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Newsbeat
Medical Mayhem Doctors in NWFP fight back against government-imposed restrictions on private practice By Amir Mohammad Khan
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The Frontier government’s decision
to ban doctors’ private practice and introduce institution-based
practice (IBP) at public sector hospitals from March 1 has created
a wide gulf between the medical profession and the government. The doctors are adamant in their opposition
to the move and term it ‘a recipe for disaster.’ The government is determined to implement the plan in the ‘best
public interest’. Talks
to bridge the gap have failed not only because the camps have divergent
viewpoints but also because the end sufferers are the patients who
have little role to play in the crisis. “The private practice of all government
doctors, including teaching staff at any place or premises, except within the
boundaries of the health institutions/hospitals concerned, shall stand banned
with immediate effect,” said a notification issued by the NWFP health secretary
on February 2002. In a press conference
the same day, the acting health secretary, Brig. Habibur Rahman, gave a grace
period of 15 days to the government doctors to wind up their private clinics. He warned that following the expiry of this
period stern action would be taken against transgressors for misconduct,
according to the NWFP Civil Servants Removal from Service (special powers)
Ordinance, 2000. The ban was a sequel to an earlier
notification in June 2001 that made four major health institutions, the Lady Reading
Hospital (LRH), Peshawar, Khyber Teaching Hospital (KTH), Hayatabad Medical
Complex (HMC), Peshawar, and Ayub Teaching Hospital, Abbottabad, autonomous
both financially and administratively. According to Brig. Habibur Rahman, the
government started institution based practice (IBP) in four major hospitals of
the province on a voluntary basis out of good faith and asked the doctors to
spare only two hours a week for IBP. “They did not cooperate and the plan
proved a failure,” he remarked. “That was a half-hearted attempt and the
government had to devise a new policy to deal with the situation and make it a
success.” According to the formula announced
by the health department in its notification, the doctors will get 60 per cent
of the revenue generated through the IBP of each institution. The clinical and administrative support
staff is assigned 20 per cent while the remaining 20 per cent revenue is
allocated for the hospitals. The
patients are required to pay 300 rupees as fee to the consultant in IBP. In a summary on regulation of private
practice by doctors, Brigadier Habibur Rehman says the objective
of the plan is ensuring quality treatment, a uniform fee structure,
maximum utilisation of hospital equipment and infrastructure during
off-hours, creating additional resources and documentation of doctors’
incomes. The doctors, who closed their
clinics throughout the province on March 1 in accordance with the notification,
are up in arms against the ban since then. They have held talks with the NWFP
governor, Lt General (Retd) Syed Iftikhar Hussain Shah, his advisor on health,
Dr Robina Gilani, health minister Dr Mehr Taj Roghani, and the NWFP chief
secretary to bring home to them that the doctors are not ready to accept the
notification. The doctors claim they
are holding talks to convince the government that introducing IBP is not the
right step and the ban on private practice is not fair. The government side asserts it is ready for
talks in order to facilitate IBP and remove the doctors’ apprehension, if any. The Joint Action Committee, headed
by Pakistan Medical Association (PMA), NWFP, president Umar Ayub, has filed a
writ petition against the governor’s order in the Peshawar High Court (PHC)
pleading that the notification is against the law. “Our meetings with the
government so far have failed to bear fruit and find common ground,” says Umar
Ayub. “We have filed another petition
against the notification in the Supreme Court on the ground that it is against
fundamental human rights.” “The IBP is
a recipe for disaster,” the PMA provincial chief claims. “The doctors have no option but to tender
their resignations if the situation persists and no common ground is reached to
resolve the issue,” he warns. Though the doctors are enraged about
the plan, few are vocal enough to criticise the scheme openly. “The chief
secretary has warned us not to press our grievances,” says a cardiologist at
the LRH. Many doctors says the health
department has banned private practice despite the fact that the hospitals do
have not enough infrastructure, equipment and facilities to accommodate the
influx of patients. “The ultrasound and X-ray machine at our hospital is a
couple of decades old,” maintains a
doctor at LRH claims. “This random act will only lead to disastrous effects,”
says another doctor. The government, however, seems to be
holding firm in its resolve to implement the plan. According to Brigadier
Habibur Rehman it is holding talks with the doctors to resolve the issue. “As
far as I know, the dialogue with the doctors is being held to discuss
facilitation of IBP, not its revocation,” the health secretary says. Though both sides stick to their guns and
are not ready to show flexibility, Dr Robina Gilani is optimistic about the
outcome of the dialogue. The doctors in their meetings contend that facilities
at the hospitals are not adequate and the decision about IBP was a sudden one
she says. “They have objections over facilities and the increased load of
patients in hospitals, not over the IBP plan, which is understandable, and the
government will definitely look into it to bring about an improvement.” The patients have become pawns in
this conflict between doctors and the government. Both sides say they are
acting to protect the interests of the patients but this is yet to be proved.
Financially, the patients are not better off with the new mechanism. They still
have to pay 300 rupees to the consultants in IBP as they did in the private
clinics. As the doctors are against the new mechanism, they are being
non-cooperative. “We have confirmed reports that certain senior doctors have
adopted a go-slow policy and are dumping patients in wards to stir up the
public about infrastructural deficiencies in hospitals,” says Brigadier Habibur
Rehman. The doctors have also allegedly started
prescribing highly expensive and rare diagnostic tests, which are
not available in the hospitals, admitting unnecessary patients through
morning OPD, and prolonging patients stay in the wards and rooms
unnecessarily. The administration of various hospitals has
also complained that senior doctors are not paying attention to
patients in the morning OPD. Also, there are complaints about the
rude behaviour of orderlies and paramedic staff at the hospitals. The introduction of IBP has also caused
difficulties for patients in remote areas of the province and in
the federally administered tribal areas.
Doctors used to go to the suburban and rural areas for private
practice and provide healthcare to the people in their villages.
Now they cannot to do so and the patients have to come to
the hospital, travelling on dilapidated roads.
Also, many doctors charge less at their clinics than the
fees prescribed at the IBP. This
means increased healthcare cost in the rural areas where poverty
is more pronounced and people cannot afford medical treatment.
Whether this will augment quackery in these areas or not
is a question staring us in the eye.
Time alone will tell whether the government and doctors will
be able to reach a common ground in their talks, resulting in better
medical facilities at an affordable cost. |
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E-mail: newsline@cyber.net.pk
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