Sheikh Zayed Hospital on the downhill

Patients become ultimate sufferers as the city’s once-prime facility Sheikh Zayed Hospital (SZH) is on the downward slope with its revenues dwindling, workforce dispirited and a lack of interest shown by the Punjab government – all since its devolution under the 18th Amendment, Pakistan Today has learnt.
The 700-bedded health facility with around 2,200 employees has maintained a reputation for quality healthcare – a notch above other public health facilities in the city and considered at par or at times higher than the ones from the private sector. Housing country’s first liver transplant center and a facility for kidney transplant further gives it an edge over other health establishments, even from the private sector. Receiving around 1000 patients in the outpatient department (OPD) and 350 in Accidents and Emergency (A&E) everyday makes it one of the metropolitan’s biggest health burden-sharers.
However, the federal government handed over the health facility, along with the affiliated medical and dental college, to Punjab with all its financial and administrative control under the 18th constitutional amendment. The employees did not seem happy with the development and currently the Supreme Court has allowed them to continue with the pre-devolution status till a verdict comes out.
However, the service delivery in the hospital is being affected, with a huge decline in the revenues bringing the hospital on the verge of being just another government health facility.
Sources revealed that SZH generated 50 percent of its budget through its own revenues, which has now come down to only 20 percent. The lack of interest of the Punjab government is evident from the fact that last year the SZH administration submitted a budget proposal of Rs 2.23 billion to the Punjab government, which put a cut of around Rs500 million to it.
Hospital sources further revealed that the government only released Rs1.22 billion to the hospital, while the rest was expected to be generated by hospital revenues. Insiders further revealed that this year the hospital submitted 10 to 20 percent higher requisition for deliberation, but the government does not plan to increase its budget.
A senior official further told Pakistan Today that the Board of Trustees for the hospital was not in place and a temporary committee for management was looking after the affairs of the hospital. The Punjab government has sent a request to the newly formed Ministry of Health Services Regulation and Coordination to constitute the BoT, but in vain.
“Initially it was for the differences between the federal and provincial governments, but now both governments are run by the same party, so we expect it will be constituted soon,” said a senior official, seeking anonymity.
Many senior doctors and administrators managing the hospital also relate what’s ailing the hospital.
“The most pertinent issue is the uncertainty among the employees regarding their future after coming under the Punjab government, which has already cut back on the allowances being given under the federal government.”
“Moreover, a doctor recruited from Sindh or Balochistan would stand no chance of promotion once in the pool of the Punjab government. Besides, the promotion of doctors is stuck for more than a year now,” said a senior doctor, on the condition of anonymity.
“Under the federal government all posts are permanent and non-transferrable, except for the chairman who is appointed on a contract for three years. Employees do not want to change this status and hence the work force is dispirited, uncertain about its future,” the doctor added.
A senior health official said the rule was not to give allowances to doctors after a 100 percent pay raise. But a doctor said both the judiciary and police service were being given allowances despite extra salaries and hence considered it a discrimination against the doctors.
Moreover, insiders further revealed that since the handing over of the hospital to the Punjab government, the hospital had become over-burdened owing to protocol duties. “Initially only the federal government employees were entitled for treatment, now in addition to that, the Punjab government employees, the social security employees and other departments have also started visiting the hospital.
Members of Provincial Assembly (MPAs), ministers and provincial ‘babus’ all now send their voters and acquaintances for treatment here (SZH) and demand protocol and free treatment,” the official said, adding that this was also a reason for the decline in the hospital revenue generation.
According to the data of hospital beds shared with Pakistan Today, the bed occupancy was on average more than 80 percent, while around one-fourth of the beds occupied were always ‘protocol’ patients, taking free treatment and benefiting from other health facilities free of cost.
However, a senior health department official on the condition of anonymity claimed there was a ‘mafia’ of senior professors working in SZH who feared coming under the Punjab government because they did not want to perform under a ‘diligent and tough’ chief minister. The official revealed that the doctors are allowed to check private patients at the Punjab Institute of Cardiology (PIC) in the evening, but at SZH the professors had this ‘strange’ provision of checking private patients even during the duty hours.
“From amongst two equally critical patients, the doctor would naturally prefer the one who would pay him instead of the other who was poor,” the official added.
Hospital insiders confided on anonymity that the professors actually worked in a ‘closed’ group managing their own ‘interests’.
“The professors do not observe any timing and the senior ones do not like going to the OPD because of the poor patients there. No doubt the training of the professors is very good but checking poor patients is also their duty, which is being compromised,” they said, adding that 40 percent of the money from private patients went to the doctor while 60 percent went to the hospital.
“When a private patient is admitted in the hospital, all his dues including room/bed charges, medicines, tests, surgery, visit of professor in the ward, is all divided between the doctor and the hospital. It is natural that the professor prefers money generating patients to a pool of poor ones. The professors fear this status will be usurped under the Punjab government as there will be frequent transfers and a massive financial loss to the senior doctors,” they said.
SZH Chairman Professor Zafar Iqbal said the administration was bound to follow the government orders, be it the federal or Punjab government. He also reiterated the health official’s stance that doctors were not entitled to allowances after 100 percent salary raise.
To a question on the promotion of doctors, he said the Department Promotional Committee on Selection (DPCS), which was previously not in place, had now been constituted with the government’s permission, while permission to promote the staff had been sought from the court as well. “All legal hitches have been approved and cases will move as well,” he said.
A hospital spokesperson further attributed the decline in revenue to expensive electricity and inflating prices of food items and medicines. The spokesperson further maintained that checking private patients during duty hours was allowed since the inception of the hospital.
Health Secretary Hassan Iqbal was not available for comments.