In the run up to elections 2018, one obvious point of consensus across the political divide was the inevitable need to reform the health sector. All were in agreement that the ailing and outdated healthcare system needed to be reformed, and done so with an urgency.

So cometh the hour. A year down the line, much has already been written on these pages on the scale of reforms in other areas. However, much of the debate, for wrong reasons though, has revolved around the Medical Teaching Institutions Act for quite sometime. Teaching Hospitals, apparently billed as the face of the Department, present complex challenges requiring complete review and overhaul of administrative structures. For a whopping amount around Rs. 230 billion from the tax payers kitty, the outcome was poor service delivery, lack of ownership, absence of accountability, unending bickering, politicking and controversies leaving a chaos. This utter wastage of resources comes at a price which a cash-starved nation like us could ill afford. One bed costs us between 4 to five million a year, high by any standards, and yet service quality remains at the lowest ebb. Imagine a workforce of 1.3 million in the department placed arbitrarily in a highly centralized structure. Routine processes pile up in such a way that no meaningful initiative can drift through. A backlog of some 26,000 pending HR queries, requiring miraculous speed. This resulted in an inertia where patient suffered the most.

After much deliberations and extensive consultations, we came round to a package of reforms aimed at restructuring the administrative scheme of things through the Medical Teaching Institutions Act. The ironic part was that the MTI came after dozens of meetings with all stakeholders taking part in recent protests. Many of their proposals became part of the final draft, till they delivered the surprise of going Avowal at the last moment. MTI’s outright rejection on one or the other pretext was indeed surprising, for it was aimed at welfare of those very protestors. Whereas we have continuously engaged them, listened to their demands and made necessary amends, their intransigence remains inexplicable. The MTI offers a choice to doctors to either continue with the existing pay scale system or take the more lucrative positions under the MTI, the fuss over job security hence totally uncalled for. Choice in service structure remains doctor’s choice, yet the blame is on us.

So the standoff continued at the cost of poor patients who continued to suffer and sulk for no fault of theirs. Our repeated requests for dialogue fall on deaf ears yet our efforts for resolution continued. The sad part was that MTI protest was being used as pretext by some work shirkers to enjoy long holidays from work. This was a difficult situation; so what were the choices? Push ahead with the preponderance of authority or let the pusillanimity prevail? Between the two, even the procrastination was not an option.

Let me emphasize it again that the MTI Act primarily aims to redefine the administrative scheme of things. It addresses the bottlenecks arising from a centralized Secretariat-based structure and replaces it with a more local, financial and administratively autonomous model, to introduce efficiency into the system.

Privatization was one big misnomer against the reforms package. When the Government remains the employer, provides the funds, ensures performance monitoring, conducts the audit, how can it even be termed as privatization? The conspiracy theories come from the introduction of a Governing Board of each institution instead of the Secretariat. The Boards shall comprise Professors, experienced professionals from health management, lawyers and financial experts in areas related to health, retired civil servants, retired judicial servants and other members from the civil society and others deemed appropriate by the Provincial Government. A number of other provincial institutions are working on the same model, yet the word privatization is reserved for MTI only?

Moving forward, lessons learnt from previous similar experiences have been incorporated. Under the previous Act, the board was formed and governed by the Secretary of the department, which resulted in an absolute control of bureaucracy in administrative and managerial affairs of each institution. The Board will now be monitoring the performance under indicators on service delivery. The Govt shall give one line budget to the institutions whose boards will fix the spending priorities as per local needs. A strong oversight system has been set up including a 3rdparty performance and evaluation to assess the performance of the institutions.

Teaching Hospitals are key institutions for improving the overall quality of education and medical training. Over the last decade, the quality has seen a steady decline. The MTI intends to provide an environment where quality education and training shall be ensured. Tertiary hospitals must become platforms for research, academic excellence and for producing quality human resource. The MTI Act provides market based remuneration to staff with structure for timely promotions and rewards for a performance based system. High performing staff shall be rewarded with bonuses, promotions and upward professional growth. A system of accountability shall be enforced for under-performing staff.

Yet for some circles, the MTI has hit a few raw nerves especially those running private facilities and enjoying govt. jobs simultaneously. For professionals wanting performance and efficiency, it offers much more. Patients will be the biggest beneficiaries of the system and healthcare service delivery will improve once the system is put on modern track.

Lastly, for a life dedicated to struggle for the rights of doctors, this is an opportunity for all of us for a meaningful change. History will judge in a few years time what we did to introduce for genuine improvement in the system. This indeed is our moment of truth.