By Syed Saadat |From the Newspaper Dawn
A
FAMOUS doctor runs a clinic set up in a house in a posh sector of Islamabad.
She even carries out surgical procedures on her patients there.
The
treatment area is on the first floor and since there are no elevators in the
building, patients, usually pregnant women, are made to go through the ordeal
of climbing highly uncomfortable stairs to the first floor. This is not the
only thing; after surgery, patients are brought down to the ground floor by
guards at the gate who lift the chair carrying the patient and climb down the
same set of stairs.
It
is akin to a tragic scene from a film when a newborn needs oxygen and everybody
runs helter-skelter searching for a cylinder; the receptionist finds one
somewhere and dusts it with the cloth used for dusting tables at the reception
area. The doctor I am referring to is no ordinary soul. She practises in
England half the year and her charges are exorbitant.
Exploitative
businessmen in the garb of health service providers are no different from the
notorious bhatta mafia as both of them ask for considerable amounts to ensure
one stays healthy. Under the 18th Amendment, health has become a provincial
subject and to ensure better coordination the government has recently formed
the Ministry of National Health Services, Regulations and Coordination, but its
scope and charter of duties remains sketchy.
The
focus seems to be on projects like the Federal Drugs Surveillance Laboratory
and the National Maternal, Neonatal and Child Health Programme, which is good,
but the regulation of private hospitals is an area nobody seems to be
interested in.
A
regulatory body should be established under the ambit of this ministry which
works with each provincial health ministry to aggressively take up the
following three issues which do not require great spending, but strong will.
First
and foremost is the lack of infrastructure at private health facilities. These
clinics and hospitals are using humans like guinea pigs to carry out procedures
without any proper facilities. During my cursory research for this piece I
personally visited several private clinics in the Rawalpindi-Islamabad area and
found more than 50pc to be lacking in basic facilities like oxygen cylinders,
instrument sterilisation etc.
A
regulatory body needs to ensure that the minimum requirements are fulfilled
before it allows a clinic, where major medical procedures are to be carried
out, to operate.
However,
care should be taken so that the sole purpose and function of such a regulatory
body does not become that of a permit-issuing entity after collecting hefty
fees, or less hefty bribes, like so many other regulatory bodies in the
country. The purpose should be improvement of standards and not revenue
generation.
Secondly,
hardly anyone points out the skewed service charges of business ventures that
are mostly owned by doctors and investors who earn their money abroad and come
to Pakistan to augment their income. They do so because here health laws are so
lenient that they can get away with medical murder without anybody even
noticing.
There
is no proportion in the treatment cost and the charges. What a regulatory body
needs to do is to link the charges and cost. There should be a list of standard
costs for most procedures. Barring very complicated cases, most medical
procedures can be covered in such a list.
The
list should take into account the fact that these ventures earn reasonable
profits. Also, the hospitals should be categorised based on their
infrastructure, quality of human resources, contribution to research, training
of employees, compensation of employees etc and charges should be in proportion
to that rating.
Linked
to the above, another important factor is the exploitative treatment of
employees of such medical institutions. So many private hospitals, in order to
evade taxes, do not offer a written contract to employees, no medical cover is
provided to even the doctors working there and no annual vacations are granted.
The pay is meagre and working hours are inhumane.
Health
is not just another sector; it is a matter of life and death. Just as the
aviation authorities have rules that limit consecutive duty hours for pilots
and associated staff, the health sector requires similar measures otherwise
deaths can occur. The problem with such deaths is that they do not make the
headlines and the problem with us is that we take notice of only the deaths
that do.
Lastly,
a regulatory body must carry out annual technical audits to assess the
hospitals in various categories and recommendations must be made in light of
the performance of hospitals (both public and private) in the annual technical
audit.
With
the same party ruling in the centre and in Punjab, the largest province in
terms of population, such a system of checks and balances is not a dream but
can be very much a possibility. Other provinces would follow suit.
Allocating
huge funds or building government hospitals is appreciable. But a bit of
lateral thinking and forthright spirit is also needed to heal the health sector
of Pakistan.