges and 10 percent from dental colleges, 10 percent postgraduate institutes, 15 percent peers in the profession, 4 percent Pakistan Medical Association 1 percent Dental Association and 5 percent civil society with Federal DG Health, provincial health secretaries, a member of Parliament and a nominee of Supreme Court or Bar Association as ex-officio members.
The provinces shall be represented on the basis of the existing numbers of their teaching institutions. The peers nominated by the government should have no current association of any kind with a teaching institution. All members and the President elected by them should have a onetime tenure of three years. Half of the inspectors shall be appointed from outside the council.
The council is incapable of performing multiple functions. It has, therefore, become obligatory to establish separate organisations for registration and re-accreditation and licensing under the Continuing Professional Development Protocol.
The reforms suggested are only a part of the overall agenda. The new government should initiate the task by appointing an expert advisory panel for formulation of comprehensive proposals, as a priority in its National Health Policy Planning.

 The writer a retired lieutenant general, professor of Cardiology, former executive director and chairman of NICVD Karachi and Sheikh Zayed PG Int Lahore.