Doctors to hold protest against proposed MTI Act/Ordinance

Asma Ghani

ISLAMABAD- Doctors working in government hospitals have decided to hold protests in Pakistan Institute of Medical Sciences (PIMS) against proposed promulgation of Medical Teaching Institutions (MTI) Act/Ordinance today.
After introducing MTI Act/Ordinance in the teaching hospitals of Khyber Pakhtunkhwa and Punjab, the government is going to implement the same system in PIMS.

The new MTI system no doubt will give the much-needed autonomy to a major public tertiary care hospital from cumbersome bureaucracy. But the employees believe it is systematic privatization of hospital that will not only seize their civil servant rights but also do away with free medicine and medical tests facility for the patients who throng the federal capital from across the country.

To clarify, Prime Minister Imran Khan on September 4 tweeted that the MTI legislation was not an attempt to privatize public sector hospitals but to “enable improved and modern management of public sector hospitals”. The hospitals will remain government hospitals. Better managed hospitals will mean better facilities for patients, he said.

Promulgated earlier this month, the Punjab MTI (Reforms) Ordinance 2019 has been drafted on the pattern of KP’s MTI Act. And the spirit of the law drafted for Pims is the same as well.

According to the Punjab MTI Ordinance, the medical teaching institutions shall be run by a fully empowered Board of Governors (BoGs) which must consist of 5-7 members from the private sector. While their attached hospitals will be run by the search committees headed by a dean that will have the powers of appointment or termination of employees.

The Provincial Policy Board shall be the top body followed by the Search & Nomination Committee, Board of Governors and Management Committee.

Fearing resistance in hospitals and from opposition parties in Punjab Assembly, the government issued ordinance instead of introducing a bill. Agitation and political activity in hospitals is banned but the employees have decided to protest against it.

In Islamabad too, Pims staffers are apprehensive and warn of protests and strike if they are not consulted and their concerns are not addressed.

They believe since the BoGs of hospitals will have the powers of hiring and firing instead of inductions through Public Service Commission, it will increase political interference and nepotism.

The employees will be given an option whether to join the MTI system or opt to remain as civil servants. But they believe it’s merely a gimmick.  At the end there will be no option left for us but to join the new system, said Dr. Qasim Awan, president of Punjab’s young doctors association, like in KP after a year all hospitals were under BoGs and employees were compelled either to continue under the new system or leave.

They argue if the KP model was so successful, why 60 to 70 percent patients coming to Pims from KP hospitals.

“We are not against reforms”, said Dr. Asfandyar Khan who represents about 4500 Pims employees, and there’s a lot that the government was supposed to do: construction of new hospitals, pending appointments and promotions for years, replacement of rundown infrastructure.

But instead of expanding and improving facilities this government is planning to seize our civil servant rights after years of government service, he said.

Merely a fight for perks?

The new system has its pros and cons and one of the big pros is that the outpatient departments will be functional in the evening and night too and consultants will be available who are rarely reachable at public hospitals for which they get perks and privileges from government.

Consultants will get better pays and allowed institutional based private practice at hospitals. Not a big incentive for them because they all already do private practice either at their clinics or private hospitals without any taxation and oversight. Besides, they get plots, government accommodations, pensions and other privileges as civil servants that they will lose if the teaching hospitals are made autonomous bodies.

In the new system fee will be determined by the board and in case they opt to practice outside hospital premises, they will lose bonus and other incentives.  Many of them will be retiring in few years but the future of lower grade staff, especially non-medical will be at stake in the new system.

It will bring a strict regime and with that oversight and accountability that is barely acceptable to anyone.

‘Cost-effective healthcare’

In emergency department of Pims medicines and tests are free for everyone and in outpatient departments too charges are nominal as compared to private facilities.

With the autonomous status of hospitals, charges of healthcare facilities will be increased gradually. In Punjab, hospitals have already started displaying new lists of lab test charges.

Those issued health insurance cards will be entitled to get free treatment from anywhere but others, especially patients from middle and lower income families will have to cope with additional costs.

But given the current conditions of public hospitals, campaigners say it’s better to get cost-effective healthcare rather than not getting it at all. Moreover, research oriented institutions are not run like that the way they have been functioning, they say, everywhere they are either autonomous or partially self-governed.

MTI is a good concept, said Nadeem Iqbal, Executive Coordinator of TheNetwork for Consumer Protection, but it should be implemented after getting buy in from all the stakeholders. “And this stakeholder inclusive MTI should go through the democratic process. Political consensus is must to make it successful”.