Farhan Raza Khan1 BDS, MCPS, MS, FCPS
Syed Sheeraz Hussain2 BDS, MCPS, DCPS, FCPS
In Pakistan, there are few regulatory bodies that govern the education and training of health care providers at different levels. These include Pakistan Medical & Dental Council (PMDC), Higher Education Commission (HEC) and College of Physicians & Surgeons of Pakistan (CPSP). There are other authorities which regulate the provision of health care services to patients visiting public and private hospital. These include service monitoring wing of PMDC, ministry of health at federal and provincial levels and health department at local government level.
An important development that has recently been observed in provinces of Punjab and Khyber Pakhtoon Khwa (KPK) is the development of Provincial Health Care Commission (PHC). This is a new player in the game of Pakistan’s health care scenario. The main objective of forming provincial health commission in these two provinces was to fill the vacuum in the existing system of health care provision.
Traditionally, the mandate of PMDC was to regulate the undergraduate medical and dental education, register the physicians and dentists as the sole statutory body and ensure patient safety and rights. However, the volume of work at PMDC for overseeing curriculum and standards of teaching and training at over 98 medical and dental institutions across Pakistan is overwhelming.1 Moreover, monitoring a huge number of 185,000 medical practitioners and 17,000 dental practitioners is a mammoth task in itself.
The above responsibilities has made PMDC so engaged that it has left with no manpower to oversee the quality of care offered at various health care facilities especially medical & dental colleges and their affiliated hospitals. Although, PMDC does have a formal system in place to resolve the complaints against medical or dental practitioners where it explore the nature of a complaint by a person or body charging the practitioner with infamous conduct in any professional respect or professional negligence etc. But in reality, the tortuous procedures make it difficult to investigate the incidents and penalize the guilty. The existing system is biased towards quality of care assessment and ignores the quality of care assurance.
Following is the mandate of the newly formed PHC:
1) Regulation of health care service through registration and licensing of the health care “establishments” (this is important as PMDC focuses at standards of teaching along with registration and licensing of individual health care providers but not the establishments where health care is actually given).
2) Development of standards for different categories of health care establishment. Like hospitals and medical practitioner’s clinic, a dental surgery clinic is a health care establishment too.
3) Management of Complaint of both patients and health care establishments.
4) Eradication of quackery.
Since, PHC has been established with an act of the parliament thus, it has the legal power to exercise its mandate. It’s obvious that the jurisdiction of PHC is not confined to public and private hospitals but it extends to all medical and dental clinics, NGO run clinics, trust hospitals, charitable hospitals, health camps, nursing homes, laboratories, diagnostic centers, homeopaths office, Hakeem’s’ matab, physiotherapy centers and acupuncture facilities in Pakistan. In other words, Pakistan Nursing Council (PNC) and PMDC will now focus on the education, training and practice of the health care personnel while PHC will oversee the patient care and organizational management of the health care premises. Presence of PHC in two provinces has created a disparity in the country. Absence of such body in Sindh and Baluchistan is a big question mark. There is no authority in the entire province of Sindh that can oversee the quality of care offered at the dental practices. The most neglected strata are the subjects who get dental treatment done at dental college hospital. The student and trainee dentists develop their skills by working on these patients. Although, this learning of skills is supposedly a supervised activity but with limited number of specialists faculty in dental disciplines, the most part of service is largely unsupervised. If a PHC is established in Sindh, a proper authority for surveillance, check and balance would be available which can protect dental patients’ right.
The implication of PHC has a great significance on the dental practice in the future. All dentists should ensure that they maintain a validated practice license with PMDC and get their clinic registered with PHC. This will actually provide a legal immunity to the dentist against prosecution, should a legal suit arises. Moreover, accreditation with PHC will provide legitimacy to the dentist for the fee he/she charges for delineated procedures. However, as dental professionals, we all need to work on the organizational management of our clinics especially in the areas of quality improvement, facility management and safety, information management system, infection control, patients’ rights/ education and overall care of the patients.
1. Operative Dentistry, Aga Khan University & Hospital, Karachi, Pakistan
2. Orthodontics, Karachi Medical & Dental College, Pakistan
Corresponding author: “Dr. Farhan Raza Khan” < firstname.lastname@example.org >