Private practice in Pakistan comes under fire

POLICY AND PEOPLE

Private practice in Pakistan comes under fire he government of Pakistan’s North West Frontier Province (NWFP) has categorically stated that it will not ban private practice by consultants working in public hospitals, but would introduce “institutionalised private practice” under which specialists would have an option to practise in or outside public hospitals in the evening. On June 3, members of the Provincial Committee on Regularisation of Private Practice said they hoped to have the new system in place by September. Regulation of private practice, the Provincial Health Minister, Shaheen Sardar Ali Khan noted, would provide medical and surgical services under one roof,

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generate resources for fund-starved government hospitals, improve the existing underuse of available hospital resources, and make the practice more ethical. Shaheen said: “as many as 200 consultants offered to set up their private practice in government hospitals when the idea was first floated”. However, a notification issued by the chairperson of the committee, Shafiq Ahmed, on June 6 asking the interested consultants to register themselves by June 14 has had “no response at all; not even a single consultant has contacted us to date”, The Lancet was told. Jamil Bangash, a health-policy expert with the NWFP government

Pakistan to promote child welfare Long accused of neglecting its children, Pakistan last week announced that it: “has accorded approval for signing a convention on regional arrangements for promotion of child welfare” in South Asia. Home to 8 million child labourers, Pakistan recently unveiled a national plan of action for the elimination of child labour, and allocated PKR 100 (US$1·9) million for the rehabilitation of children withdrawn from labour. Pakistan’s military government said it has been taking steps to bring the country’s juvenile justice system in the line with the standards set forth in UN Convention on the Rights of the Child. For example, Pakistan recently raised the age at which an offender can be classed as a juvenile delinquent to 18 years—a decision which had remained in limbo for years.

says: “since under the new system consultants’ income would be closely monitored, unlike the private clinics where they could not be properly taxed, the fear of taxes may be the main reason why consultants with established private practices would not go for this option”. He noted, however, that young consultants who do not have the funds to pay in advance to rent a clinic will find it helpful. In phase one, NWFP’s four largest hospitals—Lady Reading, Khyber Teaching, Hayatabad Medical Complex, and Ayub Teaching—will adopt the new system which is already in place in Armed Forces Hospitals, where about half the consultation fee goes to the consulting or operating doctors, around 20% to hospital, and 20% to the auxiliaries. The four teaching hospitals with more than 4000 beds have a capacity for 400 consultants, but Jamil said: “inefficiency of hospital staff and poor quality of diagnostic and laboratory services needs to be addressed before the new system is implemented”. Khabir Ahmad

Canadian government urged to improve end-of-life care Committee on Euthanasia and ontending that most Canadians Assisted Suicide, the subcommittee die in pain and isolation without says little has since been done to adequate support from the healthmake palliative care “a core value” of care system, a Senate subcommittee the health-care system, despite the has urged the creation of a compreincrease in chronic diseases in the hensive intergovernmental strategy ageing population and higher incifor end-of-life care, including meadence of such dissures to guarantee eases as cancer, incomes for people Rights were not granted AIDS, and cardiowho take time off to include this image in vascular impairwork to care for ment. Every terminally ill family electronic media. Please Canadian is entimembers. refer to the printed tled to “expert, Income assisjournal. compassionate, tance and job secuand interdisciplirity protection nary care at the should be offered end of life”, the to Canadians It’s not complicated subcommittee forced to take sosays, adding that funding should not called “eternity leave”, a five-member be an issue. “As Canadians, we will Senate Subcommittee chaired by afford what we value”. Senator Sharon Carstairs says in the Among other recommended meaJune 6 report Quality End-of-Life sures are ones to ensure proper trainCare: The Right of Every Canadian. ing of doctors and nurses in palliative The report suggests benefits should care; the development of clinical at least mirror those offered to new practice guidelines; standardised data mothers, who are entitled to 55% of collection; increased research on endtheir salaries for 26 weeks. of-life care issues, including the effecCreated to update the June, 1995, tiveness of interventions; and the report of the Special Senate

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THE LANCET • Vol 355 • June 17, 2000

provision of home care and drugs, free of charge, to all palliative-care patients (a projected 5% of the estimated 220 000 Canadians who die annually). The wide-ranging report drew immediate praise from palliative-care associations and academics for identifying current deficiencies in the system. “Our goal should be to make sure that the 222 000 people who die every year in Canada receive A-quality care” rather the C-quality care, says Peter Singer, executive director of the University of Toronto Joint Centre for Bioethics. A national strategy must be based on patients’ perceptions of what quality end-of-life care entails, Singer adds. “What it means to people is something like a death free of pain and other symptoms with appropriate-for-them decisions around the use of life sustaining treatments and the appropriate support, including psychosocial, cultural, and religious support of their families and themselves. It’s not complicated.” Wayne Kondro

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