It has been generally perceived that if an honest leader were to become the head of the state Pakistan would be pulled out of corruption that has bogged it down for seven decades. It was in this equation that many saw Imran Khan, being an honest man, an antidote to the crises. Now that he is the Prime Minister, lets hope he turns a new chapter and make institutions responsive to the needs of the general public-----the reason why institutions are formed inthe first place.

The success of any institutions, however, depends on checks and balances and the system of accountability. Because no matter how honest one could be, guarantee will always be rare for this good will to continue and not taken for granted. When checks and balances are in place, and the process of accountability is defined, leaders and workers with intentions and deeds gone awry are automatically shunted out. It is this promise of the US system that the President like Trump has been tolerated and allowed to continue. So, what is needed is not only an honest leadership, but someone who has the will to make this honesty contagious. If Pakistan has survived so far, it is also an indication that not every institution has been underperforming or negating rules and laws. One example of this is the Punjab Healthcare Commission (PHC). Since we are not accustomed to seeing institutions running in a clean manner, therefore, our first instinct at the encounter of such organization is to react conspiratorially. For the last many months, ever since the National Accountability Bureau has unleashed its drive against financial mismanagement in Punjab bureaucracy, the PHC has been unnecessarily dragged into the controversy. Over the months, because no loophole could be found in its performance, the dissenters have attacked the Commission on misusing funds. This anomaly of disqualifying quality to justify the allegation of mismanagement of funds has unfortunately become a lethal weapon to disown institutional integrity. If not plugged now, this black hole would discourage people from performing, fearing a witch hunt in the name of accountability.

The development of the PHC started with an incident that wrenched many hearts because of the death of a three-year-old child out of sheer negligence of the doctor. Imane Malik was brought to a local private hospital, on the Canal Road, Lahore, in 2010, with a minor burn on one of her feet. The doctor, in order to bring immediate relief, administered an injection that turned out fatal and the child was dead in a matter of six hours. The case took the breath out of the Punjab government. It was hence decided to revisit the Punjab health policy. Though many holes and lacunas were found in the performance of the health system, what turned out alarming was the absence of an overarching body to regulate the performance of the health sector. The deliberation resulted in the enactment of Punjab Healthcare Commission Act 2010, and the formation of the Punjab Healthcare Commission in 2011. It was a beginning of a new ear in the Punjab health sector.

Seven years down the road the Commission has at least given a direction towards quality care. In spite of not achieving best practices in medicine, on the line of civilized and advanced countries, because of various administrative reasons of the health department, the Commission has nevertheless set a threshold of quality in the health sector through the enforcement of Minimum Service Delivery Standards (MSDS). The process in the Commission begins with the registration of the management of the healthcare establishment. Who is later handed over the manual of the MSDS and invited to attend the workshops to learn the implementation process of the same. After pre-assessment and final inspections the Healthcare Establishment (HCE) is given the license by the Commission. It is an arduous exercise, and only those HCEs are licensed that show maximum compliance to the performance indicators identified in the MSDS. As of November 30, 2018, a total of 35,487, HCEs have been given licenses.

Bringing out change in the governance structure is easier than mending behaviours. It will take many more efforts and years to make the culture at the hospitals civilized and empathic. We often hear stories of misbehaviour of doctors and other medical staff with patients. We also hear stories about the greed prevalent at the private sector. We have been hearing stories about quackery making life miserable for those who happen to fall in its clutches, either because of paucity of income, ignorance or both. We also hear stories about the insufficient Punjab health budget. All these stories together have made it difficult to put the Punjab health sector in order. The Punjab Healthcare Commission can only advise, prepare standards, create awareness and sensitise doctors, the government, the concerned councils and other stakeholders on how to improve performance for quality care. The Commission can close down HCE if found detrimental for the health of the patient. But the Commission cannot ‘force’ those attached to this profession to act responsibly. It would require the effort, the sincerity and the willingness of each stakeholder in medical industry. It is hence, no solution to force institutions to change policies and manpower to suit new setup. This policy has badly affected Pakistan’s image, while taking away trust of the people from the capability of these institutions to progress.

Keeping to its spirit and refusing to give in to the negative propaganda, the management of the Commission has kept its focus on its mission to provide quality care in HCEs. Institutions, as we have said, are as much about people as about checks and balances…something on which, the PHC has never compromised.


The writer is a freelance journalist based in Lahore.