Leaking public health sector
By Imtiaz Gul
Express Tribune, Oct 16, 2014
In Pakistan’s leaking healthcare system, citizens find themselves at the mercy of insensitive and commercially driven medical professionals. Incompetence, official apathy and brute commercialism continue to drive the private and public health sector.
While senior government functionaries, ministers as well as affluent private citizens have access to optimum facilities at state-owned or private hospitals, common people suffer the most — both in terms of fair treatment, as well as financially. With little accountability and overriding commercial greed, private hospitals make a killing once a patient lands at the facility. Public hospitals do offer refuge to the majority of patients, but there is incompetence, insufficient facilities, absence of medicines and no accountability present. They are geared to take care of VIPs but poorly equipped to look after the needy ones.
PIMS — the major state-owned hospital in the capital, we are told, badly needs funds to repair, upgrade or replace aging machines but governmental apathy is holding the funding back. This hospital only has one functional ventilator, which is kept aside in case a VIP needs it.
Can the public health sector be turned around? The opinion is divided. Professionals, with some feeling for the people, suggest a complete ban on the private practice of doctors. They believe that without such a paradigm shift, including strict monitoring mechanisms for the private healthcare system, people will keep suffering.
Sincere medical professionals suggest that the amount of funds allocated to healthcare be raised to 10 per cent of the GDP. Pharmaceutical companies should be subjected to a strict regulatory framework to prevent them from committing fraud and arbitrary price-fixing as these companies fleece the public by working on profit margins as high as 500 per cent. Greater attention and resources should be dedicated to rural health centres, where state-employed doctors are often missing because they are mostly busy at their own clinics. Doctors should either be on the payroll of the state and fulfill their obligations or pursue their profession privately. By retaining their official jobs, these medical professionals essentially, not only cheat on the state, but are also involved in massive tax evasion as private practice can yield a daily income that runs into hundreds of thousands, but is hardly ever documented or taxed.
That is why, doctors suggest incentivising jobs at state-run medical facilities — accompanied by strict monitoring once private practice is banned. Little incentive at state-run facilities is also a major cause of not only the propensity among doctors to pursue private practice, but it has also led to a huge brain-drain, with many doctors — on whom the state spends million — opting to leave the country. Most of them end up in the Middle East.
Inadequately monitored medico-legal departments represent another malaise afflicting state-run hospitals — they are a source of massive corruption resulting in violation of fundamental human rights of both the accused and the victims. The police usually turn to the medico-legal officer for opinion in criminal cases, like murder and rape. This often turns into a conduit for money-making because the police and the court rely on the medic-legal officer’s opinion.
“The fate of the person under investigation is almost entirely in the hands of the medico-legal officer and the police. Because there is corruption at every level, this results in violations of fundamental rights,” says a frustrated doctor who watches such crimes being committed on a daily basis at one of Islamabad’s prime health facilities.
Imtiaz Gul is the executive director of the independent Centre for Research and Security Studies