The core responsibility of the Punjab Healthcare Commission (PHC) is to ensure quality in the Punjab health sector. The enforcement of Minimum Service Delivery Standards (MSDS) is the first step towards the implementation of the quality regime that a Healthcare Establishment (HCE) is required to follow. The PHC is now ushering into another phase of quality assurance through a system of Performance Assessment (PA). If MSDS are about service delivery to determine if an HCE is complying with the best medical practices in carrying out its operations, the objective of the performance assessment system, as the name suggests, is to look into the organisational performance and its effectiveness. In a nutshell, the main objective of the PHC, like any regulatory body is to improve the performance----the metric by which regulatory performance is measured and evaluated.

There are many definitions of quality, but the one given by W. Edwards Deming covers the entire spectrum of quality. What he did say was that “Quality begins with intent which is fixed by management.” Quality does not happen because somebody wants it to, or desires it to, or wishes it to. Quality results from a deliberate and intentional act of individuals, within organisations. In short, quality is a way of thinking about work.

Just like any other organisation, the ‘quality of services’ provided by a HCE is dependent as much on the optimal functionality of its equipment and processes, as on the attitude and behaviour of the workforce. In fact, it will not be an exaggeration to say that for the HCE staff, it is their behaviour and attitude that matters most. The element of ‘care’, as an integral part of services offered in the hospital industry cannot be valued against money, it can only be weighed against compassion and empathy a society fosters in its people.

In an efficient governance model it is assumed that quality is not an option but a necessity, and that regardless of the status, people deserve quality products and services, especially in areas where government’s intervention is indispensable, such as in the provision of health, education, sanitation, clean drinking water, clean energy, etc. The difference between a culture where quality is given importance and where it is taken for granted is a difference that distinguishes a lawful society from the one where rule of law is used as an exception and not as a constitutional right of the people.

Unfortunately, Pakistan over the years has been experiencing a decline in the provision of quality in nearly every field. That explains the brain drain, the flight of domestic capital and the reluctance of the investor to put money down in the country. This reluctance has been due to the governance and the economic model that supported political expediency and not excellence.

Each day we complain about the quality deteriorating. Mistreatment at the hands of police, lawyers, teachers, government offices and doctors is a common phenomenon. In the medical profession, since we deal with lives, miscarriage of justice in the dispersion of care could result in more bitter aftermath--- loss of life and limbs. Research indicates that countries where the quality of care is low, both life and trust are given least premium. The Quality Assurance Directorate at the PHC, after putting into gear the Quality Management System for the improvement of internal systems and processes, and having established a well-functioning monitoring and evaluation system, is now endeavouring to bring ‘quality of care’ into the health system. Though the mandate of the PHC is about regulating the health sector to an extent that it acquires minimum standards of quality, stopping there would not do justice with the image of the Commission built to be an entity that values quality above any other thing. However, PHC is dependent on the government’s health policy and initiatives to be completely successful in its overall goals and objectives.

The good news is that not just in Pakistan, but world over the medical industry has moved away from being an industry based on trust and partnership between the physicians and their patients to one of gentle tension between those who provide care, those who receive it, and those who pay for it. This moral crisis has become intense in the case of Pakistan because the public health sector is fragmented and workers are demoralised by development in the sector making the need for adopting the quality framework even more acute. Healthcare expenditures and population have increased manifold, but the health budget has not been adjusted accordingly. This predicament should be resolved. Usually, the blame of bad practices in the public hospitals are laid on doctors and their staff, which is not usually true. If the hospital is not provided with the required and necessary paraphernalia, how is the doctor expected to reduce the factor of morbidity or fatality. It is a two-way street.


The writer is a freelance journalist based

in Lahore.