Health and nutrition have been key agenda points of the PTI manifesto ever since PTI started parliamentary politics. The Prime Minter in his victory speech on July 26th, 2018 had categorically mentioned the development of health and nutrition as the key priority agenda for his Government. health sector
PTI: A special penchant for the health sector
Even before that, when in power in KP, the PTI led government had unleashed a reform agenda despite teething resistance from various stakeholders. This didn’t deter it from marching with what it believed good for the province’s health sector.
Successful or not is another debate but at least the seriousness of mandate was there.
The Prime Minister has a special penchant for the health sector because of his linkages with health professionals, and mainly because of his signature project of Shaukat Khanum Memorial Cancer Hospital which is the first of its kind in modern history of hospital services.
Mr. Kiyani’s entry in health sector
After forming government in August 2018, the health ministry was given to one of PTI’s founding members, a close confidante of Imran khan and someone who had great respect in PTI ranks and files.
To support the ministry, a high level national task force on health sector, with health practitioners on board, was established to provide technical inputs and policy advices to the ministry for the execution of the health reforms of the PM.
Being non-technical and a first timer, Mr.Kiyani had challenges in running the ministry as it should have been.
The situation got to a level where the PM had to ask Kiyani for resignation and the gentleman showed no hesitancy in accepting all the blames (though he had some to share which could have silenced his detractors). The allegations made against Kiyani haven’t still been proved but the purpose of the crooks was served and they survived.
Need to fill Dr. Kiyanis position
With his exit the need for filling his position emerged and there were many aspirants in the party for that coveted position. In the meanwhile sensing PM urged for a technical, honest and dedicated person. Some close people of his team introduced Dr. Zafar Mirza who at that time was working in WHO EMRO region as its health system director.
Dr. Zafar Mirza
After being convinced, the PM opted for a reformer rather than pleasing party parliamentarians. PM spelled out his priorities to Dr. Mirza who assured the PM that he would deliver on all fronts. Unfortunately the sixteen months period of Zafar Mirza’s employment was marred by allegations, scams, performance issues and nepotism.
He commited the same mistake of relying more on the people who had stakes in the ministry. It is said “never test the tested one” but perhaps it is power intoxication that clouded Mirza’s intellect, and he promoted and installed some people who were removed for poor performance.
He even installed advisors to the ministry (people who had no credibility/ standing or skills). Paradoxically for polio, a junior level person who was the main advisor to the ex PM was elevated to a ministerial advisor position in contravention of rule of business.
The Ex Coordinator for polio was reinstated and many other favorites were granted prized positions. Some cabinet members made hue and cry. Media, especially social media created a hype and the Dr. Mirza was chanted as the only one responsible for lapses in health sector; of particular were the medicine price hikes, the PMDC issue and worsening Polio situation in the country.
The shrewd lobbies again played their cards very well and escaped the public as well as PM outburst, and poor Mirza alone had to bear the brunt. The validity of the allegations would best be clarified by an independent high level inquiry, however, all this led to the resignation of Dr. Zafar Mirza who otherwise is considered a thorough gentleman and reputable professional.
Vacuum created again in lead health sector seat
Again vacuum was created and many aspirants within the party, and from outside the party started lobbying for the position. At a time when there were other pressures and the majority of the ruling party in the parliament is only marginal, it requires a brave heart to think of the system rather than politics.
This time PM chose Dr. Faisal Sultan who was CEO of SKMTH before this. Faisal reputed as an honest, clear headed and straight forward person who had run SKMT to perfection. He was engaged in the recent Corona response as PM focal person and was applauded for his role in the pandemic.
It would equally be a tough nerve game for him as was for his predecessors, there are some daunting challenges which would put to test his technical and leadership skills as below.
Medicine Price Hike
The most cumbersome issue that can lead to some sleepless nights for the incumbent minster is the unprecedented price hike of medicines. It is a multi billion issue and various lobbies are involved in managing it. At the minimum taking strength from his moral grounds he can conduct inquiry in to this, take remedial actions and make the findings public. This way the public anger and political point scoring would be managed.
The chain of events revealed that the conversion of PMDC into Health Care Commission (HCC) was not the right strategy and many lapses were unleashed in this transformative move. Ranging from HCC leadership, conflict of interest and domains, all had lacunas and could be either a will or skill issue. This is still an area where concerted strategic decisions be made to make this a neutral and independent authority on medical education and practice.
Health Regulatory Authority
One top priority for the newcomer would be to regulate health practice in both public an private sector for patient friendly and quality health services. In Pakistan health sector like education is main profit earner in private sector, taking advantage of the faulty regulation. Again there are many stake holders and powerful actors who would resist it one way or the other.
Seemingly under control but this still a major public health concern as no vaccine has yet been developed for it. The second wave of pandemic has been deadlier in Italy, Spain and Australia etc and the little lull period should not take the nation to any complacency.
Building health system capacity, work force, community perceptions/ attitude and political wrangling around it are some of the harsh challenges that has to be addressed.
Pakistan like Afghanistan are the two countries still struggling with stopping transmission of wild polio virus. As of now Pakistan still has 61 WPV cases and 50 cVDPV2 cases ( a vaccine virus mutated & remerged after vanished in 2012). It is an irony that countries like Somalia, South Sudan and Sierra Leone to name a few have been cleared off Wild Polio though they have the worst health indictors like MMR,IMR,under 5 mortality etc .
Pakistan Polio program has been converted to a pollical program, poor leadership, lack luster performance, stereotyped strategies and internal lobbies have damaged the program beyond repair. Unless drastic and radical reforms at the top are initiated we would continue to be unjustly blamed for the omission and commissions of others.
Merit and standards
The liking, disliking and nepotism in senior level posting was one reason assigned by media circles for ousting of the ex. Minister Dr. Mirza. He was away from the country for quite long and he didn’t have that knowledge on the performance and credentials of some senior persons. He was guided by his advisors, close circles and at best used his own analysis for such postings. Dr. Faisal equally has the same challenge as he is not a product of the system and his only interaction was a short time Corona response and his working as CEO of an independent entity.
The high rising political mercury in the country had its toll on health ministry and the ex – Minister had endured that to the maximum. The same spree would continue with same or more intensity. It depends on the response how one make but surely it can be one distraction. In an age of digital media one has to be on his/ her guard in all actions especially for those of visible public concerns.
Reformist vs traditionalist duo
PTI has pitched itself in the political arena as herald of reforms in institutions as well as parliamentary policies/ practices. History would judge success or failure on that front but the forces of inertia are deeply entrenched in all institutions more so in health sector and they would again manipulate their interests through whatever means they can. It would be a big test for the incumbent minister how far he goes in battling those forces of status quo and reform an otherwise wretched health sector.
What could be the way forward health sector
The challenges seem multifaceted, daunting and taxing yet these are very much manageable if there is a strong will, unflinched commitment and readiness to pay the price.
The medicines price issue direly needs a pro poor legislation and once a people friendly policy is enacted the issue would die out once and for all. This however doesn’t rule out implementation of stringent monitoring mechanism and across the board accountability. A comparative study on the medicine price in the region be commissioned and that learning can bests inform the policy makers.
Conversion to locally manufactured generic drugs is a cheap and workable option that should be tapped in urgently.
Both medical education and practices in private sector works largely unregulated and this call for an urgent stock taking based on which necessary legislations and polices be developed. The PMDC and health regulatory authority need fine tuning for making these highly professional, efficient and “fit for purpose.”
Non-pollical but highly professional executive bodies be established and these institutions be made independent of any pollical influence yet be duly monitored by a high powered “cabinet committee on health”.
The current health task force structure, ToR , constitution and membership be revisited and the new structure should leverage the space provided by the government as “ Health Governance Task force”.
The country health sector needs urgent development of its emergency risk analysis, response and resilience capacity building and this should be taken as a cross cutting theme in all national and provincial health programs, medical education and governance structure.
The NCOC be capacitated, expanded and equipped to manage other health and natural/ man made emergencies. It should work for coordinating the response to diseases like dengue, influenza,Polio etc which would be cost efficient and effective. Pakistan polio program needs urgent restructuring at the top for making it a government led, purpose fit and community friendly program; moving from quantity to quality, verticality in to integration, from centralization to decentralization and from top heavy to bottom focused public health program would help realize the dream of a Polio Free Pakistan.
For positively shifting community perception and attitude to Polio and Corona a well thought integrated strategy customized to local needs and values be urgently developed and rolled down.
Last but not the least the minster is not “Mr. Do All” and if he fails it’s the failure of the whole team and retaining them while removing one person is counterintuitive. This calls for urgent changes especially at the top since its the senior program leadership who are responsible for the failure.
Merely a single change of guard would serve the optic not the purpose.
The learning on the wall are as fresh as fresh ink and some wisdom must be learnt from it for lasting changes in the system.
Dr. Nadeem Jan (Tamgha-I-Imtiaz) is a highly recognized health expert who has an illustrious career with UN, USAID, DFID, World Bank, Gates Foundation and Governments of Pakistan, Somalia, Kenya, South Sudan, Afghanistan and Philippines. He can be reached at Nadeemjan77@hotmail.com. The views expressed in this article are the authors own and do not necessarily reflect the editorial policy of Global Village Space.