By Zubeida Mustafa
THE health sector in Pakistan is in a crisis. Various reports and surveys paint a bleak picture which is not surprising given the breakdown in the healthcare infrastructure.
If the country has a high infant mortality rate, if polio cases have taken an upwards turn and the state of health is abysmal, prompting observers to warn that the Millennium Development Goals are unachievable, the root causes are obvious.
In every sector of life, human resources are central to performance. Qualified and well-trained manpower (and also womanpower) with professional commitment and motivation can overcome many barriers that can come in the way of success.
A look at the state of the human resources in our health sector is quite revealing. Dr Shershah Syed, ex-secretary general, Pakistan Medical Association, and ex-president, Pakistan Society of Obstetricians and Gynaecologists, is articulate when shedding light on what is ailing medical education and planning.
Having been an inveterate champion of the people’s right to healthcare, he has immense capacity to identify the cause of a problem and to fearlessly call a spade a spade.
He identifies three basic causes for the malaise in human resources in the health sector. First, the poor quality of medical education which has hit rock bottom, the exception being the few pricey institutions in the private sector. Second, there is an intense shortage of doctors and surgeons in the country.
Third, the poor planning of health manpower has resulted in a lopsided structure that is inadequate for our needs.
In some ways, this reflects a grave paradox in the system. Why should a country with 129 medical colleges face a shortage? One reason is that the medical graduates being produced are generally of poor quality and unemployable.
The better ones form the brain drain that is robbing the country of its best talent. Those who choose to stay in Pakistan and work are not necessarily the best stuff that goes into the making of a competent doctor. Many, especially women, who study medicine do not practise.
The fact is that the recently dissolved Pakistan Medical and Dental Council that supposedly regulated medical education was not doing its job honestly. The medical community demanded the abolition of the PMDC which had become virtually a mouthpiece of the private sector whose interests it had begun to scrupulously safeguard.
Eight years ago, Dr Shershah tried to correct the balance in the PMDC’s composition when he was elected to the council as the representative of the doctors from Sindh. But he was not allowed to participate effectively in its proceedings despite a ruling of the court.
Over the years, medical colleges mushroomed all over the country many of which did not even meet the specified criteria but yet managed to obtain the PMDC’s recognition. Nineteen of them are reported to have paid Rs50 million each to get registered. It is unbelievable but the fact is that many of them do not even have the 150-bed hospital that is mandatory for a medical college to function.
Other requirements such as a full-time faculty for the basic sciences and laboratories are also missing. Some of these institutions were functioning as evening colleges and charging exorbitant fees. Some parliamentarians are said to be involved and at one stage NAB was asked to look into the matter.
The medical community’s persistence has paid off. In February, there were reports of 24 or so medical and dental colleges on the hook as they lacked the basic conditions prescribed for them.
In March, the federal health minister went further and dissolved the controversial PMDC and announced the formation of a seven-member committee which has been given 120 days to hold fair elections for a new PMDC.
Given the representative composition of the committee, hopefully the new body will resolve the crisis.
The new PMDC may play an efficient regulatory role. What, however, needs to be addressed urgently is the lopsided health manpower planning. No need assessment has ever been carried out. Rational estimates call for 10 paramedics/nurses for every doctor produced.
Instead, Pakistan produces one nurse/paramedic for 10 doctors. This reflects the class biases in our society: paramedics and nurses do not enjoy the same social status as doctors. And we know how our education system is skewed against the underprivileged.
The private sector is not interested as nursing schools do not earn as much profit as medical colleges.
In that context, the Sindh Institute of Urology and Transplantation’s move to launch courses to produce physician assistants is a bold step in the finest tradition of social justice. Some medical universities are following suit now. But their high fees — SIUT does not charge a penny — may yet erect barriers for the not so affluent.