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Proposed bill sparks privatisation debate in KP.

LAHORE: The Khyber Pakhtunkhwa government and doctors of the province are at loggerheads over a proposed bill seeking drastic changes in the health sector.

The doctors are against the proposed bill titled The Khyber Pakhtunkhwa Regional and District Health Authorities Act 2019, which is yet to be tabled in provincial assembly. Doctors call it "privatisation of health services" but the government says it is aimed at health reforms and devolution of powers to the districts.

Eggs and scuffles

Doctors, under the umbrella of Young Doctors Association (YDA) and Provincial Doctors Association (PDA), were opposing the bill from the day news of the bill surfaced in the media.

They began staging protests in the provincial capital and on Tuesday, May 14, thing took an ugly turn when the KP Health Minister Dr Hisham Inamullah attacked Dr Ziauddin Afridi, an assistant professor of surgery at Khyber Teaching Hospital (KTH), who threw eggs at Dr Nausherwan Burki during a policy board meeting of the KTH. Burki was chairing the meeting.

Dr Burki, the head of National Health Task Force and a relative of Prime Minister Imran Khan, is the architect of the Medical Teaching Institutes (MTI) law in KP and is also said to be the designer of the above mentioned draft bill.

Sources say Dr Ziauddin Afridi had come to the meeting to share his grievances against the hospital administration over the issue of his promotion from assistant professor to associate professor.

After the incident at the meeting, Health Minister Hisham Inamullah reached the hospital with his armed guards and confronted Dr Ziauddin inside the hospital. The health minister and his armed guard then had a scuffle with the doctor. The government attempted to cover up the incident and blamed the doctor for the incident, CCTV footage from the scuffle went viral on social media. Even a section of electronic media reported that a doctor attacked Dr Burki with eggs during a meeting and the minister health was injured in a scuffle with the doctor.

The footage also provoked doctors from across the province who suspended services at the KTH and other major health facilities in the city. Protesting doctors took to University Road and blocked it for traffic to register their protest against the health minister and Dr Burki.

On Wednesday, the doctors announced a strike across the province and boycotted all elective services at public hospitals and closed their private clinic as well. Only emergency services were open at the hospital.

"Doctors were searching for this moment and the health minister provided them the best opportunity to start their protest," said Sirajuddin, a senior journalist in Peshawar who covers the health beat. "Doctors are actually protesting against the controversial KP Regional and District Health Authorities Bill. The minister and Dr Burki are just small part of the bigger picture."

Sources in the KP government say that the government should have tested the plan as a pilot project and then extended it to the entire province.

"The model is based on the Medical Teaching Institute (MTI) system. Has the MTI system been evaluated over its success? No. Then why this system is being extended to the province?" an official of the KP government requesting anonymity asked.

The Bill

The controversial Khyber Pakhtunkhwa Regional and District Health Authorities Bill 2019 seeks the establishment of a policy board at the provincial level, regional health authorities at division level and district health authorities at the district level to run all health facilities.

The Regional Health Authority (RHA) shall be comprised of two doctors, a nurse and two eminent persons with significant experience in the field of law, finance, management or economics. Retired government servants, educationists, social workers, civil society, businessman and renowned philanthropists may also become part of the body.

The chief minister will appoint members of the RHA on recommendations of a search and security committee. The search and security committee shall be chaired by the health minister and its members will include the provincial secretary health, director general of the Health Department, a representative from University of Peshawar, a representative from Khyber Medical University, a representative from a reputable private hospital in the province and a representative from the civil society or retired government servant or retired high court judge or industrialist or any noted person with achievements.

According to Section-7 (9) of the bill, the RHA will be accountable to the health minister for its performance.

"This is a conflict of interest as the minister is also the chairman of the search and security committee that recommends the names to the chief minister for appointment of members of the RHA," said an official of the KP government requesting anonymity.

There are other issues in the powers and functions of the RHA, including its powers to take disciplinary action against civil servants which come under separate laws. Its powers to create or abolish posts are also objectionable on the grounds that such powers would be used for creating posts for recruitment of favourites. Section-9 (3) of the bill gives arbitrary power to the chairman of the RHA to appoint the chief executive officer, hospital director, medical director, nursing director and finance director for health facilities if needed and the appointments shall be approved from the RHA within three months.

Section-11 of the bill states that management cadre in the Health Department shall be made a priority through the appointment of hospital director, medical director and nursing director. "Why should the management cadre be given preference?" questioned another senior official of the KP government. He also wondered why the position could not be filled through open competition if the government intended to appoint the best people for these slots.

Section-11, which deals with the appointment of employees, further states that the Health Department should transfer existing civil servants (doctors appointed through KP Public Service Commission) to the respective districts of their domiciles. These civil servants shall be treated as 'dying cadre' and they shall continue till their retirement. After their retirement the posts shall be abolished and the RHA may fill it through its prescribed rules. This means that no doctors would be appointed on regular basis in the province after the commencement of this act--a move that is one of the main causes of agitation among the doctors.

"Doctors were going to peripheries and far flung areas with no facilities just because of the permanent jobs through the public service commission. When these jobs will be on contract, who will be ready to go a remote area as a medical officer with no facilities, no laboratories, nothing to learn and even with no electricity?" questioned a doctor who applied for a medical officer post in Karak through the KP Public Service Commission. "This would further aggravate brain-drain in the medical field," the doctor said.

Section-12 of the proposed bill states that the chief minister may abolish the RHA on the recommendations of the health minister, which means the latter has arbitrary power without any collective wisdom involved. Furthermore, the KP Health Department will the make interim arrangements to exercise the powers of the abolished RHA until the new RHA is constituted. "One person --the health minister - has the powers to recommend to the chief minister to dissolve any RHA and then his department will run the interim setup. Is this not giving absolute power to the health minister? Where is the devolution here?" questioned an official.

The District Health Authorities (DHA) will be established in each district and will have CEOs appointed by the RHA, a member from doctors appointed through votes from among doctors of that district, a nurse elected through votes from the nurses and three eminent persons appointed by the RHA, preferably from the same region. "If the RHA is to make appointments in the DHA, then how do you call this devolution to district level? It is devolution to the division," said the official.

Section-17 of the bill states that the minister health may dissolve the DHAs and then the health department would make interim arrangements in that district. "The minister is getting absolute power through the interim setup if he dissolves the DHA."

The official also expressed concerns over the budgeting of the RHAs and DHAs. He said the RHAs would have the power to increase charges of OPDs, tests and X-rays. "This would certainly increase the cost of treatment for the people," the official said. He said the charges of OPDs and tests had been increased at all MTI hospitals in Peshawar.

Section-30 of the bill seeks amendments in the KP (Appointment, Deputation, Posting and Transfer of Teachers, Lecturers, Instructors and Doctors) Regulatory Act 2011 by removing everything relating to doctors in this law. This means that doctors will not be appointed on permanent basis via the KP public service commission.

KP Doctors Council representative Rizwan Kundi says the doctors in the province were not ready to accept the KP Regional and District Health Authorities Bill because it will end permanent jobs for doctors in the province. "It is like privatisation of the health sector," he said.

"The authorities will increase charges of OPDs, laboratory tests and X-rays. Poor patients have to pay for ultrasounds and other tests at public hospitals. Grants and loans provided by the government to the districts will not be enough to run hospitals and they will charge patients to bridge the gap," he said. He added that doctors were ready for transfers to their domicile districts but they would not accept the bill in its current form.

He said doctors were demanding resignation of the health minister and Dr Burki along with the police officer who thrashed doctors at the police station.

Health Minister Dr Hisham Inamullah dismissed the assertion that the bill was on privatisation of health services, saying it was intended to bring reforms in the health sector.

"Calling it privatisation is misleading the public. Doctors are protesting against their transfers. We will not compromise on transfers and reforms," he said in a statement. The minister added that the Health Department was transferring doctors to overcome shortage in districts where they were needed. He said 1,000 doctors had been transferred to their respective districts and the department was in the process of transferring 2,500 doctors to their districts.
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Publication:Friday Times of Pakistan (Lahore, Pakistan)
Date:Apr 6, 2019
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