M. Afzal Najeeb Medical profession is currently being subjected to intense criticism, causing widespread disillusionment among the general public. It is in the dock for wilful neglect. The overzealous media is highlighting instances of negligence of duty and carelessness in patient care. There are allegations of mismanagement, corruption and unethical practices in the public and private healthcare sectors at all levels. It is being propagated that the medical personnel are exploiters and their sole purpose is making money by all means, fleecing the public, receiving commission for referrals, kickbacks from pharmaceutical and biomedical industries in the form of foreign trips, family excursions and other benefits, as well as 'under the table dealings. Some of the aspersions are, indeed, true in respect of a segment of healthcare providers. Having conceded that, it is pertinent to evaluate the accusations in the overall context of healthcare delivery system in Pakistan. The major provider of primary care at the time of partition was through allopathic, ayurvedic, herbal and homeopathic practitioners and quacks, who treated all minor ailments. Secondary and tertiary health care was provided mainly by the public sector plus some private hospitals run by foreign missions and local charities. The rich availed the facilities of private wards in these hospitals. Specialists were allowed private consultation practice at their residences. There was hardly any purely commercial clinic or hospital. Moreover, hygiene and sanitation was the responsibility of municipal administrations. The arrangement catered for the needs of the poor, middle and the upper classes of society for sometime. However, things started changing in the late fifties due to major epidemiological and demographic influences including population explosion, urbanisation, illiteracy, unemployment, poverty, socioeconomic upheavals, environmental haz-ards, market economy, globalisation, increasing burden of communicable and non-communicable diseases, increase in the disposable income of middle classes and rapid upsurge in the cost of treatment. Considerable growth in the public sector in the form of upgradation of existing facilities and addition of new tertiary, and specialty care centres has taken place over the years, but it has fallen short of the multiplying demands. The government being unable to meet the challenges started abdicating its responsibility by disinvesting in health, actively encouraging the private sector to take over and propagating the theme of public-private partnership. The circumstances, thus, became conducive for private enterprise to thrive. Initially, the medical teachers and government specialists entered the open market by owning clinics hospitals and diagnostic labs with participation of their junior doctors and paramedics. It soon became their primary occupation making them part time workers in the government institutions. Soon the private entrepreneurs converted health-care into an industry open to the vagaries of market forces. The standard of teaching institutions, cradle for developing medical manpower, began to decline due to the establishment of several medical colleges in one stroke during the seventies. The real rot, however, started in the last couple of decades with mushroom growth of private medical and dental colleges and universities. The infrastructure in most of them is substandard, the quality of the faculty which keeps shifting in quest of greener pastures is questionable and the affiliated hospitals are ill-equipped. Academic excellence is not the motivation of these ventures. They are charging exorbitant tuition fees of almost Rs 700,000 per annum. The quality of medical or dental graduates qualifying from some countries is not up to the mark. As a result, 90 percent fail in the licencing examination that they have to qualify in Pakistan. Postgraduate training again is not properly structured and the PG institutes have failed to produce any worthwhile research work. There is certainly room for improvement in the conduct of the College of Physicians and Surgeons, Pakistan, which is supposed to be the guardian of PG training. The contribution of Pakistan Medical Research Council has been scanty. Pakistan Medical Dental Council a statutory body charged with the primary function of regulation of medical education has in fact degenerated into a registration authority. It has been in the news from time to time for charges of inefficiency and graft. It is currently dominated by the spurious private sector and is serving its vested interests. The senior doctors in pursuit of higher standard of living are tempted to devote more time to private clinics. The juniors are underpaid, overworked, without job security and career structure. Their working conditions are also poor. Having spent large amount of money, they expect to achieve instant recovery but are soon frustrated. The present state of affairs of the medical profession is in fact part of the overall decay in every profession and institution in the country. Expectations of higher standards of commitment and devotion may, therefore, be misplaced. This scenario, however, is not being presented as justification for the malpractices being attributed to the medical profession. Individual instances of carelessness and negligence in patient care and institutional failures should not be condoned, and the guilty should be given exemplary punishments. But the clamour for indictment on murder charges is diabolic and the public slandering of the whole profession is preposterous. There is no systematic accountability in the public health sector and the private domain is totally unregulated. Fundamental, structural and institutional reforms are needed to address the challenges and issues involved. Health should be a provincial subject and the respective roles of public and private sectors should be defined clearly. Mechanisms of regulation (state and self), monitoring and audit should be precisely delineated ensuring protection of the rights of health providers, as well as the consumers. A consistent and sustainable National Health Policy has eluded us so far. The policies launched from time to time were never fully implemented. It has taken two years for the Federal Ministry of Health to produce a draft of NHP 2009 and to table a Healthcare Bill of 2009. The former consists of platitudes without any implementation strategies, and the latter has been deferred and returned to the Task Force for reconsideration because of its highly controversial clauses. It is not known how long it will take for their enactment and whether implementation would be possible during the tenure of the present regime. Both documents need detailed discussion in a separate dispensation. The writer is a retired lieutenant general and professor of Cardiology.