AUTONOMY OF HEALTH INSTITUTIONS — WHERE DO WE STAND?

Abstract

Autonomy laws had raised the hopes of those
who wanted to see a positive change in the landscape
of healthcare provision but the fact is that those dreams
have not been translated in to reality. There are
problems at three levels i.e. problems with the
legislation, problems at the institution level and
problems at the stake holders level.

Problems with legislation
The perception of the government is that
autonomy would make health institutions
self-sustainable. This would allow phased reduction
in Grant-in-aid by 20% per year. This reduction in
financial load would ultimately help the government to
invest in hospitals at rural and district levels. However,
the concept of autonomy is not uniformly understood
by various stake holders and consequently it has not
borne fruit yet. To some it was total independence while
for others it was the same old story with difference in
mere nomenclature.
Health care providers (Doctors, Nurses,
Paramedics and class IV) and consumers (patients)
saw it as a step towards privatization. They were
probably not wrong. Forcing the doctors to get into
Institution Based Private Practice was seen as forced
labour and victimization of clinical staff. Promulgation
of Khyber Medical University act further enforced this
idea. This time it was not only considered to be a
financial threat but also a threat to career, mainly
targeting teachers of basic sciences. Consumers also
got worried when they saw user charges being levied.
This was negatively projected by various segments of
the society including electronic and print media. God
knows whether it was out of love for poor masses or
for cheap popularity but it did not help.