Facing challenges

August 30, 2020

The provincial health sector had to deal with the impact of budget cuts and strikes in hospitals

The health sector performance in the Punjab under the Pakistan Tehreek-i-Insaf-led government has drawn criticism. While the authorities and PTI supporters point to the launch of their flagship Sehat Insaf Card and ‘successful control’ of coronavirus pandemic as achievements, patients and some medical professionals, however, complain that patients’ treatment and care at public health facilities has suffered tremendously on account of curtailment of budgets and tensions over the controversial Punjab Medical Teaching Institutions (Reforms) Act 2019.

The PTI government, which completed two years in office in the Punjab on August 20, had raised hopes by naming a health minister who is not just a politician but a medical practitioner, too. However, progress on the government’s reform agenda has been slow. Provision of quality healthcare services in public sector hospitals, particularly to the poor, for example, still looks like a distant dream given the tug of war between the health sector bureaucracy and the medical fraternity.

There have been long and frequent strikes in government hospitals across the Punjab by doctors, nurses and paramedics, resulting in the suspension of healthcare services to the patients, except in the emergency wards.

Most medical professionals see the Punjab MTI (Reforms) Act 2019 – which puts state-run health facilities under the supervision of boards of governors (BoGs) dominated by private sector members, as an attempt to privatise government hospitals. Several associations of doctors, nurses and allied health professionals, who have formed a conglomerate under the banner of a Grand Health Alliance (GHA) to resist the initiative, call it a draconian law.

The government insists, however, that the Act aims to improve the functioning of the health services delivery system in the public sector by creating an autonomous body without surrendering financial and administrative control to a private organisation or individuals. No wonder, the implementation of the law, initially designed to be piloted in five medical teaching institutions in the Punjab, remains in limbo.

Plagued by economic constraints since taking over the reins in the Punjab and hit by an unprecedented coronavirus pandemic this year, the provincial government has slashed the health sector development budget by 33.18 percent, bringing it down to Rs33.612 billion for financial year 2020-21 compared to PML-N’s last full-year budget of Rs50.308 billion for the fiscal year 2017-2018.

The figures cover both the Primary and Secondary Healthcare Department (P&SHD) and the Specialised Healthcare and Medical Education Department (SHC&MED). The health sector development budget allocation of Rs33.612 billion for fiscal year 2020-21 is 26.12 percent less than its own maiden budget (Rs45.5 billion) which sets out its priorities, focusing more on prevention and restricting progress on development projects in primary, secondary and tertiary care in the province.

The delivery of curative healthcare to the poor patients has suffered as they are now forced to pay more for diagnostic services in public sector hospitals and purchase medicines from the market as inventories of medicines ran out quickly. “The PTI government’s policies have forced poor patients, not just to spend on diagnostic tests in hospitals, but also curtailed the facility of free medicines from 30 percent under the PML-N government to 10 percent,” says Dr Salman Haseeb Chaudhry, president of the Young Doctors’ Association (YDA), Punjab.

The government claims to have inducted up to 15,000 doctors to fill the vacant posts in Punjab. Dr Haseeb, who is also chairman of the Grand Health Alliance, says, however, that the recruitment in medical institutions was an ongoing process. About half of the inductions, he says, had been sanctioned during the PML-N tenure. “Meanwhile, he says, the present government removed nearly 9,000 doctors who had been working on an ad hoc basis.”

The provincial health authorities had yet to recover from the impact of the budget cuts and strikes in hospitals, when novel coronavirus broke out in the Punjab in mid-March this year, forcing the government to revise its strategies and divert resources to contain the spread of the virus through social, diagnostic and curative interventions.

Many public hospitals in the Punjab were evacuated and converted into dedicated Covid-19 facilities. This deprived general patients of healthcare services at the hospitals. “The hasty closure of so many hospitals, instead of dedicating certain hospitals for Covid-19 patients, possibly caused a greater loss of lives due to curable diseases in the absence of treatment services in public sector hospitals,” says Dr Shahid Malik, the general secretary of Pakistan Medical Association (PMA), Lahore chapter.

“The setting up of field hospitals was a sheer waste of money, considering fully-equipped private hospitals were available for use,” he says. The Sindh government, he says, did even better by adopting a home isolation policy for asymptomatic coronavirus patients.

Commenting on the unexpected decline in coronavirus incidence, Dr Malik says, “An unexplained natural phenomenon became the PTI’s guardian angel and flattened the curve when all official projections were showing an upward trend in the number of cases in the Punjab in the subsequent months.” He refuses to credit the government’s social and medical interventions for the containment of virus in the province.

The Sehat Insaf Cards extend a free treatment facility of up to Rs720,000 to underprivileged families across the Punjab. “The Punjab government has scaled up services through the Sehat Insaf Card programme and included government employees among its beneficiaries,” says a spokesman of the P&SHD.

The Mother and Child Health Initiative is another project of the government, the groundbreaking of which has taken place for five Mother and Child Hospitals in Mianwali, Layyah, Attock, Rajanpur and Bahawalnagar. “A University of Child Health Sciences and the Centre of Excellence for Mother and Child Care in Sir Ganga Ram Hospital, Lahore, is also part of this initiative,” the spokesman says.

Prof Dr Yasmin Rashid, the health minister, tells The News on Sunday that the government is trying to provide quality health services to the patients in accordance with the vision of Prime Minister Imran Khan and Chief Minister, Sardar Usman Buzdar. In order to meet the Sustainable Development Goals (SDGs) targets on Mother and Child Health Indicators, she says, the government is establishing seven M&C Hospitals in the Punjab. Through its Sehat Insaf Card Programme, she says, the government is providing free healthcare to the people living below the poverty line across in Punjab.

In addition, the minister says, the government has recruited over 16,000 doctors through a transparent process to fill vacant posts. “In view of the Covid-19 pandemic, as many as 14 BSL-3 labs have been set up to enhance testing facilities,” she says, adding, “the government has been able to control the corona virus by employing effective social and medical interventions like smart lockdowns, promulgation of standard operating procedures (SOPs), targeted testing and treatment at hospitals across the province.

The writer is a reporter for daily The News where he covers health sector

Facing challenges