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trange as it may sound, but no amount of development and civilisation has stopped the prevalence and acceptability of quackery. It was expected that with the emergence of sophisticated and advanced innovations in medical sciences, people impersonating as doctors would have no reason to exist. However, not only has quackery flourished in the developing world, the civilised world is not without charlatans either. Why? Because ignorance breeds as much on cynicism as it does on illiteracy and poverty. It is in view of this understanding that the Punjab Healthcare Commission (PHC) has not relied only on sealing the clinics of and sending quacks behind bars, because that would have amounted to only skirting the surface but allowing the wound (read mindset) to fester underneath, but has also taken up the advocacy role. Section 4 (2) (I) of the PHC Act, 2010, entitles the Commission to develop awareness about the provision of high-quality healthcare services among the HCEs, doctors, government officials and the general public. The Commission therefore uses all the forums available such as seminars, conferences and meetings to change the thinking process concerning untrained, unqualified and unregistered health service providers.

Under section 2 (29) of the PHC Act, 2010, “Quack” means a pretender providing health services without being registered with the Medical and Dental Council, Council for Tibb, Council for Homeopath and Nursing Council.” All kinds of health service providers are supposed to provide credentials to the PHC in order to get registered with the Commission. Under section 13 (2) of PHC Act, 2010, “An existing healthcare service provider shall, within a period of ninety days of coming into force of this Act, apply for registration in accordance with this section and the regulations.” The premises of an HCE is sealed if the service provider is found not registered with the PHC.

The anti-quackery department of the PHC has so far sealed 16,713 outlets and has collected Rs 162.77 million in fines.

At the Punjab Healthcare Commission, there is a separate Directorate for Quackery. In fact, the focus of almost all the activities at the PHC is directed at identifying quackery. If an HCE, be it a Homeopath or a Tibb Centre, is dispensing allopathy treatment, even for as minor a cause as a cough, the treatment centre can be sealed forthwith. Recently, the PHC had sealed many drug addiction centres because they either were not treating their patients through qualified psychiatrists or had not appointed Medical Officers. In many instances, in violation of human rights, the addicts were kept in an inhuman condition. All such centres were shut down by the Commission. So far out of 81 inspected drug treatment centres, 36 have been completely sealed and six partially sealed. Altogether the Commission has evacuated 651 patients from different centres. Some of the patients were sent back to their homes after administrating minor treatment, while the rest were admitted to different public hospitals. Almost 10.4 million rupees fine has been imposed overall on the fake drug centres.

Having described the facts about quackery and the reformatory steps the PHC has been taking to eradicate this monster, the question still remains why in spite of globalisation and related advances, quackery has resisted the challenge to its survival. We shall answer this question in the context of Pakistan and countries similar to it in terms of development.

Healthcare does not happen in a vacuum; it is a state that people produce themselves by interacting with the healthcare system. For the interaction to be beneficial the patients should have trust in the providers; trust that they are being given the right treatment and trust to understand the message about what is good for them. Such trust is not possible in a system that provides low quality. Unfortunately, despite all the efforts, Punjab’s health sector has failed to provide quality care. Quality in the health sector has been overvalued to make possible the survival of the highly exploitative and exorbitantly expensive private health sector, though there is a big question mark on the quality of care the private health sector provides. At the PHC the highest number of complaints are received from the victims of private sector health services. It is this gap between competence and the ability to dispense quality care that creates room for quacks to penetrate. Therefore, in the absence of trust, the choice to make the right selection of a service provider becomes irrelevant, especially when people are illiterate, ignorant and poor.

PHC can only identify and seal quackery outlets, but to stop them from sprouting elsewhere, the government has to intervene with a more robust health policy laced with a higher health budget that is at least commensurate with the WHO benchmark that recommends health outlay to be at least six percent of the Gross Domestic Product. Presently, it is less than one percent. Population growth is another area because of which the health infrastructure has become more inefficient. Research shows that the disease pattern in Pakistan is heavily dominated by malnutrition and poor dietary practices. This calls for an overhaul of human development policy and aligning it with the health sector.

It is high time that the health sector shifts its focus to quality care from the held belief that people only need a diagnosis and a prescription to feel healthy. At the end of the day it is a question of mind over body.

The writer is a freelance journalist based in Lahore.

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