By Zubeida Mustafa
Why is the SIUT a success story when other health institutions in the public sector in Pakistan have failed? This question is frequently asked by people who are wonderstruck by the SIUT’s performance. Few can believe that this immaculate hospital that sprawls before them is in the public sector. It has taken it 40 years to reach its present greatness. And it is still growing.
The only feature that betrays its ownership is the over-crowding you see there. Being in the public sector, this tertiary healthcare institution attracts all and sundry. Moreover it is a hospital that is affordable and actually works, where people are treated and recover from their illness.
So one may ask again what makes it tick? The fact is that if you were to adopt the same criteria as the SIUT uses to measure its effectiveness, you will find that most private sector and NGO-run health institutions are failures.
There are four yardsticks one must accept in a country like Pakistan, if one recognises healthcare as a fundamental right of all citizens as decreed by numerous international human rights instruments. They are
- Capacity to deliver healthcare effectively
- Accessibility to all
- Respect for the dignity of all with compassion
It is also important to look at an institution in the context of the society in which it operates. Unfortunately Pakistan has a highly stratified, fragmented and class-based society. It comprises a huge under-privileged and impoverished class (nearly 70 pc of the population) and a small privileged sector. If an institution cannot meet all the above mentioned criteria with reference to the have-nots, it cannot lay claim to success.
These criteria are the offshoot of the philosophy of the SIUT’s founding director, Dr Adibul Hasan Rizvi. He has repeated this on countless occasions in different words. He might say, “Healthcare is the birthright of every citizen and so we will not let anyone die who cannot afford to live.” Or the words may be, “We believe in the three ‘c’s, that is no distinction of caste, colour and creed or economic status in our treatment of those who come to us.” This philosophy sums up the secret of SIUT’s success.
How does it translate into action? Since the SIUT’s doors never close its patient load continues to grow. Last year 1.5 million people visited the hospital and received treatment with the help of state-of-the-art technology — some being as sophisticated as lithotripters and PET CT Scan (the first in a public sector hospital in Pakistan). The statistics are staggering as all the services — howsoever expensive — are offered free: over 58,000 new admissions, 117,000 surgeries and 8.2 million lab tests. The 301 kidney transplantations were the highest performed in any hospital in the country. Add to that the fact that one transplantation costs Rs250,000 and the SIUT provides the patient free Cyclosporin for life costing Rs 300,000 per annum.
These figures have been growing and the SIUT has been upscaling itself as the need arises.
The SIUT’s accessibility is unbelievable. No one is refused treatment but one must be prepared to wait given the large numbers who visit it. This is possible only when an institution is affordable and inclusive. Many hospitals exclude patients by simply imposing high charges which the majority cannot pay. Since the SIUT provides consultation and tests free, it is the first choice of the poor in the field of urology, cancer, liver diseases, transplantation and other fields that are provided by the Institute.
Besides it is so easy to drive away patients by not respecting their dignity or showing them compassion. Many commercial ventures claim to provide health services to the poor at a concessional rate. But in the process a person is humiliated when the hospital seeks to determine his economic status and distinction is made between the rich and the poor.
In the SIUT all receive equal respect and compassion. Dr Adib Rizvi doesn’t have a separate office for himself because he doesn’t want to single himself out as someone with a higher status than his colleagues or the patients he examines. The principle of equity is ideologically ingrained in him.
And how is this institution self-sustainable? Economically it has been growing. Starting as an eight-bed ward in the Civil Hospital Karachi it has grown into an 850-bed hospital spread over four buildings in CHK’s vicinity and three structures (one each in Korangi, Kathore and Sukkur) and four satellite centres for dialysis. The budget runs into millions with the government providing half the finances and the rest being raised by the community. Over the years, the SIUT under Adib Rizvi has won the confidence of the government and the community. Each and every paisa is stretched a long way by devising low cost medical approaches without compromising on medical principles, with the overheads being kept low, and zero-tolerance for corruption.
Expenditures grow because of the rising number of patients and the deteriorating economy that leads to higher costs of drugs, equipments and medical products. Thus the SIUT organised 297,000 dialysis sessions free of charge for patients with endstage kidney failure in 2016. By snipping off frills it saved on expenses and one dialysis session cost it maximum Rs 2000 which SIUT financed from its own budget when other hospitals charge as much as Rs 5,000 per session from the patient. That is how the SIUT has won the confidence of the community and the government which have continued to sustain it money-wise.
The key question is: will the SIUT be sustained in the future? Any institution doesn’t grow out of thin air. Remarkable institutions are the creation of remarkable founders who leave their stamp on the institution they build. One can understand the SIUT if one understands Dr Rizvi. He is scrupulously honest, an indefatigable worker, a task master, a skilful surgeon, an idealist and a true friend of the poor with whom he identifies himself.
Small wonder he has shunned ostentation — living in his austere North Nazimabad house, wearing simple clothes and travelling in a small old car. He makes no distinction between himself and the patients he loves.
Founders do not live for ever, but an institution must. To make it sustainable the founder has to leave a legacy — a philosophy and workers to keep the wheels turning. How does he do that, I ask Dr Adib.
He is quick with his reply: “All working in the institution should be given a sense of belonging and participation. For that you must look after your staff and address all their problems — not just theig financial difficulties. There should be absolutely no compromise on work ethics and discipline, though. You must stand behind the workers when they are in trouble. Even the most senior must be seen working together with the juniors. That means that food and drink served at the workplace should be the same for all. Thus alone by participating in the work will they become a part of the progress that takes place.”
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