Government's role in healthcare should only be of a monitor: Dr Manzoor Qazi, CEO Shifa International Hospital

In 1987 a group of young doctors decided to come back to their homeland and build a hospital. Today that hospital is known as Shifa International Hospital, which has not only become one of the significant players in providing quality healthcare to the people of Pakistan but it is the only stock market listed hospital in Pakistan.
BR Research sat down with Dr Manzoor Qazi, Chief Executive Officer of Shifa earlier this month. What followed was a long conversation on issues related to the health care system of Pakistan and the latest expansion plans of Shifa International Hospital.
Dr Manzoor Qazi is a founding member of Shifa international Hospital and has been a board member since its inception. He received his medical degree from King Edward Medical College Lahore. Later he was trained in USA at Little Company of Mary Hospital in Chicago and in Flushing Hospital in New York for Internal Medicine and later on in Louisina State University for Cardiology. He was actively in the initial planning and founding stages of Shifa and later on in the management of the hospital and has been Medical Director of Shifa International Hospitals Limited since its conception, planning, implementation until recently when he accepted the position of Chief Executive Officer.
BR Research: How is Pakistan's healthcare sector doing? Has there been any improvement in indicators? Dr Manzoor Qazi: The healthcare sector is weak here, but it is not broken. It is definitely growing; I can't put a number on it, but wherever you go you see a new hospital, new doctors, the number of graduates in medical college is increasing, and we're seeing more general practitioners where there weren't any before.
In terms of indicators, we're doing better in maternal mortality, infant mortality, and preventable diseases than a lot of central Asian and African countries. Life expectancy is going up; there was a time when it was 45-50, but now we're near 70. So overall, we are improving.
There are problems however; the distribution of funds isn't happening priority-wise. The biggest issue is the lack of monitoring by federal and provincial governments. I think that's where the problem is.
BRR: The public sector healthcare funding has increased over the past several years. Has the quality of government hospitals improved?
MQ: There's no improvement in government health sector. Perhaps in one or two hospitals if the MD is overly efficient, hard-working, and God-fearing, then that hospital will be far better. But that's dependent on individuals and not the system.
BRR: What should be the role of the government in Pakistan's healthcare sector? What examples can we draw from abroad?
MQ: In the US, other than a few army hospitals, no hospital belongs to the government. All are private. The private sector, because of competition, will provide good resources and maintain self-sufficiency, etc.
I feel that the government does have a role but it should pertain to monitoring. It should come to the hospitals, carry out inspections, punish malpractice, and see if requirements are being met. There needs to be a central level healthcare policy that should be enforced.
A lot of governments facilitate the private healthcare sector; they give tax breaks, remove duties, etc. In the US, the state gives private hospitals certain funds and tells them to treat a percentage of people for free. That way, the government doesn't even have to set up a hospital itself. There are also many communities that invite the people to take the land and set up a hospital.
BRR: But isn't private sector healthcare in Pakistan very expensive?
MQ: The medications, supplies, machinery, equipment, etc all have to be imported. We pay the international price. In India, they make it themselves - X-Rays, MRIs, pacemakers, etc. Making it yourself could cost almost one-third. But until the private sector grows that much and demand grows for those areas, that industry won't be established here.
Healthcare will be cheap when there are more institutions, demand is more, and a local industry is set up. There are a lot of patients, but not enough private sector hospitals.
Having said that, we incorporated Shifa Foundation with the government the year Shifa was founded. Through that, we give free care to those who can't afford it. We visit places via Shifa Foundation time to time.
BRR: Aren't private hospitals exempted from duties?
MQ: No Those hospitals that declare themselves charity hospitals are exempt from duty. We are not a charity hospital.
BRR: What other policies do you think can be introduced?
MQ: The government can mandate employers to provide healthcare through health insurance to its employees. The big corporations do it, but here, there aren't too many companies that do. The government should give incentives such as tax relief and make this happen. Also, government gives tax breaks to certain industries. The items that are being imported for patients, they can be taxed less.
BRR: What other problems are there in the healthcare sector those aren't due to policies?
MQ: Nursing has a lot of deficiency. Healthcare is dependent more on nurses than doctors. If the nurse isn't educated, confident, experienced, then the level of care will suffer. There's a shortage of nurses in Pakistan, but more so their quality of care is very sub optimal. I believe they're paid alright, but the problem is basic training. After matriculation, those girls that can't go to medical college do a three-year diploma in Holy Family, Sialkot, Daska.
Aga Khan invests the most in their nurses. After that it's us; we're doing a lot for nurses' training and education. We are improving that: nursing school, nursing education department, paramedical training - a sizeable amount of our budget is spent there. And we feel good that the patients get better care then.
BRR: Your expansion is good in Punjab. You're in Faisalabad as well. What does the future hold?
MQ: When any organisation stops growing, its decline begins. So we have to grow. When we started Shifa all those years ago, we knew even then that we don't want to limit ourselves to Islamabad. It took us some time but now we're at a stage where we can expand. But it's not just about building a building; we have to put up a whole system - nursing college, medical college, pharmacy, etc. We're looking for a place in Lahore. Hopefully in three years we'd want to set up a hospital in Lahore and based on our experience hopefully it will be better than this one even.