The Islamabad High Court this week declared a presidential ordinance for the dissolution of the Pakistan Medical and Dental Council (PMDC) as null and void and reinstated the employees of the council. The court also ordered the dissolution of the newly formed Pakistan Medial Commission (PMC), declaring it to be illegal.
Legal conflict started last October when President Arif Alvi promulgated an ordinance that dissolved the PMDC and paved the way for the establishment of the PMC. The president in his wisdom signed a new ordinance titled “Pakistan Medical Commission Ordinance, 2019” by virtue of which a new era would have begun with reference to regulation and control of the medical profession by establishing uniform minimum standards of medical education and training and recognition of qualifications in medicine and dentistry.
This meant that the PMC would be run by a nine-member body and the head of the commission would be called its president. Implementation of the new ordinance required dissolution of the PMDC and that the PMC would be a body corporate consisting of (1) the Medical and Dental Council; (2) the National Medical and Dental Academic Board; and (3) the National Medical Authority, which would act as secretariat of the commission.
In response to the order, the National Health Services Ministry through the Islamabad district administration and police took over possession of the PMDC building and informed its 220 employees that the office would remain shut until further notice. After this, the aggrieved employees submitted a petition against the PMDC’s dissolution on October 30 in the Islamabad High Court.
When contacted, PMDC employees said they were worried that under this new ordinance the responsibilities of the PMDC, as a regulator of medical colleges, would be minimized and colleges would be allowed to increase fees, they would not be pushed to have a certain number of faculty members, they would be allowed to set their own criteria of admission, and each college would be allowed to choose the university of its choice. Apart from their unjust dismissal, PMDC officials were obviously hinting at the under-the-table move played by the education mafia.
In an effort to resolve the conflict, the special assistant to the prime minister on health, Dr Zafar Mirza, said the new ordinance was the need of the hour and that the world had progressed, but in Pakistan we were still following decades-old methods for our medical education.
In fact, what did not happen, and should have, was the tabling of a bill in parliament so that all stakeholders would have given their input. If it was necessary to promulgate the ordinance, the government should have abolished the PMDC 1962 Ordinance, as the new edict violated the 1962 ordinance’s provision that a council shall be established through elected representatives from the medical fraternity.
It is worth mentioning that the PMDC has faced a number of issues for a decade as successive governments tried to get control of the council. The current debates in Pakistan over the constitutionality of the PMDC’s mandate and the government’s plans for radical reform of the National Health Service emphasize the importance of health systems and of the quality of care they provide to the entire nation. While health-care systems are necessary in all countries, their importance to fragile nations, and the damage done to these systems during such management conflicts, receives less attention than it should.
There are various definitions of what constitutes a fragile country or society, but most agree that a fragile state is one in which the government is unable or unwilling to deliver basic security and public services to the majority of its people, especially to the poor. These countries are frequently plagued by high rates of poverty, creating a vicious cycle from which it is difficult to emerge.
The future of health care in Pakistan, and indeed the likelihood of the state emerging from its fragile status, is far from certain. In 2018, the infant mortality rate in Pakistan was about 57.2 deaths per 1,000 live births. While significant progress has been made in reducing infant and under-five child mortality rates, 24.3% of the population continues to live in poverty. The country has also been dependent on international donors to support its rebuilding and redevelopment financially; in the current economic climate, diminishing donor aid poses a significant hurdle to maintaining and increasing the gains made in the country to date.
The Pakistan Medical Association was started in 1948. However, unlike medical associations in such countries as the US, the UK and Canada, Pakistan’s has not been prominent in shaping medical policy. It has no history of providing leadership in identifying the health problems faced by Pakistanis and providing input into how they should be tackled. The pitiful state of health affairs in Pakistan, with some of the worst health indicators, has not prompted this large group of health professionals to conduct introspection on the situation and come forward with constructive suggestions. Instead they have stood by as a spectators to the chaos in medical care in Pakistan.
Many policy documents of the government of Pakistan as well as agencies such as the World Health Organization and United Nations Educational, Scientific and Cultural Organization (UNESCO) have remarked on the poor health indices in Pakistan. It is disappointing that the legal conflict between the PMDC and the authorities has once again humiliated the medical profession and that government has not come forth with any action plan or draft document of suggestions to remedy this sorry state of affairs. Its actions so far are those of a petty interest group. It is not surprising, therefore, that it is treated as such, and nobody pays any heed to its pronouncements.