Health profession in Pakistan is passing though very critical time. Doctors, collectively and individually, need to acknowledge that being a doctor means taking responsibility not only for their own practice but for the wider system of which they are part.

Quality, from the patient’s view, is not only the work of one person but the system as a whole. Doctors are under heavy stress to keep alive their traditional image of medical professionalism. There is no policy at the government level where doctors should be engaged in more open dialogue with the public and play a more active role in managing and designing health services.

It is fact that individual doctors are highly trusted by the patients and their attendants but generally confidence in the profession as a whole has badly been affected. Doctors are facing serious professional challenge in ensuring that the quality of out of hours services are sufficiently high to warrant handing over clinical responsibility of their patients.

Our health system has been designed, developed and maintained by politicians rather than physicians which is one of the most distressing aspects of health care infrastructure. Doctors should be allowed to look at the infrastructure they work within.

To do better for health care system in Pakistan, planners should opt for doing best for the tertiary health care system rather than starting from the top down. Doctors changing their profession from practicing medicine to planning infrastructure should plan working health system that delivers effective, affordable, acceptable care for our citizens. Their mostly likely jurisdictions are epidemiology, health care analysis, business acumen, political effectiveness, accounting and management skills and information system expertise.

Brain-drain in emboldened by lack of incentives, barring from taking part in health care infrastructure and no attractive career structure. Greater discussion would certainly help to reduce public concern about ending GP’s duty to provide out of hours duty. Those involved in public health programmes are aware of the fact that about a third patient were unhappy with the arrangements.

Government formed National Health Commission in August 2004 and promised to submit their report within three months. Many steps were taken like increasing stipends for postgraduate doctors, house officers, medico-legal legislations and change in nursing service structure. It’s almost five months passed but there is no report from that commission. One of the tasks for this commission was to review the Career Structure of Health Personnel service structure of doctors, dentists, pharmacists, nurses and paramedical staff but there is no such ‘review’ so for. Consistency in government policies is imperative for building confidence in departments. We are optimistic that this commission will emerge one day with amicable solution but question arises how much time require?

Its need of the hour that stalwarts at the policy making level should consider revamping health care infrastructure and introduce such a model where all citizens can get better health care facilities in Pakistan.