SIUT’s philosophy: a rare creed

By Zubeida Mustafa

imagessiutI DISCOVERED the SIUT in the 1980’s when the private sector had begun to invade the healthcare system in Pakistan in a big way.

My quest was for an institution that could meet the health need of the masses at a time when the government was stepping back from its basic responsibility of providing citizens their fundamental right to health.

Of course the SIUT was not known by this name then. It was the Urology Department of the Civil Hospital – a public sector health institution. But even then it was so distinct from its parent body in its working and approach to issues of health and disease that one could not fail to take note. Be it its impeccable hygiene or the atmosphere of kindliness radiated by those who took care of the patients, this institution stood out for its uniqueness.

Its exceptionality was vindicated in 1991 when the Sindh Provincial Assembly adopted a bill granting it an autonomous status and that is how the Sindh Institute of Urology and Transplantation was born from the seeds sown 15 years earlier.

Today philanthropy has emerged as big business. As more and more people fall below the poverty line, their need for healthcare has gone up. The international human rights core instruments recognise healthcare as a basic right of men, women and children as much as the rights to life and freedom are universally recognised. Yet healthcare is one of the most neglected human rights in Pakistan. An ill person, especially if society and the state have also kept him impoverished and illiterate, is in no position to fight for his right to health.

There are many institutions in Pakistan claiming to provide affordable healthcare to the poor. They dole out charity and manage to alleviate the physical sufferings of a miniscule section of the population but rob them of their self-esteem. The SIUT is different because its performance is based on a philosophy that needs to be understood if it is to become a model for Pakistan’s healthcare system.

The basic principle underpinning the SIUT’s Charter is that health is a fundamental right of all citizens. In recognition of that the institute provides services to patients “free with dignity”. As such the SIUT’s Charter adopted in 2009 makes it clear that the institution is not run on the concepts of a Public-Private Partnership or a Non-Profit Organisation. The SIUT describes itself as representing a government-community relationship where professionals act as catalysts.

How does this translate into reality? It means that no patient – rich or poor — who comes to the SIUT is turned back. It also means no one is required to pay a paisa for medical consultation, diagnostic tests, day-care procedures, and hospitalisation if needed.

More importantly in the SIUT no questions are asked about a patient’s economic status and one is not required to prove his poverty. This approach adopted by private hospitals which provide treatment at concessionary rates to the poor is most demeaning. It reduces a person to the state of beggary. It is also realised by the SIUT staff that a person who is ill needs compassion more than medicine for the healing process to begin. This is provided in abundance.

One may well ask, how is such a hospital to be financed? That is where the SIUT’s philosophy comes in. It proclaims itself to be run as a government-community relationship with the professionals as catalysts. Graphically this is shown as a triangle with the patient in the centre. The three sides of the triangle comprise the government, the community and the professionals. The ownership is that of the government, the community makes donations as a part of its social responsibility and the professionals provide the services.

This approach may sound too idealistic in today’s capitalist world but it is working in the case of the SIUT. Pakistan is a poor country but it is rich in philanthropy and the SIUT has proved that people are generous in donating to a cause they have confidence in and know that the community will benefit.

To justify the public’s confidence, the SIUT’s philosophy specifically envisages a methodology that is doable. It follows an incremental and need based approach. In other words it expands gradually according to the needs of the patients. It seeks low-cost solutions for the most complex medical problems without compromising on cutting edge technology if that offers the best treatment. The preference is always for indigenous expertise and when that is not available, manpower is trained free of cost. If this is still not available, foreign experts may be recruited. In the process SIUT is developing trained manpower and inexpensive indigenous technology which is important for self-reliance. Thus it is also contributing to medical education in Pakistan.

Source: Dawn, 9 Dec 2015