The death string at the Punjab Institute of Cardiology (PIC) is just the tip of the iceberg of an ailing health system in this country and the public sector at large. Is it a mere coincidence or possible biological, chemical or political warfare that the province of Punjab is the repeated centre of attraction for casualties of a mismanaged health service? The provincial government had barely got a breather from the dengue mosquito before the onset of the next season that takes off in February, that the casualties at the PIC, possibly due to a reaction of substandard medicines, has hit hard on the government.
In this case, medicines from a specific batch were administered and prescribed to thousands of heart patients. Deaths of over a hundred patients occurred in a matter of days. Although the data is computerised at the institute and claimed to be maintained for all patients, the facts and figures being released by the hospital, the Chairman Parliamentary Committee for Health and the Secretary Health do not match. There is a discrepancy in the number of deaths and affected patients suffering from a reaction or illness, following the drug administration and the number and detail of patients prescribed or using the fake medicines. Also, it seems that there is no mechanism in place to call back the disbursed medicines of the affected batch.
If the data is flawed, then its collection and reporting (IT) systems are also flawed, and hence ineffective and inefficient. It would surely be interesting to know who awarded the contracts for computerisation, who were the contracts awarded to, and what was the criteria and process adopted to digitalise the patient records.
In addition, there are many other aspects that need to be taken into account to ensure that credible and authentic information required is available at a given time for effective decision making. So, mere computerisation does not ensure that all essential parameters are fulfilled. Indeed, this is a word of caution to Chairman PTI, who believes that when he is in power, he will computerise the public sector and have honest officers head the organisations. Thus, all public sector ailments will end!
Needless to say, much of the public sector is already computerised: FBR, NDMA, NADRA, passport office, health services organisations etc. Information technology management is of key significance in computerisation and an ongoing process. Otherwise, the essence of information technology would be lost. But not in Pakistan!
Anyhow, the PIC incident has once again jolted the reactive strategy of Chief Minister Punjab, who holds the portfolio of the Ministry of Health, along with some other ministerial portfolios as reiterated on the electronic media. Nevertheless, the only way to manage a public health sector is to have a proactive strategy that outlines a complete and comprehensive framework to incorporate all services, workflows, interrelationships and roles, and responsibilities of all allied departments, and has an inbuilt accountability mechanism to pinpoint responsibility and punish the culprits.
Certainly, a considerable share of death and disease surfacing in this country every day can be accounted to the mismanagement of the public sector. The programmes being sponsored and partnered by the international donors, such as UNDP, WHO, World Bank, AUSAID, UKAID, USAID etc, in Pakistan today are far more in number and amount of money than the previous decades. Yet, there is no visible improvement in the health services available to the common man to reciprocate the international funding and effort. Quiet to the contrary, the quality and quantity of services is fast going downhill. Likewise, the number of officers and doctors being trained in management by the international organisations are far more today than a few years ago. But there is no system in place to utilise their education.
The decision to make health a provincial subject through the 18th Amendment was a mistake, given the infrastructure and level of health service available in the country. It is easy to hoodwink a nation low in literacy by offering cosmetic changes, while issues of substance rot like gangrene. A bulky chunk of our health services materialises only due to the availability of international funding, which is largely received at the federal level and channelled into the provinces through fat bureaucratic layers. Although a provincial subject, the health sector is cornered badly as many allied organisations, such as drug quality and control and licences for pharmaceutical production, operate federally where regulations and monitoring procedures are ineffectively implemented.
The issues in the entire public sector, including health, have many commonalities, as well as individualities specific to the sector. Sector-specific professionals are expected to practice managerial expertise to successfully run sick organisations and provide satisfactory service to the public. Alternatively, corrupt and ill-educated people, such as Adnan Khawaja, are appointed as heads to ensure that even healthy organisations are doomed and ready to be offloaded to the private sector. Surely, we need to have the right people in the right place to avoid mishaps in future. This, however, leads to my next question: Is education important for the elected representatives who sit in Parliament and decide the fate of over 180 million people, or do they deserve fake degree parliamentarians who use, misuse and abuse citizens’ rights as they like?
The writer is an ex-assistant commissioner Income Tax, IT and Change Management consultant and a Public Sector Management analyst.