PTI’s Health Reforms and MTI Act after KPK goes to Punjab

Shiffa Yousafzai

Systems dont work for individuals and laws are not made for exceptions but for the masses.

Since 1947 administrative and financial powers when it comes to public hospitals rests with secretariat and single secretary has the
power to run every hospital in the respective province. Everything in health sector is under the command of a Secretary.

Since PTI formed government in Khyber Pukhtunkhwa in 2013 and came up with Health Reforms which are also referred to MTI
(Medical Teaching Institute) Reforms Act, the government has faced lot of hurdles in implementing the reforms in its true spirit. But
after launching a pilot project of MTI Act in KPK now Pakistan Tehreek e Insaf and PM Khan’s team takes the MTI Reforms Act to
Punjab province.

Dr. Yasmin Rashid the provincial Health Minister for Punjab has worked extensively on health reforms in Punjab. MTI Act in Punjab
has been formulated in more than 32 meetings after the consultation with numerous stake holders including Vice Chancellors of
medical colleges and universities, Young Doctors Association, Medical superintendents of teaching hospitals, professors, doctors and
social activists.

It took PTI government more than six months to formulate the draft of the Act and it has been reviewed five times in the light of
recommendations from all stake holders in KPK and Punjab.

When I asked about the hindrances PTI government may face in Punjab province while implementing these reforms like it has been
facing in KPK, Special Assistant to Prime Minister Iftikhar Durrani said, “Government is committed to resist every hindrance that
stops them from implementing this law. Any objections or reservations to this law can only be addressed through proper dialogue
and discussion. No one is allowed to hold the system hostage to record their protest.”

Dr. Zafar Mirza, State Minister for Health, has been witnessed visiting public hospitals in Islamabad to observe the quality of
services several times since he took charge of the office. He also accompanied Prime Minister Imran Khan on 25th May, 2019 to
DHQ Hospital Sargodah. Dr. Zafar Mirza who worked in various countries responsible for health system development when asked
about MTI Act and best thing about this Act, He said, “The best thing about MTI is that it will bring decision making within the
institution, it will bring transparency and accountability, and efficiency in managing the affairs of the hospital locally.”

Dr. Zafar Mirza pointed out some flaws that will be fixed through the MTI Act, saying, “Currently the hospital management or the
executive director of a hospital do not even have the power to hire or fire a doctor. For every hiring a file is made, it goes to the
ministry, it keep making rounds from one officer to another. Things are delayed and are inefficient. Hospital management cannot
decide if they want to expand hospitals in order to address the needs of the people, merit is not taken into account. So once MTI is
implemented Board of Governors will be selected in a meritorious way and they will make these decisions. Government will keep
supporting these hospitals financially, will provide grants and they can manage their resources. 240 hospitals in Pakistan have been
taken on board when the PTI government distributed Sehat Insaf cards to people but all these hospitals are private.”

Dr. Mirza said, “When poor patients come to public hospitals they are provided with services free of charge but they have to incur
lot of expenses. They have to get their investigations done from outside, sometimes they also have to buy medicines from private
pharmacies so once these people are given health insurance in these public hospitals then they will be financially protected.”

Dr. Mirza when said currently public hospitals are not facilitating patients with Sehat cards raised another question that why are
they not, to which Dr. Mirza replied, “Currently these hospitals are not mandated to manage their own resources that is why they
cannot become part of the Sehat Insaf Insurance card scheme.”

Dr. Mirza also talked about people mixing up MTI Act and privatization. He said, “Many people have started equating MTI with
privatization, and this is absolutely incorrect. Hospitals are not being given away to the private sector but actually hospitals are
being managed in a better way under the new MTI system.”

What is MTI Act? MTI Act will enhance the professional capacity of the public hospitals in both the provinces KPK & Punjab. The
hospitals will be autonomous administratively and financially and would be free from any political influence. It ensures the
availability of 24hrs emergency services as well as the availability of free medicines and services at all the public hospitals. A third
party monitoring system has been introduced to audit the public hospitals and to keep a regular check. MTI brings a new concept
for doctors to shift their private practice from private clinics to the public hospitals and it is called Institution-Based Practice (IBP). It
will allow doctors to continue their private practice at public hospitals ensuring their additional earnings while being available for the
patients at the hospitals. MTI Act in KPK has proposed an increase in the salaries of doctors (which was demanded by them) while
the promotions are on the basis of performance. Hospital administration will deal with the hospital staff (nurses, sweepers, doctors
etc) and issues pertaining to them. Doctors will have to serve in the areas where they obtained their domicile from for atleast two
years starting from their appointment.

How MTI can help? For example, If a hospital would need an X-ray machine, hospital will have its own budget and hospital can
buy it within a day. What used to happen before MTI Act was that hospitals used to request the secretary for any kind of equipment
or budget and then after days or weeks of delay the request would be processed and then the equipment would be provided to the
doctors to facilitate the patients.
Previously doctors had a haphazard system someone was a Medical Officer, someone was a civil servant and there was no concept
of a medical specialized institute like you have in the UK. Bureaucratic and political involvement in transfers, postings, hirings have
ended due to MTI Act.

Whats happening in KPK? Under MTI Act every hospital will have its Board of Governors and decision making would take place
at the institution instead of secretariat. Powers will be shifted to the hospitals and there would be a decentralized system. Board of
Governors of Lady Reading Hospital, Peshawar is headed by Dr. Nausherwan K. Burki. Dr. Burki is also called the Architect of PTI’s
Health Reforms and is heading the Task Force for Health Reforms in KPK. He is a founding member of Shaukat Khanum Memorial
Cancer Hospital. He is a P.hD and a Professor of Medicine. He completed his MBBS from King Edward Medical College and
completed his doctorate from Charing Cross Hospital Medical School, University of London and is an award winning Intensive
Pulmonologist.

Audits Peshawar’s leading and one of the biggest public hospital Lady Reading Hospital’s Cardiac Surgery ward was audited under
MTI Act by a third party, that found mortality rate of Cardiac Surgery was 36%. Which means one out of 3 patients was dying
which is against the international standards. When doctors were asked for an explanation they said they were not having required
equipment and supplies. Then they were asked to give that in writing and they couldn’t because it wasn’t about the supplies but it
was about them, it was the doctors at fault, hence senior doctors were removed from their positions like Dr. Abdul Maalik and a few
others.

With MTI Act comes the accountability of doctors. Everything in Pakistan is political. Accountability of doctors have never been our
priority and when uniformity, merit and accountability comes a group of people will always stand up and start a campaign against
the change.

There were days when doctors in KPK wanted a role in decision making now when they are getting it they have problem because
with autonomy comes accountability and responsibility.

Transfers: Students come from tribal or under developed areas get admissions in government medical colleges like Khyber Medical
College by having a domicile of those areas on a special quota where their education and medical degree is subsidized by the
government but when it comes to serving people there they just don’t want to go back.

73% positions in government hospitals and dispensaries are vacant in the peripheries and there are no health facilities because
everyone would want to work in hospitals in Peshawar. Under MTI Act they are supposed to spend at least two years in their
stations where they obtained their domiciles. What happens is that when doctors aren’t available in smaller districts or villages then
those patients come to Peshawar and this is the reason public hospitals in Peshawar are over burdened.

Health Minister KPK, Dr. Hisham Inamullah Khan’s cousin has also been transferred to Lakki Marwat. Provincial President of Insaf
Doctor’s Forum, Dr. Kamran Durrani has also been transferred from Lady Reading Peshawar to his own district.

“PTI government in KPK gave a 200% pay raise to the doctors”, says Advisor to Health Minister KPK, Dr. Jawad Wasif. He also said,
“There were only 3000 positions for doctors previously now that number has increased to 8000.”

Pay Scale: Category A: Peshawar (Rs. 105,000), Category B: Karak, Bannu, Kohat etc (Rs. 135,000) & Category C: Shangla,
Torghar, D.I.Khan, Tank, Swat and Swat’s suburbs etc (Rs. 175,000).

Accountability & Transparency: With MTI Act, appointments could be challenged for example the appointment of KMC’s Dean
has been challenged in court as there were anomalies found in his appointment.

Advisor to Health Minister, Dr. Wasif said, “Two cardiac surgeons are coming back to join Lady Reading Hospital from the UK, the
system has started to flourish and those lobbying against it are doing so for only political reasons.” Dr. Wasif also said, “Two new
specialties have flourished in LRH after the implementation of MTI Act which are Rheumatology and Endocrinology. Previously there
was one doctor who used to treat patients with all sorts of problems without being the specialist because one doctor cannot be a
specialist of every specialty now the hospitals will have specialized wards for specific needs of patients.”

“Prime Minister Imran Khan’s vision to decentralize the power to speed up the system and to make health sector delivery oriented is
the essence of the MTI Act” says Iftikhar Durrani, Special Assistant to Prime Minister. Moreover SAPM Durrani said, “The health
systems should be able to provide quality services to the poor masses just like the rich have been able to receive at private
hospitals.”
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