By Zubeida Mustafa
THE health sector should be of concern to all — even to those who go to the best private medical practitioners. Disease transcends borders, and strikes the rich and poor alike, though the latter are more vulnerable. Besides, health issues affect the country’s international status as was demonstrated by the polio emergency that led to the imposition of new conditions on Pakistanis embarking on foreign travel.
Hence should not the concerned citizens be involved in what can be termed the regulation of the medical system as they are reaching out in the education sector? Not just altruism or civic responsibility but also narrow self-interest should prompt the intelligentsia to take more interest in the healthcare delivery system.
There are many factors contributing to the dismal state of the health infrastructure in Pakistan. One is our inability to train skilful physicians committed to upholding the noble spirit of the profession. Another is our willingness to give the medical profession a free hand in indulging in malpractices of the worst kind.
As a result, the products of our medical colleges and universities are not made of the stuff that will change the dismal scenario. The fact is that the system for regulating medical education and licensing doctors that we have in place is highly inadequate and obsolete. Additionally, it is riddled with corruption.
Now is the time to redefine PMDC’s role.
Although many sane and responsible voices in the medical profession have from time to time expressed their concern, their calls have fallen on deaf ears. The problem has centred on the Pakistan Medical and Dental Council (PMDC) which describes itself as the “statutory regulatory body setting standards for medical and dental and professional competence, care and conduct of medical/dental practice to protect public interest in Pakistan”.
Few would deny that the PMDC has failed to perform its duty conscientiously and honestly. Stacked with principals of private medical colleges it assumed the responsibility for regulating medical education as well. As was expected, private institutions proliferated and from one in 1990 their number has jumped to 52 today. There are only 32 in the public sector.
The PMDC has had a good share of the limelight — not favourable at all. After being deprecated for its misdeeds it was suspended by an ordinance issued by the government in March this year and superseded by an interim committee that was asked to hold new elections within 120 days. But not even a month had passed when the ordinance was rejected by the Senate and the move aborted.
Meanwhile, scores of medical colleges have been ‘de-recognised’. This vindicates the charge that medical education, like many other branches of knowledge, is being undermined by corruption. The only problem is that it is a matter of life and death when there is cheating in medical education. That is what it amounts to when medical colleges are allowed to operate without a permanent faculty or an attached teaching hospital.
It now appears that many doctors are dissatisfied not just with the composition of the PMDC. They also believe that now is the time to redefine its role. Dr Naeem Jafarey, a veteran physician who is professor emeritus at the Ziauddin Medical University and its adviser academic affairs, asks, “Should the PMDC be a licensing authority or a regulatory body?”
He believes the PMDC should be “a licensing body and this is the function on which it should focus”. He cites the example of the UK’s General Medical Council whose role is defined on its website: “We protect, promote and maintain the health and safety of the public by making sure that doctors follow proper standards of medical practice.”
That should also be the role of the PMDC and for that, Dr Jafarey believes, the PMDC will have to be restructured since this is not simply a medical issue to be decided by professionals alone.
Besides as a licensing body it will hold qualifying examinations and also accredit the medical colleges whose graduates would qualify for these exams.
Dr Jafarey has a point when he suggests that the licensing and regulatory roles of the PMDC should be separated. The Higher Education Commission or the universities could play the regulatory role by laying down the criteria — facilities, faculty, curricula, etc — for medical education institutions.
The fact is that the time for reforms is here. If medical education in the country has to be saved restructuring must be introduced. A system of checks and balances could pre-empt the concentration of powers in one body that leads to so much corruption.
Most importantly, there is need to provide an avenue for redress for the public when it suffers at the hands of medical professionals. The PMDC website details the procedure for launching complaints against registered medical practitioners. One hears many complaints from people but little about what is being done.