A recent legislation, under which health authorities will be established at regional and district levels is the bone of contention
Thousands of patients across government hospitals in Khyber Pakhtunkhwa (KP) have been suffering since doctors and paramedical staff went on strike. The strike was called in response to the ill treatment of staff by the police at Lady Reading Hospital (LRH) and the Regional and District Health Authorities Act 2019. The passing of the bill resulted in a protest at the LRH, where police used force against the staff. A protest by doctors had been anticipated and authorities had imposed Section 144 at LRH - banning any gathering of people.
The police received widespread criticism when videos and pictures of bleeding doctors, nurses and paramedical staff went viral on social media. Police officials defended their action by saying that they had resorted to teargas, baton charge and arrests after medical personnel pelted them with stones, injuring eight policemen including a deputy superintendent, and civilian bystanders.
The Grand Health Alliance (GHA) - comprising associations of doctors, paramedics, nurses and non-technical staff at public sector hospitals - announced a strike, till their colleagues arrested at the LRH protest were freed and cases against them withdrawn. Medical services in outpatient departments; operation theaters; pathology and radiology labs have been suspended since September 27. A number of doctors who were willing to attend outpatient needs, said they were hesitant due to the pressure from protesting colleagues; particularly paramedics and non-technical staff. Resultantly many patients suffering from dengue fever did not receive any treatment at government hospitals.
Clashes between medical personnel and the government are not new in KP. In May, doctors and the health minister had clashed at the Khyber Teaching Hospital (KTH). A senior doctor, Ziauddin was seen injured in videos and photos shared on social media. He was attacked by the health minister’s guards, after he reportedly threw eggs towards Professor Nausherwan Burki; chairman of the Prime Minister’s Health Task Force. On October 7, the management committee recommended the dismissal of Dr Ziauddin on disciplinary grounds, and transfer of 14 employees from KTH to Kohistan and other remote districts; due to their role in the strike.
On the same day, the GHA held a meeting after which they issued a call for continuing protests. The alliance claims that their colleagues held in the Mardan prison are being mistreated and their families and lawyers are unable to visit them. This growing clash between medical professionals and the Pakistan Tehreek-i-Insaf (PTI) government has also invited comment from by opposition parties. Some groups of doctors have announced their support for Maulana Fazlur Rehman’s march and sit-in, saying they will set up free medical camps for the activists. Other parties have already announced their support for the strike.
Efforts are being made to de-escalate tensions between medical personnel and the administration. Dr Mushtaq Aurakzai, a senior doctor at the Hayatabad Medical Complex has offered to mediate between the two camps, saying that poor patients have been suffering the most, in the stand off.
The bone of contention has been the recently passed Regional and District Health Authorities Act 2019, under which health authorities will be established at regional and district levels. The central and provincial government will provide funds to these authorities, which will in turn report to a policy board, presided over by the health minister. According to the new laws, the authorities will ensure that objectives set by the Regional Health Authority (RHA) are achieved, alongside: overseeing effective management and service delivery; issuing strategic directions; ensuring transparency and implementing government policies. The authorities will also have the power of the purse: approving the RHA budget and allocation of funds.
The recent Act has received criticism not only from doctors but also opposition parties. Opposition leader in the provincial assembly, Akram Khan Durrani said that the government was trying to privatise health institutions through this bill. Flanked by Sardar Hussain Babak of the ANP, Sher Azam Wazir of the PPP, PML-N’s Sardar Yousaf and JUI-F’s Mian Nisar Gul; Durrani told the media that the speaker had steamrolled the legislation through, in the absence of the opposition. Furthermore, he condemned the use of f orce against medical professionals, demanding a comprehensive report on the incident. He said that the opposition "stands shoulder to shoulder with the medical community" and believes that the government is suppressing the rights of the media, medical professionals, teachers and other communities.
Sahibzada Sanaullah of the PPP, was the only opposition member who supported the new legislation. He was critical of the attitude of doctors who refused to work in remote areas. "As a representative of the people, their interest should be our top-most consideration. Almost all basic health units in my constituency are without doctors. If doctors are unwilling to work in their own districts, then how can one demand that the government fill the vacant posts?" Sanaullah said on the assembly floor.
The biggest victims of this situation are the general public. Many patients across government hospitals have not been treated since September 27. "We brought a relative from Dir to Peshawar, taking him from one hospital to another to no avail. Finally, a doctor we know in Hazara told us to bring him there, where he is now being treated", said Abdul Wahab a resident of Talash. He further added that, "people are fed up with doctors’ strikes". While doctors say they are providing treatment in emergency rooms at all hospitals, many people are suffering on account of downgraded medical attention.
Minister for health Dr. Hisham Inamullah has denied that public health institutions are being privatised. Talking to reporters he asked, "How many of the 6,600 doctors and 17,000 paramedics in the province are protesting? Most of the health staff is not interested in it. There is a faction with vested interests. They are trying to make the health reforms controversial," said the minister.
According to the Information Minister Shaukat Yousafzai, "worthless doctors used to pleading for jobs are now threatening the government’s writ and authority." His previous statement about "doctors and engineers selling pakoras before the PTI government gave them jobs" had enraged both communities across the country.
Yousafzai had also said that "the provincial government hired 4,s000 doctors in the recent years, as part of its agenda to bring reforms in the health sector. However, some doctors who refuse to work in their hometowns have now formed pressure groups."
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