By Zoon Ahmad Khan
Punjab’s problems are not only escalating (vertically), but also very visibly expanding (horizontally). The unscheduled load shedding, Energy Crisis, and the Doctor’s strike. The perceived culprits in Punjab’s suffering vary from the federal government, the provincial, or corruption and the jealous peripheries, influenced for the most part by prior political leaning.
During the past few weeks we have witnessed deep conflict between the Punjab government and the Young Doctors’ Association, little was spoken about the health structure proposed by each party. The morality of doctors, who gave up their duties and put lives at stake, has been questioned. The Punjab government has aired a campaign against the YDA strike worth Rs 40 million, and used army doctors to pressurize the young lot going astray. Only on Friday, Punjab government also replaced the Principals of Allama Iqbal Medical College (Dr. Javed Akram) and Quaid-e-Azam Medical College. Was this the fallout for failure to curb the young doctors? Or worse, was it punishment for supporting the rebels, as the Parliament and Intelligence Agencies have suggested? Frankly, the Punjab government’s decision to remove the few influential, senior doctors, who should have been used as an asset to bridge the ever-increasing gap between them and the doctors, seems premature. Of the few of this profession who chose to side with the state must have been interrogated and removed only if after interrogation any signs of disloyalty surfaced. When well respected senior doctors, both inside and outside of their profession become the collateral damage, levels of suspicion escalates.
While Punjab Government’s latest decision to slash some of the doctors off its team might aggravate the problem, solely holding one side responsible for the matter under question would be unreasonable. With the bone of contention, what started the problem, the proposed health structures by both parties, easily brushed away, a lack of education about the matter seems prevalent. The perception of political field as subject to a zero sum game by the Central and Provincial, or in the Doctor’s case, between the Provincial government and the YDA has resulted in a dearth of facts. Neither the YDA, nor the Punjab Health Department, have made their proposed health structures public. To make the service structure public is by no means a criterion, but in a dysfunctional setup where doctors and government can’t seem to agree at this point, it becomes the right of the masses whose lives even in some cases have been compromised.
Firstly, my aim is not to justify the strike, but perhaps to gauge a better understanding of the technical problems that the young doctors are suffering from. The basic issues of political influence and corruption are not unique to the medical profession. But drawing a comparison with the much more successful Army setup, helps understand a few areas that the Punjab government can work on to improve the working conditions of doctors in general.
Secondly, it is crucial to educate those at the brunt of this ‘healthcare’ malfunction to at least understand the service structure of the Civilian Doctor, in light of the Army Doctor, who heroically came to the rescue of the people. The answer is simple: the Pakistan Army Medical Corps, in contrast to the Civilian Doctor, inherited an excellent service structure from the Royal Indian Medical Corps. There are two categories of appointments: short commission and regular commission. The former is administrative in nature whereas the latter is specialist. Whereas initially only administrative officers could rise to the highest rank, now even the specialists enjoy this privilege. Pakistan Army as an institution posts these doctors based on merit and takes responsibility for their further education and training. While the career of an Army Doctor is merit based and decision making is undertaken by a board making it transparent, in contrast Pakistan’s Civilian health sector is influenced by the whims of politicians, ministers and the bureaucracy.
Young Doctors bear up to 80% of the workload in all major hospitals. Their further education is not the responsibility of the institution that hires them, rather comes at a high opportunity and material cost. As dumb-witted politicians, with little acumen to administrate handed over technical matters, it is convenient to misuse the overflowing services of under experienced doctors, still partially in training, for the free check-ups, while keeping the specialists reserved for elite clientele or those with access to the right strings. This leads to, as mentioned earlier, more strenuous working hours, and compromised healthcare. Here is where the Army Structure, with administrative matters in the hands of technical people, really wins the edge.
What young doctors therefore need is a service structure that makes their future less dependent on an ill-equipped administrative unit, where further education and training is based not on personal means or an influential family member, but on merit. As far as fixing the administrative unit is concerned, ideally the Army Structure where doctors handle the management of hospitals should be practiced. It is high time that the Civilian Government use the Army’s Structure as a template to improve the working conditions for Government Employees.
The Health Service needs to understand that hospital administration is a full time job, which must be undertaken by medical doctors, further trained and qualified to fit the job requirement. When laymen make decisions that neglect the fragile needs of a running hospital, and instead order billions of rupees worth of split air conditioners (as CM Shahbaz Shareef did), the already low health budget fails to deliver the little that it can. Technical staff handling these matters will be more beneficial if there is more accountability of course. Even a trained and aware individual may choose to make the wrong decisions for personal gain. But corruption in the government sector is a matter that is relevant to all service sectors; therefore it becomes futile to comment on that.
Another major concern, the journey from Grade 17 to Grade 22, is based on available vacancies, and becomes relative. Therefore a doctor could be brilliant and well qualified on an absolute scale more than worthy of promotion to the next Grade; however this promotion depends on availability of slots. Little can be done about promotion except make it entirely merit based, to assuage the pain of the wait. Once the government can ensure solely merit based progress, and politicians cease to treat their areas as personal kingdoms, where the quota of even generic drugs can be influenced by the political elite, even the best service structure might fail to deliver. The problem of the young doctors is only a microcosm of what Pakistan’s civil service sector is facing. With stronger structures in all sectors, there will be lesser loopholes to maneuver through.
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