Rao Dilshad Hussain

Health is one of the most important sectors but it has never been given the priority it deserved. Pakistan is facing an acute shortage of doctors compared to its population. The population of Punjab is large when compared to Sindh province but the number of doctors in Punjab is very limited. Out of 136,700 the number of dentists is 8302, 51934 lady doctors and 20557 specialist doctors. The total number of doctors in Punjab is 55448, in Sindh 56198, in NWFP 15260, in Balochistan 4090 while the number of doctors in AJK is 2478. There is great rush of doctors in the public sector hospitals where each doctor examines more than 100 patients daily while the international standard are 25. There is urgent need to open new medical colleges and also to cut down the expenses of medical education.

Government provides funds to ensure provision of free medicines to the patients but these too are at times are not enough. Government should not only enhance the health budget but also increase the salary packages of doctors and paramedical staff. The doctors and paramedics are not happy with the budget allocated by Punjab government for the health sector. Pakistan Medical Association, Punjab Specialists Doctors Association, Young Doctors Association, Paramedical Staff and other associations of doctors’ community are protesting against the budget for health sector.

Doctors’ community has many reservations about the Punjab government’s intentions to bring change in the health sector. Talking to Sunday Plus, the President Punjab Specialist Doctors Association, Dr. Tanvir Zubeiri said frustration among the young doctors was increasing as the government was doing nothing to address their issues. “Government spends millions of rupees for producing a batch of doctors but when time comes for serving the nation doctors start searching for greener pastures and go abroad to work in other countries,” Zubeiri explained.

“The salaries of doctors are low in Pakistan. They earn a lot more if they work abroad. Doctors’ priority is to leave the country after doing MBBS. Recently 1500 doctors left the country for Saudi Arabia. 4000 doctors are ready to leave for UK and USA.

“Provincial budget allocated for health sector is not sufficient to meet the requirements of the doctors’ community and public hospitals. The need of the hour is to establish more public sector hospitals because the population of Lahore has passed the 8 million mark. Public hospitals are few in number. Government should take to task the DHA and LDA’s managements for not constructing big hospitals in the housing societies. “As new hospitals were not established the burden remained on the existing hospitals. Health is not Khadam-e-Aala’s priority. He doesn’t want to get his medical treatment from Pakistani public hospitals. He goes abroad for routine check up.

“He should think about the doctors’ salary packages. If the government wants to stop the increase in flight of doctors abroad then it would have to ensure handsome salary packages for them in Pakistan,” Dr Zubairi was of the view.

PMA’s Lahore General Secretary Dr Tanvir Anwer said construction of new hospitals at district level has become necessary. “Instead of building new hospitals the government has increased the seats in the existing medical colleges. This is a blunder. Both doctors and public would have to suffer because existing colleges are already working to their full capacity.

“Every lecture theatre has more than 175 students, which is unfair. With the increase of 452 seats the lecture theatre would not be possible for the students.

“The government is striving for quantity rather than quality. Government should have established the medical college that would have been associated with Lahore’s General Hospital. The Pervez Elahi government had given approval of the project. The current government is ignoring it.

“The Punjab government is reluctant to give jobs to the doctors. More than 1400 jobs are available in medical colleges and hospitals but the government is not willing to fill the vacancies.

“Government never consults doctors on issues related to the health sector. It fails to understand that doctors are the major stake-holders in health sector. Chief Minister just focuses on suspending the doctors but doesn’t think about system that needs to be revamped. Chief Minister humiliates the doctors whose response is to leave the country and work abroad.

“The salary and pay scale of the doctors should be increased as federal government announced 50 percent rise in the salary. 50 percent adhoc relief should be implemented on the pay of HOs and PGRs. The recent increase in health budget would not bring good results. Most of the health budget would be spent on purchasing medicines and giving salaries to doctors and paramedical staff. General public would not be the beneficiary,” Dr Anwer said.

He was of the view that launching of the mobile ambulance hospitals would be the biggest blunder. “Public money would be wasted. Government should provide better facilitate at the Basic Health Units, Rural Health Centres and District Head Quarter Hospitals. These units do not have the same facilities as urban hospitals. Public hospitals have infrastructure but the government lacks the vision to run them. Mobile hospitals would be waste of money and energy. Government should spend the money wisely and stop the flight of doctors to the West by offering them attractive incentives.” Dr Anwer said.

General Secretary Young Doctors Association Punjab Dr Sulman Kazmi was of the view that the announced budget is never implemented. “A number of paramedical seats are vacant. The government is not taking initiative to fill them.

“Chief Minister just takes interest in conducting surprise visits at the hospital emergencies to check the facilities and to suspend the doctors. He should concentrate on providing maximum funds and construction of new medical units and wards in the existing hospitals. Government should not have increased the seats in medical colleges. They are already running over the capacity.

“More than 200 consultants from teaching side and 1200 PGRs (post-graduate residents) have left the country while more than 4000 are planning to leave. Nobody cares about this grave issue. The task force set up for health sector has failed to deliver. Mobile hospitals will fail to deliver. Millions would be wasted on the project that will not bring good results,” Kazmi said.

The doctors’ organisations have been staging protest demonstrations for some months to press the government to increase salary package for doctors and paramedics. The allocation in budget for health sector has disappointed them. “If the 50 per cent ad-hoc relief would not be implemented on the pay of HOs and PGRs then all associations of the doctors will start protest. We are planning a long-march to the Chief Minister’s residence.” Dr Kazmi maintained.

President PMA Punjab Dr Akhtar Rashid has also criticised the plan to increase in medical colleges. “The government should have started evening classes in the same colleges. Government has done nothing for welfare of doctors. If government continues to act like this it would become difficult to pursue the Millennium Development Goals – a road map that had to be followed till 2015.

“If the government continues to fail to provide maximum facilities to primary and secondary hospitals like DHQs (District Head Quarter Hospitals), the public would continue to suffer. Special pay and package should be increased to 100 percent for the doctors and paramedic staffs. The health budget should be enhanced by 400 percent,” Rashid demanded.

Chief Minister’s Task Force Chairman Dr Saeed Elahi when contacted said the Punjab province was providing better health services to the people than the other provinces. “Chief Minister Mian Shahbaz Sharif has given top priority to the health sector, which earlier had meagre allocation of 0.7 percent of the GDP. He has raised the health budget up to Rs 27 billion, which had been targeted to be further raised up to 4 per cent of the GDP. The Punjab government has ensured the provision of free medicines in government teaching hospitals and DHQ hospitals of the province.

“Government is already giving best packages and stipends to the PGRs. The government has already announced to establish four medical colleges in Sialkot, Sahiwal. Gujranwala and Dera Ghazi Khan in two years time. Increasing the seats in the medical colleges is very good initiative because a number of our doctors are studying in China, Russia and Central Asian countries. We are also working to upgrade the district headquarter hospitals across the Punjab. Huge amount of money is being spent for the purpose,” Dr Elahi said.

He revealed that Punjab government will soon be launching 10 mega projects in health sector. Liver transplant facilities would soon be introduced in the province. The liver transplant centres would soon be functional in General Hospital Rawalpindi and Nishter Hospital Multan. Four hospitals each having 300 beds would be built in Bahawalpur, Multan, Rawalpindi and Dera Ghazi Khan.

“Beside these hospitals six modern mobile hospitals are also being launched. Punjab government is just providing them the doctors and paramedics staffs while they would be run by foreign experts,” Dr Elahi said.

The issues related to health sector are serious and need immediate attention of the government. The doctors should be taken into confidence over the plans to bring changes in the health sector.