One of the coveted occupations for children in Asian families is the health profession. Do most of the children really want to become medical doctors? The answer is no. Nevertheless, each year, thousands of children are forced to dedicate their lives to a profession they lack aptitude for. In India, there is close competition between engineering and the health profession. The same is true for other Asian countries. However, Pakistan is slightly different, as the health profession is a dominant choice for the middle class. The obvious motivation to push talented minds to this path is economic aspiration and security. This is in line with Karl Marx’s view of a capitalist society, where a human’s life is weighed by his ability to accrue wealth.
There was a time when merit reigned supreme in this profession, and other careers—closely related to medical science, such as pharmacy, nursing, veterinary care, and the like—were pursued by those who were unsuccessful in securing admission to medical colleges. This mad race eventually led to the present-day attrition of the whole healthcare system in Pakistan.
Low Merits and Deregulation
Among the top factors for the sudden degradation of the health profession is the opening of private medical colleges. In 1983, Aga Khan University’s Medical College was established, and it has, unlike other private institutions, maintained a high stature globally to this day. In the 1990s, a few medical colleges were founded, but the PMDC (Pakistan Medical and Dental Council) regulations kept things in check.
Things went downhill in the early 2000s, during President Pervaiz Musharraf’s era, when significant deregulation in multiple sectors, including education, took place. PMDC’s regulations became lax, and getting a license for private medical colleges became easier. Later, an abrupt rise in these private colleges occurred from 2008 to 2013, the era of the Pakistan People’s Party. This period is criticized for political influence and the commercialization of medical education in the country.
In 2012, the PMDC Ordinance further eased the regulations, paving the way for the unabated growth of low-quality medical schools. Resultantly, the merit of MBBS and BDS admissions dropped to a shockingly low level. A profession that took pride in its high merit criteria is accepting candidates with a total aggregate of less than 60%, as evident from the University of Health Sciences’ 2025 merit lists for private medical colleges.
Educational Problems
A corollary of numerous medical educational institutions is a sea of medical doctors with substandard education and skills. Many colleges don’t fulfill the prerequisites to train a health professional. To put things into perspective, a significant number of institutions don’t even have cadavers to teach basic anatomy and surgery, a core requirement for a doctor. Likewise, they lack a functioning tertiary hospital with multi-departmental facilities. Emergency services are almost nonexistent.
A proof of this is the fact that a large portion of graduates from such institutions do unpaid internships in colleges that have such facilities to hone their skills. Another dilemma in the present-day medical education system is the discrepancy between the grades of government graduates and private sector graduates. While the former score well in the written examination, the latter perform well in viva voce. This raises questions about the standard and uniformity of the entire academic system. They vie for jobs in the government sector, which used to be a prerogative of government graduates.
A Saturated Market
Consequently, this profession is completely saturated, with supply surpassing demand. To make matters worse, there is a huge supply of foreign medical graduates from China, Cuba, and the Central Asian Republics with questionable credentials. Kyrgyzstan alone hosts around 12,000 Pakistani students pursuing medical studies. The overall impact of this saturation is the unfair and unmeritocratic hiring practices. There is negligible, if any, merit in contract-based jobs for medical officers.
Although PPSC still holds merit, it is partial at best. Corruption, nepotism, and influence peddling reign supreme in this aspect. Transfers are also done on the same grounds. Subsequently, the hired medical officers are often more interested in economic gains than public service. Even basic medical ethics are not exhibited, let alone clinical skill development. Absenteeism, embezzlement, malpractice, and mismanagement are a few of the many clearly apparent traits of health professionals today.
The Clinic-pharmacy-laboratory Complex
A worth-mentioning aspect of the health profession is the “clinic-pharmacy-laboratory complex.” This trio is a hallmark of almost every private practice in Pakistan. A doctor sets up a clinic with a large billboard explaining his qualifications, which are often ridiculous to read and almost impossible for a layman to understand. The other corner of the triangle consists of a pharmacy (commonly known in Pakistan as a medical store). It contains the same medicine that the doctor prescribes. Most of the time, he or she prescribes medicines that are found only in that particular pharmacy.
The major players in this link are pharmaceutical companies, a multi-billion-dollar industry that shapes medical practices not only in Pakistan but also around the entire world. The way these companies exert their influence is evident, especially during the 1970s in Pakistan; however, that is a whole other dimension that might digress from the topic at hand. Moving on, such companies strike a deal with doctors who prescribe their brands of medicines with a certain share in sales, and these shares are pretty generous.
At the third corner of this triangle are laboratories. The same mechanism as that of the clinic and pharmacy applies here. An interesting dimension here is the doctor husband and doctor wife collusion. Often, the latter handles the laboratory, and the former ensures a stable supply to that laboratory. The end product of this complex is profit and more profit.
A Web of Lies
Blowing dust in the eyes of the authorities is another reason for the dilapidated health system. Time and time again, visits of high-level state officials to hospitals make their way to headlines. However, nothing changes or improves. Any doctor will tell you the reason behind it. There is a robust, interlinked communication network in healthcare that informs hospital administration about any visits, even the surprise ones, beforehand.
Within hours, several janitorial staff members, who aren’t known on regular working days, appear from a void and clean the entire hospital, which is usually as filthy as a butcher’s shop, to near perfection. All doctors adorn themselves with white coats, with senior doctors having a green lace stitched to the coat’s collars to be distinguished. All of a sudden, the entire hospital staff is working diligently, and abruptly, machines that are hidden in stores start operating. In short, hospitals look like what a hospital should be during these visits.
As far as the visiting authorities are concerned, they enjoy a photoshoot for which they come and leave after putting up their theatrics. Both the hospital staff and the visitors know what is going on. Who is at fault? The answer to this question is up for the reader’s interpretation.
The Consequences of Poor Healthcare
The ultimate victim of the wretched healthcare system in Pakistan is the common man. They suffer from malpractice by doctors on a daily basis, consuming medication that they don’t need. A major consequence of this is the alarming increase in antibiotic resistance, as shown by the annual reports of the WHO. Around 59,200 deaths were directly attributable to antibiotic resistance in 2019, and 221,300 deaths were indirectly associated with it.
Moreover, the bellies of pregnant women are cut open by gynecologists without any indication. I am alluding to the burgeoning number of C-sections in the country. The rate of C-sections is 54.2%, compared to the WHO-recommended rate of 10–15%. To view the extent of inhumane approaches of doctors, Pakistan is facing an epidemic of blood-borne diseases. Approximately 15 million people are living with hepatitis C and B. Health professionals are a major catalyst behind it. Countless reports from local as well as international news agencies are available on this subject.
A concerning development is that the masses are getting used to the unethical practices and malpractices of health professionals. A doctor following basic guidelines of medical practice is labeled as unskilled, as he doesn’t inject antibiotics and steroids at the slightest inconvenience. In other words, people have become accustomed to practices against which they should be out on the streets.
Is There Any Hope?
Although the situation looks bleak, it isn’t difficult to make it better. The answer lies, just like most things, in good governance. Current health policy needs to be overhauled to make room for improvement. The National Health Vision of Pakistan aims to enhance healthcare services. However, like many other visions and policies in the country, this falls short of action. The need is to start changing things from the grassroots level, which is the training of young doctors. It is a must to change the training modules by following the first-world countries like the United Kingdom’s NHS and the welfare model of Scandinavian states.
PMDC should be obligated to tighten its regulatory measures so that no compromise is made on the professional development of young doctors. The 2018 suo moto action of the Supreme Court over PMDC was thought to be a revolutionary step, but the efforts were thwarted by political meddling. This points toward the necessity of establishing an autonomous committee, comprising Pakistani health professionals working at senior positions in America and Europe, to head reforms in the health sector. Pharmaceutical companies should also be reined in.
Apart from that, it is vital to set up a body with civil groups’ oversight to handle complaints regarding malpractice and criminal negligence by doctors to end the decades-long norm of impunity. For example, Norway has independent complaint boards, including civil representatives (non-doctors), to investigate cases of medical negligence. Equally important is the dismantling of the pharmaceutical-doctors nexus.
The Sunshine Act 2013 in the U.S. is a good model, which requires pharmaceutical companies to publicly report payments and gifts to doctors. To ensure responsible prescription and consumption of medicines, France’s Hospital Oversight and Ethical Board, which prevents over-medication and unnecessary procedures, can be emulated. While the words of reforms always look promising, the end result depends on social pressure and political will.
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