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The curse of the healthcare bill

The medical fraternity has taken to the streets, protesting against a proposed bill to privatise public hospitals and what they see as the subsequent loss of job security, leaving the poor patients to suffer

The curse of the healthcare bill
Though the staffs in public hospitals across the province are perturbed, Lahore seems to be the action centre.

The streets of Lahore were choked yet again for long hours, the past entire week, much to the misery of the commuters, as medical doctors and paramedic staff of public hospitals came out in protest against a proposed bill of privatisation.

Traffic gridlocks were observed at the GPO Chowk, Queen’s Road, Jail Road, and Ferozepur Road, as the strike by medical fraternity entered week three.

The medical professionals are chiefly contesting the government’s plan to enforce the proposed Punjab Medical Teaching Institutions Reforms Act, 2019. They have several reservations against the bill. For instance, they are not comfortable with the idea of unrelated people coming on board for hospital administration, making contractual appointments (of doctors) for limited periods, and denying benefits like pension and provident fund to new recruits who may be hired on higher salaries. They are also against fixing consultation fees for doctors doing private practice, and the ban on forming associations etc.

The situation at the moment is such that the doctors have flatly refused to work in outpatient departments (OPDs), leaving the poor patients to suffer. They aren’t willing to even assist the senior doctors who may decide to operate on patients.

Though the staffs in public hospitals across the province are perturbed, Lahore seems to be the main action centre.

During the course of the strike, the protesting doctors and paramedics usually stayed within the hospitals’ premises, and came out only a couple of times. The government has already threatened to sack them and hire new people in their place. Besides, the Health Department has issued show-cause notices to eight senior nurses who joined the strike.

The mess created on the streets seems to be too much for the traffic police to clear, especially because the protest rallies are held simultaneously at several busy points of the city without prior announcement. In this situation, the daily commuters are condemned to look for detours. Wherever they go they are met with public smack-downs, as people are yelling at one another and the wardens are trying helplessly to intervene. There have been reports in media about ambulances carrying patients stuck in traffic. People, it seemed, wanted to give them way but could not move an inch.

The question arises whether it is acceptable for medical professionals to deny services to patients suffering back in the hospitals. The protesting doctors justify their actions by saying that they haven’t shut down emergencies; they have only denied services at the OPDs, that too only during the strikes. But this hasn’t helped to pacify the patients and their attendants who are outraged.

Muhammad Ali, a resident of Shadbagh, Lahore, is one of the many patients who have been affected by the strike. He says, “The patients who are here from other parts of the province are condemned to suffer. Their expenses on transportation and stay in the city increase unimaginably as the strike lingers on. They are forced to turn to private hospitals where the consultation charges and/or test rates are too high for them.”

He also speaks of the problems faced by patients from within the city. “During the strike, the burden on emergencies increases manifold, as the OPD patients also queue up.

“Secondly, there are repeat patients of diabetes, hypertension, and even severer complaints who must be treated without delay.”

Under the proposed law, the doctors will be allowed to continue with private practice of and outside the public hospitals. However, those practising outside the hospitals will have their professional medical allowances removed from their salary packages.

There’s a rub. Many services are available only at government hospitals. These cannot be had at private facilities, even if the patients arrange for money.

“The government must enforce the Essential Services Act that bars certain professionals from going on strike,” says another patient. “Medical profession is about saving lives but here the doctors are risking patients’ lives.”

A protesting doctor whose surname is Ahmad claims that even those senior doctors who cannot come out in the forefront for some reason, are supporting the cause. “The strike is not only by young doctors but all the hospital staff, including paramedics (nurses, attendants, and equipment operators), because the careers of all of us are at stake. That’s why, this time it is not just the YDA [Young Doctors’ Association] but the Grand Health Alliance that gave the call for strike.

“Can you believe that the proposed law gives independent hospital boards the power to even dispose of immovable property which is owned by the hospitals? On top of that, they are taking away your job security which is the biggest incentive in government service.”

Dr Salman Haseeb, the Grand Health Alliance chairman, , confirms that doctors, paramedics and other hospital staff are observing strike all over the Punjab. He says that the protestors are not working in the OPDs, though the provision of services to serious patients continues in emergency wards. The strike, he adds, is against the government’s plan to privatise hospitals and giving over control to selected people.

“The public must join forces with us because they are also going to be affected adversely if the new law comes into force.”

On the other hand, the government claims that the Punjab Medical Teaching Institution Reforms Bill, 2019 is meant to improve medical education and healthcare services in teaching institutions in public sector.

Under the proposed law, the doctors will be allowed to continue private practice at and outside the public hospitals. However, those practising outside the hospitals will have their professional medical allowances removed from their salary packages. Secondly, the medical teaching institutions shall have the power to acquire, hold, and dispose of movable and immovable properties. Boards will be composed of eminent technical and professional people from various fields including law, regulation, finance and management.

Another clause provides that a consultant’s professional fee for private practice shall not exceed the fee fixed by the said board.

Dr Ashraf Nizami, a senior office-bearer of the Pakistan Medical Association (PMA), rejects the notion that the association has extended its support to the government or come half-way. “We offered certain recommendations [to the government] to be incorporated in the new law. The government is falsely claiming that our demands have been fulfilled. There is no documentary evidence to confirm this. Once things are in black and white, the protesting doctors will be ready to negotiate.”

According to Nizami, the recommendations forwarded by the PMA include ensuring continuity in seniority while services under deputation to MTI-governed institution, 360-degree evaluation of re-employment which means getting feedback from the seniors, juniors, and patients etc; regularisation of job after two successful tenures; condition of having medical qualification for the post of hospital director; removal of powers to terminate without assigning reason; and disposal of property only by the government and not the board.

The PMA has also suggested that the institutions should raise their own funds to cater for Contributory Pension Funds, Benevolent Fund, Group Insurance, and General Provident Fund for employees of the institution without incurring any financial liabilities, and make regulations for their operations.



Shahzada Irfan Ahmed

shahzada irfan
The author is a staff reporter and can be reached at [email protected]

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