KP Health Act 2019 Gives Unprecedented Arbitrary Powers To Health Minister
The government of Khyber Pakhtunkhwa (KP) has given unprecedented powers to the provincial health minister through the KP District and Regional Health Authorities Act 2019, violating its own election manifesto that promised to devolve powers at the grassroots level.
Doctors and paramedics have been protesting in the province for the last two weeks and have shut down the entire health system across the public sector hospitals, affecting millions of people.
Naya Daur spoke to different stakeholders including doctors and a government official who, on condition of anonymity, revealed that the newly-passed Health Act will adversely affect the poorest of the society by increasing the price of OPDs, Labs and diagnostic tests, and ward charges etc (despite the minister claiming otherwise).
The reason being that the District and Regional Health Authorities Act will most likely shift financial liabilities to the hospitals, meaning that hospitals will be generating their own funds. This would ultimately burden the poor.
The objectives of this Act, we are told, is to establish ‘comprehensive and efficient health care system’ and to ‘devolve authority and accountability at the regional and district level’, but the government has in fact done the opposite.
Section 3(1) provides for Policy Board at the provincial level which is chaired by minister for health, secretary health as its members and chairmen of the regional health authorities powers which has exclusive powers over the regional authorities. It specifically mentions powers regarding ‘all posts in regional health authorities’.
According to Section 5(1) (2), the CM will appoint members of the regional health authorities on the recommendations of search and scrutiny committee. This is the continuation of the current government general tendency to run government machinery through nominated (as opposed to elected) representatives.
The Act has no bar on appointment of employees of the Regional Health Authorities to be member of the authority. The minister may appoint the subordinate employees its as members of the authority, which further strengthens the grip of the health minister over the RHA.
Section 5(6): The health minister may remove a member(s) from regional health authority if he finds him to be ineffective. The point of concern is that though the Act enumerates in section 5(7) grounds for removal, but then grants powers to the minister for health, beyond these grounds. A member can also be removed on the grounds of them being ‘disruptive or otherwise’. Whether difference of opinion with the minister for health should be judged as ‘disruptive or otherwise’ is something he will decide himself.
Section 7(8) provides for the Regional Authority to incur expenditure even beyond approved budgetary provisions. This is in total violation of the international principles of financial propriety and discipline and accountability. Budget is used as a prime tool by all public and private organisation as an effective check against financial mismanagement and safeguard against misuse of tax payer’s money, which has been done away in the Act.
Section 7(9) makes the regional authorities accountable to the minister, and subsection (10) of the same section on the one hand grants powers to the minister for health to issue directions to the Regional Health Authorities, and on the other hand makes it binding on the Regional Authorities ‘to act in accordance with such directions’.
Section 8 provides for the composition of the search and scrutiny committee which is again chaired by the minister for health.
Subsection 2 of section 8 again authorises the chief minister to remove private members of the committee any time after affording them only the opportunity of being heard.
Section 9(3) provides for the discretionary powers to Chairmen of the RHA to make appointments against the key positions of the “Chief executive officers, Hospital directors, medical director, Nursing Director and finance director etc” on officiating basis.
Section 11(2) grants the power of transfer and postings of the civil servants to the health department, thus again circumventing the powers of the District and Regional Health Authorities, as all the current employees are civil servants.
Section 15(j) binds district health authorities to procure medicine “from manufacturers and importers, and not from middle man on such rates and brands as approved by government medicine coordination cell (MMC) after carrying out technical evaluation of offered bid at centralised rate contract. ”
Section 17 provides for the powers of the minister for health to dissolve any district health authority and health department shall appoint an interim arrangement to exercise powers of the District Health Authority till constitution of the new authority. This particular section reminds one of the erstwhile powers of the President of Pakistan to dissolve national and provincial assemblies under 58 (2b).
Section 19 excludes the district health authorities from the budgeting process and only CEO of the District Health Authorities and Regional Health Authorities are supposed to approve budget – it has again excluded the basic functional unit i.e. District Health Authority from the prime functioning of the budget formulation and its approval.
Section 23 provides for the centralised procurements of medical equipment at provincial level. This section is a question mark on the much-acclaimed parts about ‘evolution and accountability’ and ‘comprehensiveness and effectiveness’ in this 15-page document.
The government seems to have absolved itself from its constitutional responsibilities under the garb of ‘reforms’.
Procurements of medicines and medical equipment have been retained by the provincial government, and not delegated to the authorities, which is the main victim of red tape. This provision alone compromises the purpose of devolution of powers.
The already devolved powers of the directorate general Health services KP and District Health offices have been done away with, and the same powers have now been given to the provincial health minister.
There is no assurance in the Act that binds the government to bear the developmental and non-developmental charges of the public sector health facilities.
Appointment and removals of the members of the Authorities have directly been granted to the health minister through the members of the Authorities.
Civil Servants Act which was meant to protect the civil servants against political interference of the political bosses, has been done away with. This is another step that grants unchecked powers to the minister for health against the employees.
The authorities are made accountable to the health minister rather than elected members of the assembly.
Discretion in the appointments of key health executives has arbitrarily been granted to the authorities in the garb of officiating charge.
Instead of further delegating powers to the regional and district level, the Act has even eliminated the powers previously delegated.
The author is an Islamabad-based freelance journalist and contributes to different national and international papers and journals.