MTI Reforms in KPK Health Sector, Presented before the class of Health Care Law, Policy, Regulations and Ethics MS - Hospital Management

1. Presentation
on
MTIRA-2015
HealthCare Law, Policy & Regulation
Presented by: Azhar Muhammad
To
DR Mehwish Faisal & the Class….

2. KP Provincial Assembly

3. Introduction to the ACT and its main Objective
This Act shall be called “The Khyber Pakhtunkhwa Medical
Teaching Institutions Reforms Act 2015”. It came into effect at
once, at 19th January 2015, and shall be applied at entire KPK.
Objective:
• To provide autonomy to the Government owned Medical
Teaching Institutions.
• And their affiliated teaching hospitals in the Province of the
Khyber Pakhtunkhwa and to improve performance, enhance
effectiveness, efficiency and responsiveness for the provision of
quality healthcare services to the people of the Khyber
Pakhtunkhwa.

4. Organizational Structure Proposed for every MTI under this Act

5. Area of Implementation of this Act
The MTI Act is formulated for “the Tertiary Care Hospitals”, including the
following;

6. Significant Enactments under this Act
• This Act replaced the traditional Beaurucratic control of the hospitals from Directorate General
Health Services (DGHS) to Board of Governors' of MTI. (See Section 5 of the Act).
• The Board members shall be selected by the “Search & Nomination council”, established under
this act, from the different areas of society. (Section 8 of this Act).

7. Significant Enactments under this Act
• The Board shall be responsible for the following ; See Section 7 of the Act;
• To ensure that the objectives of MTI within overall ambit of government policy are achieved.
• Policy making of MTI, and Performance monitoring.
• Prescribe procedures for appointments, Terms & Conditions of services, disciplinary actions
etc.
• Approval of Vision & Mission statement of each MTI.
• Approval of annual business plan.
• Review & approval of major transactions. E.g. Procurement and Logistics.
• Approval of financial plan and annual budget.
• Approval of program and services, to ensure that MTI fulfills its legal, regulatory and
accreditation requirements.
• Approval of by-Laws of Medical staff.
• Constituting Finance committee, Recruitment committee and related sub committees.
• Compliance to government policies and standards.

8. Significant Enactments under this Act
This Act under the section 10, replaced the Chief Executive Officer (CEO) by
the Hospital Director. The Hospital Director shall be responsible for the
following under this Act;
• Shall be appointed by the Board, for the period of three years.
• Shall possess a non-medical degree, with Master degree in “Hospital Management”, along
with administrative experience.
• Shall be responsible for all Non-Clinical activities in the hospital.
• Shall be responsible for developing infrastructure, purchasing state of the art equipments, and
hiring trained human resource.
• Shall be the chief Accounting officer, and shall be responsible to develop annual budget plan
and present it before the policy board for approval.
• Shall be responsible for facility management and risk mitigation.
• Shall be responsible for purchase and procurement.
• Shall be responsible for the smooth running of the hospital in day-to-day operations.

9. Significant Enactments under this Act
This Act under section 12, has replaced the Medical Superintendant (MS) with
the Medical Director.
• The Medical Director shall be appointed by the Board for the period of three years.
• The Medical Director shall possess a Medical degree along with masters in Hospital
management.
• The Medical Director shall be responsible for all clinical activities.
• All clinical department heads will report to the Medical Director.
• Undertaking clinical governance for quality control.
• Assessing and auditing existing clinical programs and developing new clinical programs.
• Develop an annual clinical budget, including capital medical equipment requests for
presentation before Hospital Director and the Board.
• Ensuring timely, appropriate management of patients.
• Ensuring clinical excellence in all aspects of hospital function.

10. Significant Enactments under this Act
The Employees of MTI can be defined as; (see section 16 of this Act);
• Before the commencement of this Act, the employees hired under KP
health institutions ordinance 2002, shall be considered as employees of the
existing MTI, and shall be dealt as on the prescribed manner.
• After the commencement of this Act, the employees are given two options,
whether to opt MTI or deputation to their respective districts.
• After the commencement of this Act, the civil servants either to opt the
MTI, or get transferred to the hospitals run under DGHS control.
• After the commencement of this Act, new appointments shall be made on
contractual basis, while shall only be extendable upon performance.

11. Significant Enactments under this Act
This Act under section 17, oriented the “Private Practice”, titled as Institution
based Practice (IBP):
• After the commencement of this Act, all Consultants working in Government hospitals,
clinics, imaging facilities and laboratories shall be given an option either to do their private
practice within the hospitals, clinics, imaging facilities and laboratories of the Medical
Teaching Institutions or to do their private practice outside the hospitals, clinics, imaging
facilities and laboratories of the Medical Teaching Institution, as the case may be.
• Employees, who opt for the private practice within the premises of the hospital, clinics,
imaging facilities and laboratories of the Medical Teaching Institution, may be entitled to such
increase in salary, adjustment, bonuses or other ancillary benefits, as the Board may approve.
• Employees, who do not opt for the private practice within the premises of the hospital, clinics,
imaging facilities and laboratories of the Medical Teaching Institution, and shall not be
entitled to any increase adjustment, bonuses or other ancillary benefits.
• In the performance of functions in the Hospital, the Consultant shall be responsible to the
Hospital Management, with respect to service provider to the patient in the Hospital and shall
follow all the rules and regulations relating to Hospital Management.

12. What goes wrong in this Act ???

13. What goes wrong in this Act ???
The MTI soon after its implementation, has faced much resistance by the side
of employees. However, it implemented in its full letter and spirit.
For instance, I have cited a “Writ-Petition” filed against the impugned MTI
Act, at Peshawar High Court Peshawar (i.e. W.P. 420/2015).

14. ACT Challenged at the Court of Law

15. Act Challenged at the Court of Law
• The learned counsel for the petitioners led by Associate professors of
MTI/HMC, MTI/ATH & MTI/KTH, have argued that, despite the existence
of the Ordinance 2002, the provincial legislature has promulgated yet
another act (MTIRA-2015) beyond its competence. They further argued
that, through this attempt, the government has given these hospitals control
into hands of non-doctors, causing disruption in services.
• The replacement of the CEO and MS by HD and MD, is challenged.
• The reasonability of the Act is challenged on the grounds of violating the
Civil servants Act 1973 and Ordinance 2002 respectively.

16. Government’s Reply in the Court
The Government has defended the case on the following grounds;
• According to Article 137 of the “Constitution 1973”, the provincial
legislature has a vested authority to make Laws.

17. Government’s Reply in the Court
• According to Article 38 of the “Constitution” it is the responsibility of
government to make new Laws, for the wellbeing of general public.

18. Government’s Reply in the Court
• According to Article 69 of the “Constitution”, the courts has no right to
inquire into procedures of Parliament.

19. Government’s Reply in the Court
• That under “Section-11-A”, of the “Civil Servants Act 1973. the services of
the civil servants are protected in MTI’s.

20. Court Final Decision
• The Hon’ble High Court Peshawar dismissed 6 petitions, while allowed
only 1 petition, while maintained the enactment of MTI Act 2015.

21. Court Final Decision

22. Conclusion
• To seek to be wiser than the Law, is the very thing which is by good laws
forbidden. (Aristotle)….
• If, we want real change, we must to set aside our self interests, & let the
Laws, Policies and Regulations to be implemented aimed at achieving
targets.
• MTI’s is not Privatization, but it is the only way to make health care sector
efficient, accessible and effective for the poor. (Imran Khan)

23. End