HYDERABAD: The planned procurement of robots for major hospitals in Sindh has been stopped by the caretaker Sindh Health Minister Dr Saad Niaz, describing the multibillion rupees venture as ‘unviable’ and ‘waste of money’.

The minister wants to divert the funds earmarked for the procurement to some other more pressing healthcare requirements at Sindh’s major and smaller hospitals.

Two robots each were to be procured for the Sindh Institute of Urology and Transplantation (SIUT) and Liaquat University Hospital, Hyderabad; and one each for the Jinnah Postgraduate Medical Centre, Karachi, and Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat.

“I have, indeed, stopped the procurement although one robot has already been procured for the JPMC,” said the minister, adding that procurement of another one has been stopped.

Describes multibillion venture as ‘waste of money’

The total cost of the six robots is Rs7.838bn and of them Rs5bn has been saved; but we will invest the same funds in other hospitals to meet more important needs,“ said Dr Niaz while speaking to Dawn over phone.

“Even major private health facilities like the Aga Khan Hospital, Liaquat National Hospital and Dr Ziauddin Hospitals are not acquiring robots for being unviable. Whilst roofs of our government hospitals are caving in, and we are poised for robotic surgery. Does it make sense?” he argued.

Inquiries made by Dawn revealed that each surgical procedure to be performed through robots may roughly cost around $1,500 (or Rs450,000 to Rs475,000) considering the recurring cost of consumables.

JPMC’s calculation of per robotic surgery cost is said to be even higher, i.e. $1,800 through the already procured robot.

Health professionals believe that it defies logic when the same surgeries are already being performed at teaching hospitals like the LUH, JPMC or Gambat with reasonable cost, why expensive mode of surgery is preferred to put additional burden on an already under-stressed public health sector system.

Merits and demerits

Robotic surgery ensures shorter hospitalization, less risk of infection and less pain and it is a precision smart procedure and with fewer complications chances which may be elite’s concerns, not the common man’s.

A surgeon operates through a console, a sophisticated machine. “Robot’s functioning needs trained human resource,” said a senior health department officer.

A sole vendor was supposed to ensure supplies of robots and their consumables to health department for which requisitions were obtained from concerned hospitals around a year back. Given fluctuations in US dollar’s exchange rate one doesn’t know how each surgery would cost eventually.

“Should we start removing gallbladder(s) for Rs450,000 through robotic surgery?”, asked the minister.

“That’s why I had to ask doctors of those institutions that had sent such requisition previously to give justification and prove viability of such expensive machinery when other healthcare needs are not met. They didn’t have a plausible explanation and rather I was told recurring costs will be sought from the government,” he explained.

“I fear the robots will be parked in museums one day,” remarked the health minister.

Corruption in the name of development?

The cost of two robots meant for the LUH was calculated at Rs2.133bn in the financial year 2023-24. According to health source, “all funds for six robots were released” and the vendor is poised to supply them to hospitals.

Sources referred to the Qatar Hospital – a Sindh health department facility in Karachi – which got one robot in 2010-11 at a cost of Rs300m. The Civil Hospital Karachi got one in 2013-14 for Rs370m. The robot at Qatar hospital remains dysfunctional for about a decade now.

The health minister did not rule out possibility of ‘cuts’ (commission) having resorted to by health officials in the whole procurement.

“Right now I can’t say who is involved. But commissions can’t be ruled out in whole procurement,” Dr Niaz said. Surprisingly, those associated with the procurement are still holding their positions although Dr Niaz holds the portfolio as a caretaker.

“Surgeries were indeed done initially. An inquiry into hospital affairs is under way. The cost of each robotic surgery is very high,” said the Additional MS of the Qatar Hospital, Dr Imran.

The hospital’s surgeon, Dr Umer Fateh, who has been heading its surgery department since 2016, recalled that the last surgery in this hospital was performed in 2012-13 period and afterwards no surgery was done due to its exceptionally higher recurring cost.

Free of cost tests

The LUH was to get two robots for surgeries but not anymore. It caters to the needs of patients from lower and upper Sindh regions. Hyderabad city alone has a population of around 2.6m in recently validated digital census. The hospital is unable to offer free-of-cost MRI and CT Scan tests considering its recurring cost. Its administration had allowed such free tests for some time but it became unviable considering multiple tests advised for every second or third patient by doctors. So, the LUH started charging a fraction of the fee privately.

“Depending the nature of MRI test, cost varies from Rs8,000 to Rs20,000. When tests were done free of cost, the hospital was flooded with requests from outdoor patients and the machine stopped working, as a result.

Other facilities denied

The LUH badly needs another MRI as well as CT Scan machines but the request was turned down by the health department. However, robot procurement was allowed in a jiffy at a hefty cost of Rs2.133bn,“ said a health department official.

Misplaced priorities

“I think robotic surgery should not be our priority when we struggle to fight hepatitis, waterborne disease, typhoid, malaria, cancer, diabetes, renal failures, tuberculosis etc. We already lack trained human resources to run an intensive care unit (ICU) as seen in the Covid-19 period,” Dr Mirza Ali Azhar, himself a professional anaesthesiologist and Sindh Health Care Commission’s commissioner. “We used to hear that cardiac issues affect the rich. But now it is the poor people’s problem too who need surgical intervention,” said Dr Mirza, a former Sindh president of the Pakistan Medical Association (PMA).

“Robotic surgery is taking place at SIUT thanks to the dedicated team of doctors, led by Dr Adibul Hasan Rizvi,” he said. Robotic surgery can benefit a fraction of population whose healthcare needs are entirely different. People travel from Sanghar to Hyderabad then Karachi due to unavailability of proper healthcare facilities in their home districts. “Such procurement is a case of misplaced priority. It reflects the intentions of how to make an easy buck,” he said.

Rational health financing needed

Director General of Health Services, Sindh, subscribed to the view, saying that given the under-stressed health system and economic conditions, health sector financing is needed to be rationalised. He pointed out that the health department has a total outlay of Rs234bn.

“Of this, Rs71bn goes to the salary component and Rs90bn to the budget grant from Sindh government to various institutions. The primary healthcare initiative gets Rs14bn while Rs54bn is meant for vertical programmes. Hardly Rs20bn are diverted to development,” he disclosed.

If Rs7.38bn is invested in meeting primary healthcare, it would make a difference. “Robots procurement will serve optics alone,” he remarked.

Published in Dawn, October 9th, 2023