octors and paramedics across the Punjab have been on strike since April 5. Consequently, the Out-Patient Departments of all public health facilities in the city remain shut.

The protesters, under the umbrella organisation of Grand Health Alliance (GHA), are opposed to ‘privatisation’ of health facilities which, they say, could compromise health service delivery and lose them their jobs.

Recently, the police dispersed the crowd at their protest camp on The Mall and apprehended 72 people. This further embittered the community. “We don’t deserve to be treated like this,” says Dr Zain Bhatti, a former health adviser to the chief minister, and a leader of the doctors’ community. “We were forced to take to the streets. We held peaceful protests only after the government chose not to engage in a dialogue with us. We went the democratic way, but they’re using force to stop us.”

Dr Salman Haseeb, president of the Young Doctors Association-Punjab, says the fraternity strongly contests the government’s decision to outsource Basic Health Units, Rural Health Centres and managerial work at major health facilities under a new health bill.

Dr Bhatti adds, “We have serious reservations with respect to the privatisation of BHUs and RHCs. We urge the authorities to address those at the earliest.”

Bhatti says the primary issue is job security. “Privatisation threatens the livelihood of health workers who have served at the BHUs for decades. Many of them are nearing retirement. The workers, such as polio vaccinators, lady health visitors, dispensers and other staff fear losing permanent positions.”

Also, Dr Bhatti says, doctors are concerned about their own jobs, including regularisation of ad hoc workers’ services. He says ‘privatisation’ is likely to raise the cost of treatment, making healthcare expensive for the people. Already, he says, the unavailability of free emergency and OPD medicines has forced poor patients to purchase those from private facilities.

There’s a serious shortage of human resource at some medical institutions, including some teaching hospitals. Staff shortages lead to doctors juggling temporary duties between the district headquarters hospitals and other facilities.

Dr Haseeb says the contractual programme is to begin with 150-odd BHUs. In the first phase, the BHUs shall be privatised and renamed Maryam Nawaz Health Clinics. In Bahawalpur, 4-5 BHUs have been outsourced. “A BHU looks after an entire colony. What will happen if more than 26 patients visited it? There could be hundreds of thousands of patients,” he says. “Moreover, the monthly deliveries are capped at 20. You can perform 20 deliveries at one centre, no more. You will be paid Rs 6,500 for one delivery.”

The GHA, which is composed of associations of doctors, paramedics, dispensers and vaccinators, fears that privatisation of smaller institutions like the BHUs and RHCs will result in job losses, particularly permanent positions.

The programme begins with the 150-odd BHUs. In the first phase, the BHUs shall be privatised and renamed Maryam Nawaz Health Clinics.

“Privatisation may also lead to a raise in the cost of treatment,” says Dr Haseeb. “It will disproportionately impact the poor.”

He also talks of the government testing “Model BHUs” by outsourcing five BHUs per division in the early months of 2025, without consulting the stakeholders. “They’ve now moved on to outsourcing all BHUs, ignoring the community and staff altogether,” he says.

The BHUs are managed by contracted doctors and have a fixed budget of approximately Rs 600,000 (or Rs 590,000) to cover operations, including staff salaries, utility bills and medicines. These doctors are permitted to charge Rs 400 per patient, with a daily limit of 30 patients.

Dr Bhatti says the new system will affect both healthcare workers and patients: “It will force doctors to cut costs, staff will be hired on meagre salaries and poor patients burdened with fees they can’t afford.”

He says the government has previously outsourced security, waste management, parking and cafeterias at public health facilities, leading to exploitation of visitors as well as workers; only the contractors were happy.

He says the security guards are now hired through private companies. “They are overworked and underpaid. They sign up for Rs 37,000 [a month] but end up getting only Rs 12,000-15,000. Besides, every other day, security issues are reported as doctors and attendants clash. That’s the reality of outsourcing.”

He says the BHUs used to employ 11-13 staff members, but the new policy mandates only four, the rest shall be sent to a centralised pool or laid off.

Dr Junaid, president of the YDA-Bahawalpur, says, “Nurses, health workers, dispensers and low-grade employees are the most vulnerable. The government is outsourcing the facilities in order to make up for its administrative failures and inability to reform the system.”

The strike has caused hardship for patients, particularly those coming from rural areas, who are compelled to look to private sector which is an expensive proposition.

The Health Department has responded by threatening to withhold salaries of absentee doctors.

Health Minister Salman Rafique has defended the proposed system, saying that if the doctors treat more people, they will make more money. No one will be fired or laid off. All the doctors will be placed in public hospitals.

He also says that doctors and paramedics are required to serve at the facilities they are assigned to.

The YDA leaders contest the minister’s statement. Dr Haseeb says, “If so many government employees, including those at the BHUs, are being relocated, does the government have enough resources to accommodate them? If not, what will happen to these employees? What will be done for those who have devoted 20-30 years of their lives to the BHUs?”

Ahsan Malik is a media veteran interested in politics, consumer rights and entrepreneurship