LAHORE - Punjab is going to introduce the much-awaited Medical Teaching Institution Act in the provincial assembly for debate and deliberations, amid sound and fury by the detractors and the critics.

Across the political divide, the point of no quibble is Dr Yasmin Rashid’s stature for the position--- the consensus transcending split among the professionals and activists alike. Following extensive consultations with experts, vice chancellors of medical universities, clinicians, professors and other stakeholders, she is all set to present to the Punjab Assembly. The protests are still on, though opinion is much divided among the more vocal bodies. i.e. YDA and PMA. The proposed framework apparently seeks to address a broad range of issues and introduce a more modern, workable, performance and incentive-based model in Punjab.

Health has dominated political discourse over the past many years. Issues in healthcare have often gatecrashed development hyperbole without exceptions across the country. The governments in the past chose to stick to the more conventional mode of governance in health, not daring to go for fundamental reforms. The world has changed; reforms are due, and the more the delay, the more difficult it becomes to catch up. Though for now, it seems our moment of truth has come.

First and foremost in this new law is the freedom from secretariat. In conventional structures, all the administrative powers are concentrated in the Health Secretariat, which is where the problems begin. The last government tried it their way --- introducing companies for supplies, maintenance and services. The idea was to fast track processes, especially budgets and procurements. The other, more sustainable model is to boost local autonomy, increase ownership and decentralize power -- incentivizing the service provider and facilitating the patient in the process. As an experienced professional, Dr Yasmin Rashid knows where the rub lies. More than anyone else she knows that the discontent on the administrative scheme of things has been at the heart of poor motivation among medical professionals. The administrative powers will be vested in the Board of Governors, which will be broad based and will impel representatives from diverse range of backgrounds. Decades of clinical experience, mastery over research and academics, and long stints as administrator and as an activist, makes her inarguably the best person for this.

Under the MTI, new doctors and paramedical staff will be appointed on double the salary package, and doctors will be allowed to conduct private practices in the hospitals.

However, the doctors practicing outside the hospital will have to forego professional medical allowances from salary package. Initially, there will be a choice for healthcare professionals from the two types of service structures --- the one with better pay, and the previous one under existing rules. This will also ensure the emergence of administrative tiers from among the healthcare professionals. 

However, opposition on certain sections has been raised in the past month. The Minister has held extensive meetings with the activists who still want to bargain even a better deal.

The most often cited argument raised against the Act is that job security could be compromised as contract appointments will replace regular ones. For younger aspirants, the increase is sizeable enough to make up for this. The manifold increase meets the long standing demand that doctors are not well paid, and their salaries must be treated on special package.

Similarly, the administrative autonomy will ensure that local issues are resolved there and then. Further the long processes involving the health secretariat could be resolved for good, as much of administrative issues could be resolved at the facility.

On papers, the framework seems perfect; however there still needs informed debate and deliberations to explore areas of improvement.

As minister can understand the picture from both sides, let us keep our fingers crossed. It will surely be beneficial for the patients, the biggest stakeholders in this entire debate.