Similarly, there are a number of other institutions, largely situated in Lahore, both public and private, providing post graduate training opportunities including the medical colleges. One issue is the limited funding available for the number of potential candidates to take up post graduation seats in the teaching hospitals. This is compounded by over-stretched faculties in many institutions, lack of a dedicated teaching cadre and dedicated clinical instructors.
4.16
COMMUNITY ORIENTED MEDICAL EDUCATION
An additional relatively new concept is that of Community Oriented Medical Education (COME) being promoted by WHO, primarily to promote and support revisions in medical curricula to include public health thus producing medical graduates more professionally equipped to meet basic primary health care needs of the population. This has been reviewed and in principle agreed by the PMDC and the health department but has yet to be rolled out in a systematic manner.
4.17
MANAGEMENT QUALIFICATIONS
Of particular concern is that of the administrative cadre of doctors. Some doctors in administrative posts have a relevant post graduate qualification such as an MBA, MPA, MHA to support their promotion or posting into the administrative cadre. For the most part doctors promoted into the administrative cadre are not trained in public administration or modern management disciplines leaving them ill-equipped to undertake their roles and responsibilities with any degree of confidence or success. The choice of a public health qualification for administrative cadres is not sufficient to equip doctors to deal effectively with all the administrative and management responsibilities that are expected from that senior role. The outcome of this is fourfold: 1. staff who are frustrated as they do not have the skills for the job; or frustrated in that having a public health qualification, MPH, they are managing a basic health facility and thereby not utilising their qualification as they had expected 2. poorly managed health facilities, especially at the tertiary level where the skill gap is most profound 3. de-motivated staff who are inadequately managed and supported 4. high levels of absenteeism and lack of accountability due to weak management and poor application of key HR protocols
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