For a life spent in clinical, academic, research and administrative areas of healthcare, I had mapped out strategic interventions for improvement before taking oath as health minister albeit the situation was much worse than expected. The first year was very challenging. It would have been rather smooth had it only been about fixing merely the administrative issues. Rather, it turned out to be a multitude of administrative, technical and political conundrums that ‘came not in single spies, but in battalions’ throughout the year.
Public offices present difficult choices and there is an easier path and a difficult one. The conventional yet often trodden path is: put inauguration plates, play up things with cosmetics and get into headlines. The second one, a touch lackluster yet the right one is to introduce sustainable reforms in system to make it productive and efficient. The latter comes with a price not to the liking of politicians yet for me it was an instant no brainer. So, came extensive consultations with stake holders to identify and address the administrative bottlenecks and devise strategies to improve service delivery.
So destiny presented this rare opportunity to bring about the change for which I yearned for all my life. The flip side is that the time and resources are scarce; yet this has to be done. Two goals are very clear; equitable and quality health service delivery for rich and the poor alike and development of healthcare facilities and institutions that can take services, research and academics a few notches higher. A few years down the road, court of history will judge how far I succeeded.
On assuming office, the painful realisation that Mother and Child Health was seriously neglected area. We were behind the Sustainable Development Goals targets by quite a distance thereby necessitating a revision on our part. Understandable, as mother and child health makes little headlines. On emergency basis, work on setting up of five new Mother and Child Hospitals in Attock, Mianwali, Bahawalnagar, Rajanpur and Layyah, as these area have poor health facilities.
The Children Hospital Lahore is now being transformed into a full-fledged Children University to promote research on this. Similarly, a special state-of-the-art Maternity Block is being added to the Ganga Ram Hospital Lahore.
The health of school children was not even given a thought. The health and nutrition checkups in schools were much needed as children are our future. A pilot project for school children has been initiated in nine districts and the teams have checked nutritional and health status of more than 10,000 school children. The project will be formally inaugurated very soon. Further, Day Care Centers have been set up in government offices to facilitate working mothers.
On assuming office, the painful realisation that Mother and Child Health was seriously neglected area. We were behind the Sustainable Development Goals targets by quite a distance thereby necessitating a revision on our part. Understandable, as mother and child health makes little headlines. On emergency basis, work on setting up of five new Mother and Child Hospitals in Attock, Mianwali, Bahawalnagar, Rajanpur and Layyah, as these area have poor health facilities
In order to create a visible impact in the healthcare service delivery, the pivotal factor is the number and quality of human resource. One shocking realization on assuming office was that the health department was short of around 50 percent doctors. Only these figures amply explain the reason for the poor state of affairs. Human resource was an ignored area; even when half-baked attempts were made to fill the vacant positions, red-tapism came in the way; nothing moved altogether.
Hence strengthening of human resource became the starting point. In the last one year, we have inducted 14,903 new doctors to the system. Over 10,000 positions of doctors were lying vacant only in Primary and Secondary Healthcare Department. Moreover, 3,543 new nurses have been added to the system with hiring of another 7,400 in process. In different technical and allied health categories, the hiring process of 3,537 is almost complete whereas works on hiring of another 1,400 have been initiated.
In over 2500 the Basic Health Units across Punjab, 93 percent new postings of doctors have been made which will help reduce burden on Teaching Hospitals. The government has filled over 2,200 positions of Consultants. Another major roadblock was the shortage of Anesthetists, as major surgeries depend on them. We have ensured their availability through new hiring and rotation arrangements with neighbouring districts. All out efforts are being to complete hiring for new positions by the end of this year.
For a country battling with poverty, provision of free healthcare to the marginalised especially in emergencies should have been the first priority. The Sehat Insaf Cards are being provided to families with income less than two dollars a day. Only in our first year, the health card has been extended to 28 districts to over three million families of Punjab. It will be extended to all 36 districts very soon. The cards provide insurance cover of Rs 720,000 in empanelled public and private hospitals. Following a similar successful initiative in Khyber Pakhtunkhwa earlier, the last Punjab government mimicked the model in haste. However, neither the hospitals were empanelled nor premium was paid. So even in the districts where the card was given, it was merely a piece of paper.
Promotions of staff were another neglected area. The process had hit snags and was a major cause for lack of motivation among the staff. As many as 1,616 promotions have been made and the process has been expedited so that unnecessary delays are avoided. It is worth comparison that in year 2018 only 603 promotions were made. Further, this goes with salary raise incentives for staff linked with different criteria. An online facility for transfers and posting have been developed which will remove other bottlenecks.
Our special focus has been on Basic Health Units and Rural Health Centers. Under the Prime Minister Health Initiative, work on new infrastructure facilities has started in eight districts like Attock, Chiniot, DG Khan, Mianwali, Jhang, Kasur, Lodharan and Rajanpur. Under this project revamping of 35 RHCs Emergency Blocks, establishment of 35 Neo-natal nurseries at RHCs, upgradation of 16 Urban Health Centers and construction of eight new Warehouses has been initiated. Till now, we have upgraded over 300 BHUs to 24/7 model. The last government upgraded less than 1,000 BHUs in over a decade
(an average of less than 100 per year) whereas we reached 300 only in the first year.
Another big challenge was the revamping project of DHQs and THQs. The former government has left the infrastructure in debris after raucous inaugurations, diverting resources elsewhere. The revamping project of 40 Hospitals in (25 DHQ, 15 THQ) has been started and allocated funds have been released for the same.
In order to create a visible impact in the healthcare service delivery, the pivotal factor is the number and quality of human resource. One shocking realization on assuming office was that the health department was short of around 50 percent doctors. Only these figures amply explain the reason for the poor state of affairs. Human resource was an ignored area; even when half-baked attempts were made to fill the vacant positions, red-tapism came in the way; nothing moved altogether
Moreover, the improvement in nine tertiary care facilities has been initiated in Nishtar-2 Multan, Children Hospital Bahawalpur, DG Khan Institute of Cardiology, Burn Center Bahawalpur (five Mother & Child Hospitals mentioned above are also part of the initiative). The initiatives are: Revamping of Emergencies at 12 Tertiary Hospitals, Surgical Tower at Jinnah Hospital Lahore, New blocks at DG Khan Teaching Hospitals, upgradation of DG Khan Medical College, Establishment of Drug Treatment Centre at SIMS and Mehman Khana for patients’ attendants.
The Punjab Kidney and Liver Transplant Authority is another story where Rs 17 billion were gifted to private entity in sheer violation of rules and regulations. We have brought PKLI under legal system, streamlined its affairs and made it fully functional.
The government has made a thorough review of the existing legal arrangements and has introduced and reviewed the following laws: Thalassemia and other Genetic Disorders Act, Violence against Doctors Protection Bill, Medical Teaching Institute Act, Drugs Act, Punjab Healthcare Commission Act, Children University Act, PHF and PKLI ACT. In order to improve the state of affairs in Punjab, a lot of new initiatives are coming. Separately, the MTI ACT that has been put under a lot unnecessary controversy on which I will like to write on these pages.
Keeping the UN Sustainable Development Goals in sight, we have prepared a 10-year Health Sector Strategy that chalks out a route for phase-wise improvement in areas of healthcare service delivery. The areas addressed are: Nutrition and Family Planning, Reproductive Maternal Newborn Child Health, Patient safety and Quality of Care, Preventive Health Services to Communicable and noncommunicable diseases, Medicines and Bio Medical Equipment, Health Management Information System, Health Governance and Accountability, Human Resource for Health, Health Disaster Management and Emergency Management, One Health Including Environmental Health and Healthcare Financing in Public Private Partnership.
