Systems dont work for individuals and laws are not made for exceptions but for the masses. Since 1947 administrative and financial powers when it comes to public hospitals rests with secretariat and single secretary has the power to run every hospital in the respective province. Everything in health sector is under the command of a Secretary. Since PTI formed government in Khyber Pukhtunkhwa in 2013 and came up with Health Reforms which are also referred to MTI (Medical Teaching Institute) Reforms Act, the government has faced lot of hurdles in implementing the reforms in its true spirit. But after launching a pilot project of MTI Act in KPK now Pakistan Tehreek e Insaf and PM Khan’s team takes the MTI Reforms Act to Punjab province.

Dr. Yasmin Rashid the provincial Health Minister for Punjab has worked extensively on health reforms in Punjab. MTI Act in Punjab has been formulated in more than 32 meetings after the consultation with numerous stake holders including Vice Chancellors of medical colleges and universities, Young Doctors Association, Medical superintendents of teaching hospitals, professors, doctors and social activists. It took PTI government more than six months to formulate the draft of the Act and it has been reviewed five times in the light of recommendations from all stake holders in KPK and Punjab. When I asked about the hindrances PTI government may face in Punjab province while implementing these reforms like it has been facing in KPK, Special Assistant to Prime Minister Iftikhar Durrani said, “Government is committed to resist every hindrance that stops them from implementing this law. Any objections or reservations to this law can only be addressed through proper dialogue and discussion. No one is allowed to hold the system hostage to record their protest.” 

Dr. Zafar Mirza, State Minister for Health, has been witnessed visiting public hospitals in Islamabad to observe the quality of services several times since he took charge of the office. He also accompanied Prime Minister Imran Khan to DHQ Hospital Sargodah. Dr. Zafar Mirza who worked in various countries responsible for health system development when asked about MTI Act and best thing about this Act, He said, “The best thing about MTI is that it will bring decision making within the institution, it will bring transparency and accountability, and efficiency in managing the affairs of the hospital locally.”

Dr. Zafar Mirza pointed out some flaws that will be fixed through the MTI Act, saying, “Currently the hospital management or the executive director of a hospital do not even have the power to hire or fire a doctor. For every hiring a file is made, it goes to the ministry, it keep making rounds from one officer to another. Things are delayed and are inefficient. Hospital management cannot decide if they want to expand hospitals in order to address the needs of the people, merit is not taken into account. So once MTI is implemented Board of Governors will be selected in a meritorious way and they will make these decisions. Government will keep supporting these hospitals financially, will provide grants and they can manage their resources. 240 hospitals in Pakistan have been taken on board when the PTI government distributed Sehat Insaf cards to people but all these hospitals are private.” Dr. Mirza said, “When poor patients come to public hospitals they are provided with services free of charge but they have to incur lot of expenses. They have to get their investigations done from outside, sometimes they also have to buy medicines from private pharmacies so once these people are given health insurance in these public hospitals then they will be financially protected.”

What is MTI Act? MTI Act will enhance the professional capacity of the public hospitals in both the provinces KPK & Punjab. The hospitals will be autonomous administratively and financially and would be free from any political influence. It ensures the availability of 24hrs emergency services as well as the availability of free medicines and services at all the public hospitals. A third party monitoring system has been introduced to audit the public hospitals and to keep a regular check. MTI brings a new concept for doctors to shift their private practice from private clinics to the public hospitals and it is called Institution-Based Practice (IBP).

How MTI can help?  For example, If a hospital would need an X-ray machine, hospital will have its own budget and hospital can buy it within a day. What used to happen before MTI Act was that hospitals used to request the secretary for any kind of equipment or budget and then after days or weeks of delay the request would be processed and then the equipment would be provided to the doctors to facilitate the patients.

Whats happening in KPK?   Under MTI Act every hospital will have its Board of Governors and decision making would take place at the institution instead of secretariat. Powers will be shifted to the hospitals and there would be a decentralized system. Board of Governors of Lady Reading Hospital, Peshawar is headed by Dr. Nausherwan K. Burki. Dr. Burki is also called the Architect of PTI’s Health Reforms and is heading the Task Force for Health Reforms in KPK. He is a founding member of Shaukat Khanum Memorial Cancer Hospital.

Audits  Peshawar’s leading and one of the biggest public hospital Lady Reading Hospital’s Cardiac Surgery ward was audited under MTI Act by a third party, that found mortality rate of Cardiac Surgery was 36%. Which means one out of 3 patients was dying which is against the international standards. When doctors were asked for an explanation they said they were not having required equipment and supplies. With MTI Act comes the accountability of doctors. Everything in Pakistan is political. Accountability of doctors have never been our priority and when uniformity, merit and accountability comes a group of people will always stand up and start a campaign against the change.

Transfers: Students come from tribal or under developed areas get admissions in government medical colleges like Khyber Medical College by having a domicile of those areas on a special quota where their education and medical degree is subsidized by the government but when it comes to serving people there they just don’t want to go back. 73% positions in government hospitals and dispensaries are vacant in the peripheries and there are no health facilities because everyone would want to work in hospitals in Peshawar. Under MTI Act they are supposed to spend at least two years in their stations where they obtained their domiciles. What happens is that when doctors aren’t available in smaller districts or villages then those patients come to Peshawar and this is the reason public hospitals in Peshawar are over burdened.

Pay Scale: Category A: Peshawar (Rs. 105,000), Category B: Karak, Bannu, Kohat etc (Rs. 135,000) & Category C: Shangla, Torghar, D.I.Khan, Tank, Swat and Swat’s suburbs etc (Rs. 175,000). Accountability & Transparency: With MTI Act, appointments could be challenged for example the appointment of KMC’s Dean has been challenged in court as there were anomalies found in his appointment.

Advisor to Health Minister, Dr. Wasif said, “Two cardiac surgeons are coming back to join Lady Reading Hospital from the UK, the system has started to flourish and those lobbying against it are doing so for only political reasons.” Dr. Wasif also said, “Two new specialties have flourished in LRH after the implementation of MTI Act which are Rheumatology and Endocrinology. Previously there was one doctor who used to treat patients with all sorts of problems without being the specialist because one doctor cannot be a specialist of every specialty now the hospitals will have specialized wards for specific needs of patients.”