Last week, in a military-style coup, Islamabad police moved into the building of the Pakistan Medical and Dental Council (PMDC), watch dog and regulatory body of the medical profession, sealed its offices, seized records and announced its takeover. Over 200 employees were immediately sent notices informing them that they did not need to come to office for a week. Within hours of the takeover, an ordinance – Pakistan Medical Commission Ordinance 2019 – was promulgated. It announced the formal demise of the PMDC and the setting up of an entirely new body called the Pakistan Medical Commission (PMC).
A statement issued by the Ministry of National Health Services (NHS) attempted to assure the people that the new medical commission will begin operations within a week. It said that the record pertaining to licensing and registration of medical and dental practitioners as well as of medical and dental institutions had been taken into custody because it was “extremely important.” It also said that the federal ministry of NHS will supervise the admissions of students to medical and dental institutions.
The PMDC was created as an autonomous body under an ordinance in 1962 as the apex regulatory authority in the health education sector responsible for establishing a uniform minimum standard of basic and higher education in medicine and dentistry as well as to regulate the conduct of medical and dental practitioners in the country. Amended from time to time, it has been mandated to formulate policies, make rules and to monitor standards of medical education.
Two attempts in 2014 and in March this year to massively alter the composition and mode of selection of members of its decision making body (the executive council) were thwarted by the Parliament by adopting resolutions in the Senate under the Constitution disapproving the ordinances.
By tilting the balance of power in favour of private medical institutions, the ordinance has made owners of private sector medical institutions as also the regulators of medical education in the country
Before the devolution under the 18th Amendment, all supervisory powers of the PMDC were under the control of Ministry of Health, later named the Ministry of National Health Services, Regulations and Coordination. The 18th Amendment placed medical profession under Part-II of the Federal Legislative List, bringing it under the purview of the Council of Common Interests (CCI) headed by the prime minister, and consisting – among others – of all provincial chief ministers.
As the PMDC decides policies in medical education, it has been natural for private medical institutions to seek a greater say in its affairs. Such attempts, however, were not allowed to succeed on the grounds that placing too much of decision making powers in the hands of owners of private medical institutions to regulate medical education and enforce discipline is unwise and a conflict of interest. After all, private owners are largely driven by the profit motive and should not have an overwhelming say in the decision making process. This was one of main reasons why the ordinance in 2014, which sought to give more representation to private medical institutions in the PMDC, was rejected by the Senate
Lately, the defunct PMDC had moved to enforce strict criteria to regulate private medical institutions in line with a Supreme Court decision. Some private medical colleges were indeed shut down while others were forbidden from offering admissions merely on the basis of huge donations even while academic merit did not warrant admission.
It also imposed a ceiling on the fee charged by private medical institutions and enforced strict criteria and standards for teaching hospitals attached with the private medical institutions. Clearly this was resented by private medical institutions.
The disbanding of the PMDC has removed a hurdle in the way of private medical institutions which will now have greater say in making decisions in the field of medical education. Under the new ordinance, private owners can now set their own criteria for hiring faculty, charge higher fees from students and even accept donations from them. Private institutions can also choose a university of their liking for affiliation.
The defunct PMDC was not a paragon of virtue and there have been many serious allegations of nepotism, cronyism and corruption against it. But its ills could have been addressed through legislation in consultation with all stakeholders and greater oversight of its functions. The haste and secrecy of the midnight raid on the PMDC has raised some serious questions.
The defunct PMDC constituted an executive body serving through an election process supervised by the Ministry of National Health Service. Taking over of the regulatory and watch dog functions of an elected body and entrusting it to a few nominated individuals has the potential to undermine the medical profession with adverse consequences for public health in the country.
By tilting the balance of power in favour of private medical institutions, the ordinance has made owners of private sector medical institutions as also the regulators of medical education in the country. This is clearly a case of conflict of interest. It is common wisdom that regulatory functions of any sector are not entrusted to private owners engaged in that particular sector. The owner of a private medical institution should not be the regulator of medical education, nor on the board of disciplinary committees responsible for taking action against those violating regulatory guidelines and criteria.
What was the need for this great hurry in promulgating an ordinance without discussion and debate and without taking all stake holders on board? It is true that the government lacks majority in the Senate to pass legislation. But is its ego too big that it does not even allow it to protect public health from being ambushed? And if its ego did not permit it to approach the Opposition, it could take the matter to the Council of Common Interest for an amicable resolution in consultation with all provinces. After all, the 18th Amendment has placed medical profession under the Common Interest Council.
The writer is a former senator