Grave Issues of Governance

On 21 January 2014 the Ministry of Health and Quality of Life (MOH) issued a press communiqué which draws attention to a number of ‘several major structural changes (that) have been brought to the Medical and Dental Councils Acts through amendments made in the Economic and Financial Measures (Miscellaneous Provisions) Act No. 27 of 2012’, done ‘with a view to ensuring a high-performing quality healthcare system.’

The communiqué follows a meeting and representations made by a group of 160 doctors who have recently completed their pre-registration training and were due to sit for ‘an examination after completion of the pre-registration training of all new medical graduates, whether qualified locally or abroad.’ These doctors were objecting to complying with this provision of the Medical Council Act as amended, and cited the letter which they had been issued by the MOH at the beginning of their training to support their claim. Minister Arvind Boolell intervened at that meeting and addressed the gathering. Subsequently the doctors turned up en masse at the MOH and the result was that communiqué effectively absolving them from the need to sit for the said examination, on advice from the State Law Office.

Thus, the government has gone back on an important provision of the law it had itself voted. Similarly for another provision regarding Continuing Professional Development, now a standard in all developed countries. Whereas it was to become effective from the 1st January 2013, now it has been pushed back indefinitely according to the communiqué which states: ‘mandatory Continuing Professional Development for all serving registered medical and dental practitioners. This measure will be implemented in due course.’ (italics added)

It will be appreciated that these are matters of serious concern to the population, which expects government to show resolve and give direction in the timely enforcement of the laws that it votes in Parliament. Especially where health is concerned, it is primarily the duty of government to ensure that health professionals are properly trained, in reputed institutions, and that the Medical Council, like all other regulatory councils, is given the wherewithal to oversee the qualifications and competence of aspiring doctors, both generalists and specialists. Something does not sound quite right in the half-hearted manner in which the government is going about implementing the amendments that it has itself made in the Medical Council Act. This weakens the Medical Council as a body and dilutes its role, the consequence of which will be felt down the line by the patients. Thus the claim in the press communiqué about ‘ensuring a high-performing quality health care system’ is in practice, because of the turnaround, effectively nullified and sounds hollow.

The impression one is left with is that things are done under pressure, and therefore in undue hurry, instead of being thought through in a comprehensive manner at an institutional level, with the appropriate professionals and representative stakeholders given sufficient time to consider all relevant issues and scenarios in all serenity and then make recommendations. Any proposed change to these must perforce be returned to the deliberating body. Such a body, as obtains elsewhere in advanced jurisdictions, must be an entity that is independent of the MOH and must be composed of experienced professionals from registered professional bodies, academic and training institutions and the relevant regulatory organisms. Unless this is done, and this must be government-driven at central level, we are going to continue witnessing seesaw movements which will be inimical to both the practitioners and the patient population.

Similar happenings in other fields force us to ask whether this a pattern in our governance of late? We will recall the similar roll back on the gilet issue, as well as the earlier, public defiance of a Supreme Court provision by protesting hawkers in a manifestation where politicians were present. By so overtly countenancing interest groups through the presence of elected representatives, isn’t the political class shooting itself in the foot? Or are the laws that they vote merely conveniences whose provisions can be thwarted at the behest and whims of interest groups which force politicians to bend to their agenda?

It is not difficult to contemplate that by creating exceptions or by systematically rolling back decisions that it had itself taken, presumably in the best interests of the country and after careful consideration of all the implications thereof, government would only be creating the conditions that would allow all manner of private interests and/or sectional lobbies to keep pressing for outcomes that best suit their interests. In the long run it’s development at the national level that will be stifled. Grand speeches about putting up this or that hub would be futile in these circumstances. For it requires more than mere rhetorical hyperboles to create a medical hub. Or, any hub for that matter.

* Published in print edition on 24 January 2014