PESHAWAR: Pakistan Tehreek-i-Insaf failed to implement the reforms programme in health sector up to a desired level despite remaining in government for about nine years in Khyber Pakhtunkhwa.

The Medical Teaching Institutions Reforms Act, 2015, passed by Khyber Pakhtunkhwa Assembly was first enforced in the province’s oldest and biggest health facility Lady Reading Hospital and later in Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar.

The law, which remained stuck for at least one year due to cases in the court, presently covers 11 hospitals and their affiliated medical colleges in Dera Ismail Khan, Bannu, Abbottabad, Swart, Nowshera, Mardan and Swabi.

The law was meant to bring reforms in health sector and improve patients’ care in the province. Under the law, the boards of governors were appointed in the hospitals with powers to run the respective institutions through recruitment of medical, hospital, finance and nursing directors and deans to head the affiliated colleges. Prior to enforcement of MTIRA, 2015, these hospitals were managed by health department.

Prof Burki says MTI law implementation an evolving process

Prof Nausherwan Burki, the architect of the law, told Dawn that the system was not fully implemented in the hospitals. “It is an evolving concept but there is still a lot of improvement compared to the situation before the enforcement of the new piece of legislation,” he added.

As per law, the members of the boards of governors are nominated by chief minister on the recommendation of search and nomination council headed by health minister to run the hospitals. The BoGs are headed by the respective chairperson with vast powers of abolition of positions and re-designations in line with the needs while the health department doesn’t have any authority over them.

However, with the passing of time, several amendments were incorporated to law. One of these amendments empowered the chief minister to remove a member or the entire board in case of violation of the law.

A senior health administrator said that still the MTI-covered hospitals had not shown any improvement despite payment of huge salaries to the top appointees. “There is hybrid system in each of the MTIs because there are civil servants as well as the staffers appointed under the new law. The MTIs don’t have the power to take action against the civil servants because they have been appointed under Civil Servant Act,” he said. The BoG can take action only against those employees, who are recruited under MTIRA on contract basis.

He said that most senior doctors quit their jobs because they were government servants and did not feel at ease with BoGs. “This has harmed hospitals. The law has brought many difficulties for civil servants, who continue to protest against it but after all, the law has been passed by the assembly and cannot be set aside,” he added.

The formation of BoG continued to haunt the framers of the law because the politicians played their part to nominate their own people and make appointments of their choice.

Another physician favoured the system and said that it had led to full utilisation of the hospitals. With the introduction of institution-based practice, patients were checked by consultants at consultation fee in evening shift in the MTIs, he said.

He said that before the implementation of law, the OPD in hospitals remained closed in the evening. The law not only helped the patients, who received proper diagnostic and consultation services, but also benefitted the doctors and other staffers besides increasing revenue of the hospitals, he added.

The physician said that many new specialists and equipments were procured by the MTIs due to the law. “However, the law hasn’t been fully enforced,” he added.

Prof Burki said that the BoGs of the hospitals would continue to work. “Unless the interim government gets up to some trick, BoGs will continue to work,” he added.

Published in Dawn, January 27th, 2023