Numbers of trained medical personnel coming out of the system are disproportionate to the number of people who need healthcare: CEO SKMCH

A US-trained infectious diseases specialist, Dr Faisal Sultan currently serves as the Chief Executive Officer of Shaukat Khanum Memorial Cancer Hospital and Research Centre.
Having served on expert committees in Pakistan in the area of HIV-AIDS and on the HPV Advisory Committee of the WHO, Dr Faisal is also a member of the academic council of the University of Health Sciences, Lahore and is a Fellow of the Royal College of Physicians of Edinburgh and the College of Physicians and Surgeons of Pakistan.
Following is a brief excerpt from a conversation that took place during his recent sit down with BR Research.
On the beginnings of SKMCH
"Shaukat Khanum's beginning of course is directly related to our Chairman's experiences with his mother's illness" says Dr Faisal, relating the story of how SKMCH sprouted from the seed of an idea that took hold in its founder's mind.
"When Imran Khan was faced with the challenge to care for his cancer stricken mother, he realized that getting good quality cancer care in Pakistan was extremely taxing, both financially and mentally as there was no specialised purpose-built cancer centre in the country; and this fragmentation further drove up the costs for those patients who had to be shuttled from one specialist to another," he said.
So the idea was basically to have a cancer centre where patients could find treatment under one roof, without the fear of not being able to pay for the facilities, he says. The idea was floated around quite widely and Imran Khan eventually put together a board, started to fundraise and once he had collected a certain amount he put together an advisory committee which then oversaw the construction of the hospital and research centre, which opened its doors in 1994.
Our mission from day one has been to have a cancer centre providing high quality research based cancer care while maintaining rigorous protocols ensuring access to the poor, says Faisal, who maintains that the journey along the years has been more than enlightening.
The initial phase was of setting a name, setting the standards of quantity of the service provisions and the second phase was on scaling both in terms of volume and complexity of the cancer care services we provide, he continues.
"Today we have followed through on all four of our founding missions and 75 percent of our cancer care is provided through hospital support funds, of which 68 percent is absolutely free and the rest is partially paid," he adds.
The economics of healthcare
Currently, Pakistan's public sector spending is around $10 on per capita health care requirements, whereas to get a reasonable level of care you require around $40 per person per annum, says Faisal. Hence the deficit is funded out of the pocket of the common man, which would be bearable for the smaller, short-term health concerns, but the problem is unfortunately compounded when dealing with a life threatening debility such as cancer.
"Since cancer demands a very expensive treatment, marshalling the resources to battle the disease in a third world country becomes extremely hard for the 25 percent of the population that can already barely muster up enough resources to battle the smaller of the health care concerns," he adds.
Faisal maintains that while diseases like cancer are clearly not more prevalent than let's say the common cold, the economic cost is simply too much to bear and devastates the households in the lowest quintile of the population. And that is where organizations like SKMCH and other private entities play their roles.
However, he adds that it is still not enough and despite all their best efforts, they simply cannot provide care to each and every single one of the deserving patients that walk in their doors. In this lieu, he maintains that going ahead, the Government needs to make sure that all healthcare models are stratified and that the poorest of the poor gets better access to some of the more expensive healthcare treatments apart from getting access to basic health facilities such as immunization, etc.
Screening at SKMCH
"At Shuakat Khanum, we have walk-in clinic where anybody can come for the initial evaluation," says Faisal, pointing out that at this stage, no questions regarding finances are asked.
"At this initial stage, patients are screened and, if cancer is diagnosed, then the next question is whether this type of cancer is at a stage which is treatable or not? Additionally, at this point we also check against the available capacity in the hospital for that particular type of cancer", he says.
Beyond this point, if the patient is accepted, its paying ability is determined, he continues, pointing out that those who can pay for the treatment bear their own expenses while those who cannot pay are interviewed by SKMCH's financial support service, where they are asked to complete a set questionnaire to adjudicate if they can pay fully, partially or nothing at all. However, Faisal maintains that the standards of cancer treatment and other health care facilities provided to both paying and non-paying patients is kept strictly at par with each other.
Early detection and preventive measures
Dr Faisal maintains while some cancers, when caught earlier can be treated with much more success, earlier detection does not inherently mean certified success across the board.
In this regard he maintains while earlier detection, interventions and screenings can help with cancers such as breast and cervical cancer, spending on the aforementioned screening processes should be in line with hardcore recommendations from professional bodies which base their advice on the ever-changing dynamics of the population data. Hence the standards of early detection need to be reviewed periodically, he adds.
Meeting sustainability challenges at SKMCH
"How many cancer patients do we need to treat privately to treat one cancer patient completely free of cost?" is the question which we first asked ourselves, says Faisal.
And in the course of things, we realized that we had to look at things in a different light. At SKMCH, revenue generation and managing the various revenue streams is a continuous challenge, he says.
"Currently, we manage half of the hospital expenses revenues we receive from paying patients and the rest of the 50 percent are met through philanthropic donations. So in a budget of Rs5.3 billion, around Rs3.5 billion is raised through philanthropy, and the rest through various streams including our Lab diagnostics and paying cancer patients", he says.
"Hence, if today, the philanthropy stopped completely, the hospital could operate and meet the fixed costs et al, but the ratio of patients who receive free of cost cancer treatments to those who pay for the treatments will become drastically skewed."
Plans on capacity enhancement
Discussing the capacity at SKMCH, Faisal maintains that focusing on the number of beds alone becomes a limiting parameter. In this context, you need to look at additional 8 to 10 parameters, he says, pointing out that just the number of beds available doesn't give a measure of how much work is being done. Hence to correctly gauge, you have to figure in the number of chemo patients, and the number of patients receiving radiation treatments, etc, because all of those are done on an outpatient basis", he adds.
However, Faisal maintains that capacity enhancement is never far from the minds of those at the helm at SKMCH. Currently, the hospital has 30 chemotherapy beds that are run around the clock and plans for increasing the number is in the works. Additionally, expanding the geographic footprint will also help take off some load from the landmark cancer facility in Lahore. Currently, a hospital-being built on land donated by the KPK government-is under construction in Peshawar and plans are to open it within the next 3 years.
Health care personnel
Faisal maintains that even today, the numbers of trained medical personnel coming out of the system are disproportionate to the number of people who need healthcare in the country. He says that even with the numerous private medical colleges abounding, the country is producing about 5 to 6 thousand doctors per annum and we have around 140,000 registered doctors on the rolls in the system, creating a gap whose worst brunt is borne by the common man.
However, he is of the opinion that opening up more medical schools is not the only solution. In this regard he maintains that today the quality and competence of the trained personnel coming out of the various schools and colleges has become too scattered and further monitoring is required to ascertain the quality of the healthcare these young incoming doctors are capable of providing, he says.