Possibilities Exploration for Public –Private Partnership A. Quddus, Mazhar Ul... · Web viewDr.Muhammad A. Quddus * Dr. Mazhar Ul Haq Baluch Khawar Ata* * Director, Punjab

2013 Cambridge Business & Economics Conference ISBN : 9780974211428

Possibilities Exploration for Public –Private Partnership (A Study of Social Security Systems Employees)

By

Dr.Muhammad A. Quddus *Dr. Mazhar Ul Haq Baluch**

Khawar Ata***

* Director, Punjab Economic Research Institute, Lahore /Pakistan**Senior Research Fellow, Lahore school of Economics Lahore/Pakistan*** Research Economist, Punjab Economic Research, Lahore/Pakistan

Punjab Economic Research Institute48-Civic Centre, Johar Town, Lahore-Pakistan

Lahore School of Economics, Main Campus Burki Road, Lahore/PakistanJuly 2-3, 2013Cambridge, UK

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Possibilities Exploration for Public –Private Partnership(A Study of Social Security System Employees)

Dr.Muhammad A. QuddusDr. Mazhar-Ul-Haq Baluch

Khawar AtaAbstract: The objective of this evaluation exercise was to study the health care facilities provided by these two types of hospitals (one functioning under the control of Government and the other managed by a company under public-private partnership) and to assess their performance and quality of service in terms of patients’ satisfaction. For impact evaluation, two hospitals of PESSI viz Shahdara Hospital, Lahore and Khawaja Farid Social Security Hospital, Multan of 100 beds each were selected. Regarding the hospitals managed by PSSHMC, both the hospitals located at Manga-Riawind Road and Muzaffargarh of 150 beds each were taken in the sample. Total number of patients/beneficiaries interviewed by the PERI’s survey teams for this study was 500 i.e. 125 beneficiaries from each hospital. The necessary information for the study was also collected from the hospitals administration. The Institute’s survey teams interviewed the doctors and paramedical staff/other staff as well in order to know their viewpoint about service delivery and service conditions/job satisfaction. The results of the study provide useful information on functioning of these two categories of hospitals with regard to their organizational structure, staff strength, number of specialists/doctors, paramedical staff/other staff, infrastructural facilities, salaries of doctors/staff, outdoor/indoor patients, lab facilities, facilities available in the operation theaters, income & operational expenditure, patients referred from/to the hospital, patients satisfaction regarding waiting time in the reception area/OPD, availability of doctors/paramedical staff, medical check-up and treatment by the doctors/specialists, behavior of doctors/staff, laboratory tests conducted, operations performed, post operation facilities, and satisfaction of service providers (Doctors, Paramedics and Other Staff) about their salary package, Job security, service conditions & working environment etc. It was observed that PSSHMC hospitals have generally better infrastructure, properly equipped with latest machinery/equipment and laboratory facilities but their performance is not as good as it should have been, when compared to the PESSI hospitals in terms of number of clinical pathology tests performed, number of emergency / outdoor / indoor patients attended, surgical operations conducted, satisfaction of the patients about their medical check up, treatment and behavior of the doctors / other staff, quantity / quality of medicines and satisfaction of the service providers (Doctors, Paramedics and other hospital staff) about their salary package, job security, after retirement benefits, service conditions and working environments etc. It was found that the overall performance of PESSI hospitals was better as compared to PSSHMC hospitals with regard to these indicators.

Introduction

Punjab Social Security Health Management Company (PSSHMC) was established under public

– private partnership, as a non – profit organization, registered under the Companies Ordinance,

1984 and was incorporated on 23rd June, 2004 as a company limited by guarantee having share

capital subscribed by the Government of the Punjab. Authorized Capital was Rs. 150 million

divisible into 15 million ordinary shares. Paid-up capital was Rs. 50 million (Rs. 20 million)

subscribed so far.

The primary purpose of setting up the PSSHMC was the provision of health care through

establishment and management of hospitals and health care facilities. An agreement was signed

between the Punjab Employee’s Social Security Institution (PESSI) and the Pakistan Social

Security Health Management Company (PSSHMC) on 19-7-2004.

According to this agreement, PSSHMC was required to manage and establish hospitals and

provide medical care services in the allocated areas to the secured persons and their dependents

defined in section 2(25) and 2(6) respectively of the Punjab Employees Social Security

Ordinance,1965. The Company was required to provide all kinds of medical care facilities as

July 2-3, 2013Cambridge, UK

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were being provided presently by the institution to the beneficiaries in term of section 38, 38-A,

44 and 45 of the ordinance in the allocated area as mentioned below.

Manga-Riawind Road and from 43 K.M at Lahore- Multan Road up to Iqbal Nagar

including the areas of Phoolnagar, Chunian, Pakpattan and Arifwala.

From Chowk Pir Bahar Shah to G.B Canal i.e., up to 20 KM on Sheikhupura - Faisalabad

Road and from Feroze Wattwoan to 8-K.M up to Warburton.

Muzaffargarh District

According to the aforesaid agreement, the institution is under obligation to transfer to the

company 80 percent of net social security (after deduction of the administrative costs of the

institution) received by it with respect to secured persons of each allocated area. Under the

agreement, the company was required to build, staff, equip and operate three hospitals at:-

Manga – Raiwind Road -------------150 beds

Muzaffargarh ------------------ 150 Beds

Sheikhpura --------------------100 beds.

Hospitals at Manga- Raiwind road and Muzaffargarh were established which started functioning

on July, 4, 2007 and 1st August 2007 respectively. Construction of Sheikhupura hospital could

not be started due to litigation before the Lahore High Court.

The company was managed by the Board of Directors consisting of 26 members, 17 from private

sector, 5 from the government of Punjab and 4 labor representatives. The administrative control

of each hospital was exercised by the Local Hospital Management Committee, Executive and the

Board. The chairman of the Board was from the Private sector. The Chief Executive Officer

(CEO) of the company had control over the affairs of both the hospitals of Mange- Rewind Road

and Muzaffargarh. There was one administrator for each of the hospitals at Manga and

Muzaffargrah.

The total number of industrial units in the area allocated to the PSSHMC Hospital Manga –

Riawind Road was 1295 units. The PSSHMC Hospital Muzaffargrah was located in

Muzaffargrah city and the allocated area for this hospital was the Muzaffargrah district.

According to administration of PSSHMC diet charges, medicines, disposables and all test


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charges were paid by the company. Accounting and financial records were being checked by

Internal Auditors on monthly basis and External Auditors on annual basis.

Overall bed occupancy ratio remained from 60 percent to 80 percent of both the hospitals at

Manga – Riawind Road and Muzaffargrah. This comparative study of assessment of service

delivery of Selected Hospitals of Punjab Employees’ Social Security Institution (PESSI) and

Punjab Social Security Health Management Company (PSSHMC) was conducted on behalf of

the Punjab Social Security Institution. The purpose of this comparative study was to explore

possibilities of practical options for public –private partnership for health service delivery system

to provide better health care facilities to the secured workers and their dependents,

Methodology

Two stage sampling technique was adopted for selecting the representative sample. At the first

stage , a sample of two social security Hospitals of the Punjab Employees Social Security

Institution (PESSI) viz Shahdra Hospital, Lahore & Khawaja Fareed S.S Hospital, Multan were

selected for study. On the other hand, both the hospitals managed by the Punjab Social Security

Health Management Company (PSSHMC), Manga and Muzaffargrah were taken for study

purposes.

At the second stage, a sample of patients of these two types of health providers was selected. For

determining the sample size of patients, the following statistical formula with known population

and guessed variability for maximum sample size was applied:-

n =

= = = 249.63 say ---250

This sample was equally distributed between both the hospitals i.e., 125 from each of Shahdra

and Khawaja Fareed hospital.


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The same formula was applied to determine the sample size for Manga and Muzaffargrah the

Hospitals, controlled by (PSSHMC)

n= = = 249.60-----250

The estimated sample size was also the same250 i.e., 125 from each of the hospitals viz Manga

and Muzaffargrah.

Results of the Study

To derive the factual results of comparison of the facilities available at both the sets analyzing

the strengths and weaknesses of both the systems i.e., PESSI and PSSHMC hospitals on the basis

of infrastructural facilities and capacity of the hospitals such as staff strength, number of

functional departments, laboratory facilities available and number of lab tests performed since

the inception of the hospitals. The other considering fact was of patients, referred by PSSHMC

Hospitals, Muzaffargrah and Manga to Social Security Hospitals (Khawaja Fareed in Multan and

Nawaz Sharif Social Security Hospital, Lahore), in case of non-availability of specialists /

facility for the disease or due to other reasons. All the facts considered essential for presentation

were discussed in this section.

The basic information of both PSSHMC and PESSI hospitals are discussed in Table 1. The data

in above table reflected that there were 36 wards in PESSI hospitals and 50 wards in PSSHMC

hospitals. Other facilities such as number of rooms for doctors in OPD, operation theaters, admin

staff, labs, waiting areas, pharmacy store and other stores were reported to be 36, 6, 16, 21, 8 and

7 in PESSI hospital and 23, 10, 21, 14,16,6 and 9 in PSSHMC hospital. Both the PESSI

hospitals were 100 bedded each and the PSSHMC hospitals were 150 each. The existence and

functional status of different wards / departments in both type of hospitals are presented in

Annex-I.

Staff Strength


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Staff strength refers to sanctioned, filled in and the vacant posts of professional and supporting

staff including workers hired on daily wages in an institution. Since the functioning capacity of

an institution depends upon the availability of the required staff, the staff situation was examined

for both types of the hospitals functioning under PESSI and PSSHMC. The data in the table

reflects that about 96.0 percent of the posts in different cadres were reported filled in the

considered hospitals. Consequently, Professional staff strength environment reflected good

situation in both types of the considered hospitals (PESSI and PSSHMC) hospitals. (Table-2)

Laboratory Facilities

To examine functioning pattern, the availability of different laboratory / diagnostic test facilities

and the number of tests performed during the last three years 2007-08 to 2009-10 were assessed.

The results reflected that plain X-rays were performed more than double (25601) in PESSI

hospital as compared with (12562) in PSSHMC hospitals. Only 146 dye-induced x-rays were

performed in PSSHMC hospitals, while the corresponding figure in PESSI hospitals was 1433.

In-brief PESSI hospitals were far ahead in case of about all the laboratory tests performed during

the considered period (2007-08 to 2009-10). This could be assessed that newly initiated system

was not yet common to be availed medical facilities in the areas (Table-3). Ultimately, this

situation might be due to time concerning of establishment of the institution (PSSHMC), since

the health care provision is generally dealt with by the people having past experience of the staff

and the dealing of the lower staff of the institution, which is again time concerning of the

establishment of the relevant institution.

3.5: Number of Patients Referred

As per agreement, the secured person was needed to be referred to other hospitals under situation

of non availability of the department / specialty, some complication or non-availability of

specialist doctors for that particular disease. To assess the performance, the cases of the social

security hospitals, which were referred to other hospitals were verified in this context. The

information provided for these cases were reflected in the table-4.

The total 4,242 patients of cardiology were referred to other hospitals from PESSI hospitals

during 2007-08 to 2009-2010. Furthermore, 397 patients of cardiac surgery were referred to


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other hospitals due to non-availability of cardiac surgeon in these hospitals. At second number

was Neurosurgery / Neurology department, where the number of patients referred was 1258.

This specialty was not available in PESSI

hospitals so they referred the patients to other hospitals. About 913 patients of urology

department of PESSI hospitals were referred to other hospitals. (Table-4)

However, the Chief Executive of PSSHMC reported that most of the patients referred by

PSSHMC hospitals to other hospitals were from Cardiology department (834 patients), and

Orthopedic department (811 patients). It was strange to observe that these hospitals have their

own departments functional and yet they referred the cases to other hospitals. About 692

patients of Eye department were referred to other hospitals by PSSHMC hospitals despite having

their own department being functional.

Ultimately it was concluded that PESSI hospitals referred those patients to other hospitals for

which they had no facility or specialty for their treatment. However, PSSHMC hospitals referred

patients from almost all departments to other hospitals, even having their own departments

functioning, and this aspect leads towards inefficient performance or intention of improper care

of the patients registered for treatment in PSSHMC hospitals, while PESSI proved relatively

efficient in their performance with respect to reference matters.

Exclusive to the cases referred reflected above the cases of PSSHMC hospitals which were

treated in Nawaz Sharif, Social Security Hospital, Lahore and Khawaja Fareed Social Security

Hospital, Multan have been shown in the table-5.

PSSHMC Hospital Manga referred more than 7 thousand patients (7321 patients) during 2007-08

to 2009-10, while the corresponding figure for PSSHMC Hospital, Muzaffargarh was 3097.

Most of the patients referred were related to Medical (2736 patients), followed by Orthopedic

(1294 patients), General Surgery (876 patients) and Gynae / Obs (815 patients) departments.

The PESSI hospitals treated these referred patients of PSSHMC hospitals without any payment

from PSSHMC. These PSSHMC checked the patients in their hospitals and after giving some

treatment referred them to PESSI hospitals and the Company did not pay even a single penny to

them. Thus PESSI hospitals had to spend a lot of money from their own resources for the

treatment of the patients referred by PSSHMC.


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It was noted that PSSHMC patients have a choice for their treatment. If they want to visit their

registered PSSHMC hospital they may go there, otherwise they can go to PESSI hospital for

their free medical treatment and PESSI hospital will not charge any amount from patients of the

PSSHMC hospital. However, example was not noticed that PESSI patients visited the PSSHMC

hospital for free medical treatment. Table - 6 gives this crucial information regarding those

patients who are registered in PSSHMC hospitals but they have chosen PESSI hospitals for their

medical treatment.

Budget and Expenditure

The performance of the institute mainly depends upon the annual budget allocated for provision

of the necessary matters and materials with exceptional provision of the professional and

supporting staff. Though the employed staff has already been working with the available

resources, yet their performance is basically linked with the yearly sanctioned and provided

funds allocated in the budget, and consequently the staff may pretend of non - availability of the

medicine stuff required for the treatment of some specific patients. The data presented in the

Table-6 elaborates the annual budget of four hospitals under study. It was important to note that

PSSHMC hospitals had no specified sanctioned budget heads (Accumulated Allocation).They

spent the money under different heads during the year according to their needs. On the other

hand, PESSI hospitals were sectioned head-wise budget and they were to spend the amount

considering heads. The data also indicated that total budget of Shahdara Hospital during 2009-10

was Rs. 116,186,447. The expenditure incurred on medicines during the year was 24.2 percent,

while the share of Pay and Allowances was 55.8 percent.

Total annual budget of KFSSH Multan in 2009-10 was Rs. 104,268,392. Total amount spent on

medicines during the year was 15.8 percent, while the budget spent on Pay and Allowances was

62 percent respectively.

Total budget of Manga Hospital managed by PSSHMC for the year 2009-10 was Rs.

113,705,796. The expenditures incurred on medicines during the year were 36.7 percent. The

share of expenditure on Pay and Allowances for the year was 40.8 percent. Total annual

expenditure of PSSHMC hospital, Muzaffargarh was Rs. 85,361,811 for 2009-10. The

expenditure on purchase of medicines during the year was 39.2 percent. However, the July 2-3, 2013Cambridge, UK

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expenditure incurred on Pay and Allowances for the year was 38.1 percent. The situation reflects

that PSSHMC hospitals were spending more on medicines and less on Salary of Staff as

compared to PESSI hospitals. This may be the reason that PSSHMC staff was not satisfied with

their salary package. On the other hand, the patients of PSSHMC hospitals were also not fully

satisfied with the services provided by PSSHMC hospitals.

The situation reflects that PSSHMC hospitals were spending more on medicines and less on

Salary of Staff despite having low allocation as compared to PESSI hospitals. This may be the

reason that PSSHMC staff was not satisfied with their salary package. On the other hand, the

patients of PSSHMC hospitals were also not fully satisfactory.


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Job Experience and Salary Structure

Since the PESSI hospitals were the older, all the staff working in the PESSI hospitals has more

experience except lab technicians than PSSHMC hospitals. In PSSHMC hospitals nurses were

only with 3 years job experience. (Table-7)

The table also reflected the average salary of the staff. The average reported salary of all the

professional staff was relatively higher in PESSI hospitals as compared with PSSHMC hospitals.

This could be justifiable on the basis of relevant job experience, since increase in salary mostly

depends upon the length of service or experience of the staff. The PESSI staff was more

experienced with better salary package and, therefore, they might be expected to perform better

in service delivery.

Along job security and higher salaries, PESSI staff has also pension benefits and medical facility

up to one month basic pay, while in case of PSSHMC hospitals the staff has only medical facility

up to Rs. 1000/- only.

About all of the consultants working in PESSI were satisfied, while 42.9 percent performing job

in PSSHMC were reported dissatisfied with their monthly remuneration. Only a small proportion

(12.5%) of MOs and WMOs working in PESSI expressed dissatisfaction with respect to their

monthly remuneration. All other staff in PESSI reported satisfaction with respect to

remuneration. However the staff working in PSSHMC, except DMO, reported dissatisfaction

regarding monthly salary was 42.9 percent of Consultants, 55.6 percent of MOs/WMOs, 66.7

percent of Laboratory Technicians and 50.0 of nurses. (Table-7)

Work Performance Satisfaction Status

Work performance was assessed by considering daily work load of the doctors through checking

the patients, nursing staff competency satisfaction level, and satisfaction status of the staff with

respect to administration behavioral attitude. In PESSI hospitals about 84.8 percent and 9.1

percent of the doctors reported complete satisfaction and satisfaction to some extent respectively

regarding daily workload of checking of the patients. In PSSHMC hospitals the complete

satisfied level and satisfied to some extent level of doctors were 44.1 percent and 20 6 percent July 2-3, 2013Cambridge, UK

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respectively. However about 35.3 percent of the doctors of PSSHMC reported dissatisfaction

regarding daily work load of checking the patient as against 9.0 percent of the doctors of PESSI

hospitals.

Majority (88.6%) of the doctors of PESSI expressed complete satisfaction about performance /

competency of their nursing staff, while the proportion of the doctor with similar response in

PSSHMC was 48.5 percent. The doctors, satisfied to some extent about performance

/competency of nursing staff, were 11.4 percent and 39.4 percent in PESSI and PSSHMC

hospitals respectively. However the dis-satisfied doctors with respect to performance of the

nursing staff were 12.1 percent in PSSHMC hospitals. In PESSI hospitals all the staff i.e., 97.4

percent and 2.6 percent were complete satisfied and satisfied to some extent with respect to

working performance of the hospital administration. No person reported dissatisfaction in this

regard. In case of PSSHMC hospitals complete satisfied behavior of the administration staff

was reported by 75.7 percent, satisfied to some extent (8.1 percent) and dissatisfied (16.2

percent). (Table-8)

*Ranking of Hospital by Hospital Staff

Hospitals under both systems i.e., PESSI and PSSHMC were ranked by the respective staff

on the basis of working/performance considering ‘Very Good’, ‘Good’, ‘Average’, and ‘Poor’.

The data in table-9 reflected that 73.8 percent of PESSI staff ranked their hospitals as ‘Very

Good, The remaining 26.2 percent of the staff of PESSI ranked their hospitals as ‘Good’. About

44.4 percent and 47.2 percent of the staff belonging to PSSHMC ranked their hospitals as ‘Very

Good,’ and ‘Good’ respectively. However about 6.0 percent and 3.0 percent of PSSHMC staff

ranked their hospitals ‘Average’ and ‘Poor’ respectively. No such ranking ‘Average’ and ‘Poor’

was suggested by PESSI staff. This situation reflected better performance of the hospitals of

PESSI as per ranking of the staff.

Preference of Institutions’ Staff Regarding Public – Private Partnership

PSSHMC has been established under public – private partnership, registered under company

Ordinance, 1984, parallel to Punjab Employees Social Security Institution (PESSI). The principal

objective of both the institutions was the provision of medical care services to the secured


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persons and their dependents. This was a quite new experience specifically in Pakistan, so its

continuation might be made capturing the perceptions / views of the staff as well as considering

comparative performance of allocated work pattern to both the institutions and also the

experienced opinions of the beneficiaries. Ultimately, the views of the staff of both the

institutions (PESSI and PSSHMC) expressed have been presented in the table-10.

A significant proportion of staff (56.8 %) working in PSSHMC hospitals ( A Company setup)

and 97.6 percent of PESSI staff did not prefer the Public –Private Partnership, whereas 5.4

percent of PSSHMC staff preferred the partnership to some extent. When inquired about the

reasons for not preferring PPP setup, 76.2 percent and 65.9 percent staff of PSSHMC and

PESSI hospitals Respectively reported that there was no job security in PPP setup, whereas 33.3

percent and 22.0 percent of PSSHMC and PESSI hospitals’ staff reported no-pension benefits

after job the reason for not preferring the PPP setup. However personal respect factor in Govt.

setup was reported by 4.8 percent and 12.2 percent of the staff of PSSHMC and PESSI hospitals

respectively as the reason not preferring the PP partnership.

All the considered staff of PESSI reported favoring PPP set up due to the solution of the

problems and better atmosphere and working condition, while 57.1 percent and 21.4 percent

favored preference for PPP system because of immediate problem solution and better working

environmental conditions.

From the above indicated environmental situation almost the entire PESSI staff did not prefer the

PPP system, so the staff of PESSI strongly supported the Sole Government setup and they were

quite satisfied and comfortable with the existing Government system.

Views of Beneficiaries

The Sample beneficiaries were distributed on the basis of usage of the hospital facilities such

Outdoor Patients, Emergency Patients and Indoor Patients. The views expressed by all the three

types of beneficiaries are discussed below.

Out Door Patients (OPD)


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A comparative behavior of the staff of both the hospitals with the secured persons regarding their

check up behavior of the doctors and waiting time in OPD has been assessed. An equal number

of patients i.e., 99 percent of both types of hospitals reported that the doctors (specialist,

MO/WMO) were available in their respective room

In PESSI hospitals 98.5 percent and in PSSHMC hospitals 99.5 percent of the beneficiaries

reported that the concerned doctor checked them. About 89.0 percent and 93.0 percent OPD

patients of PESSI were satisfied about their check up and behavior of the doctors respectively,

while the corresponding figures in case of PSSHMC were 59.9 percent and60.8 percent. About

21.3 percent and 21.6 percent of the respondents were not satisfied with their medical checkup

and behavior of the doctor respectively.

The patients, who had to remain waiting for more than half an hour to get themselves checked

up, were 10.5 percent in case of PESSI hospitals and 40.8 percent in case of PSSHMC hospitals

(Table-11). A relative better situation was obvious in PESSI hospitals considering reported

satisfaction level by the beneficiaries regarding check up and doctor’s behavior as compared

with PSSHMC hospitals.

Experience about Availability and Quality of Medicines

Respondents Experience about availability and quality of medicines for outdoor Patients and

indoor patients were considered for making comparison of the dealing of both types of hospitals

to assess for the continuity of the PPP hospitals on the basis of the experience of the patients by

visiting themselves or with their dependents there.

Since the availability of free medicine is a part of services provided to the secured workers by

the hospitals, their views might get appropriate weight to make decision in the context of

continuity of PPP hospitals.

A great majority of beneficiaries i.e., 95.6 percent of PESSI and 92.1 percent of PSSHMC

hospitals shared their experience that they got full quantity of medicines as prescribed by the

doctor. However 3.4 percent and 7.9 percent patients of PESSI and PSSHMC hospitals

respectively indicated negating responses in the context of provision of full quantity of medicine

as prescribed by the doctor, From them75.0 percent of patients of PESSI patients reported that


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hospital staff arranged the medicine where as 25.0 percent from negating response reported

purchase of the medicine by themselves, while from the negating responding patients of

PSSHMC hospitals, 50.0 percent reported purchasing the medicine by themselves (Table-12).

Emergency Patients

Emergency unit is very crucial with respect to attending patients. Consequently this unit provides

chances for patients to attend the other units of the hospital considering the dealings, quality of

services, availability of doctors and medicines in the emergency unit of the hospitals. The

information regarding performance of the emergency unit of both types of the hospitals on the

basis of patients’ responses has been obtained and presented in Table-13.

Since the time is the most critical factor for the emergency patients, time taken to treat the

patients was given top priority. The staff of PESSI hospital emergency units found ahead for

giving treatment within five minutes as it was reported by 85.3 percent beneficiaries, whereas

only 50.0 percent beneficiaries of PSSHMC hospitals were provided treatment in emergency

within 5 minutes. An equal proportion i.e., 25.0 percent of patients of PSSHMC hospitals have to

wait for 6 to 10 minutes and above 10 minutes to have treatment in the emergency. The indicated

situation was better in PESSI hospital relative to PSSHMC hospitals in all the considered

aspects.

All the patients were checked by the doctors in the emergency of PESSI hospitals as compared to

92 percent in case of PSSHMC hospitals. The patients (7.7 percent) not checked by the doctors

in the PSSHMC hospitals’ emergency was due to non-availability of the relevant doctors at that

time. Underlying reason might be less staff deputed in the emergency unit, nature of emergency,

holiday or late night emergency etc.

In-Door Patients

Indoor patients are referred the patients, recently admitted in the hospital for more than one day

due top minor or major operation or for medical treatment/ complication. The responses of the

indoor patients regarding their satisfaction level regarding frequency of visits of the specialists,

MO/ WMO and their availability and behavior of the nurses according to views of the

beneficiaries were obtained.July 2-3, 2013Cambridge, UK

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About equal proportion of beneficiaries i.e. 38.1 and 40 percent stayed in the hospital up to 2

days in PESSI and PSSHMC hospital respectively. The stay of one third (33.7 percent) of the

PESSI hospital patients was more than 6 days as compared to one fourth (25 percent) in case of

PSSHMC hospital beneficiaries. (Table-14)

When the patients were inquired about their satisfaction regarding visits and behaviour of the

specialist, MOs / WMOs and nurses in the ward, the response was quite encouraging. It was

observed that more than 94 percent of PESSI hospital beneficiaries were satisfied with the visits

and behaviour of the Specialist, MOs / WMOs and Nurses during their stay in the hospital. For

PSSHMC hospital, 84 to 90 percent of beneficiaries showed their satisfaction regarding the same

indicators under review. It is thus evident that the PESSI hospitals beneficiaries were more

satisfied as compared to those of the PSSHMC hospitals.

Satisfaction of Indoor Patients regarding Availability and Quality of Medicines

As far as the availability and quality of medicines is concerned, about 99 percent of respondents

of PESSI hospitals got full quantity of medicines while their treatment in the hospitals, whereas

the corresponding figure in case of PSSHMC hospitals was 95 percent (Table - 15). The response

about the quality of medicines was also encouraging. About 98 percent and 95 percent

beneficiaries of PESSI and PSSHMC hospitals respectively were satisfied about the quality of

the medicines.

Views / Satisfaction of Indoor Patients about Facilities regarding Operations Performed

Those beneficiaries who had gone through the services and facilities available in the operation

theater of both hospitals, their views have been obtained to assess performance of both the

hospitals of the system under study. About 31 percent of PESSI hospital beneficiaries reported

that they were operated in the hospitals, whereas the corresponding figure for PSSHMC

beneficiaries was 36 percent. A significant proportion (about 96 percent) of PSSHMC hospital

beneficiaries and about 86 percent of PESSI hospital patients operated in the hospital were

satisfied with the facilities provided in the operation theater. It was noted that not even a single

person was dissatisfied with the facilities available in operation theater of PSSHMC hospitals

but 14 percent patients operated in PESSI hospitals showed their dissatisfaction (Table 16).


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Complaint Cell in the Hospital

Complaint cell reflects indirectly the performance of the hospital or provide guidance for the

management authority to make the working of the hospitals with introduced circumstances,

available resources and utilization of the available resources more effectively and efficiently for

the benefits of the beneficiaries considering their demands. About 78.5 percent of the PESSI

hospitals’ beneficiaries and 23.2 percent of PSSHMC hospitals’ beneficiaries stated that there

was a complaint cell established in the respective hospital. (Table-17).

Only 5.8 percent and 14.1 percent respondents of PESSI and PSSHMC hospitals respectively

informed that they did not know about the Complaint Cell in the hospital. About 73.5 percent of

the beneficiaries of PESSI hospitals reported their Complaint Cell as efficient when compared

with 42.9 percent patients in case of PSSHMC hospitals. About one third of the beneficiaries

(33.9 percent) of PSSHMC hospital opined that their Complaint Cell was not efficient as against

17.9 percent beneficiaries of PESSI hospital. Thus the Complaint Cell to deal with the problems

of patients was present in both types of hospitals but its effectiveness varied a lot as reported by

the beneficiaries of these hospitals. (Table-17)

Ranking of PESSI & PSSHMC Hospitals by the Beneficiaries

The beneficiaries of both types of hospitals were asked to give their opinion for their satisfaction

about the behavior of administration and overall performance of the respective hospitals and then

rank them accordingly. The response of the respondents is given in Table-18.

According to Table 18, a great majority i.e. 90 percent beneficiaries of PESSI hospitals were

satisfied with the behavior of their hospital administration, while 58.7 percent beneficiaries of

PSSHMC hospitals showed their satisfaction in this regard indicating better performance of

PESSI hospitals.

An interesting response came out when the beneficiaries of the both hospitals were asked to

evaluate and rank their hospitals i.e. ‘Excellent’, ‘Good’, ‘Average’ or ‘Poor’. A little less than

half of the respondents (47 percent) of PESSI hospitals ranked their hospitals as “Excellent’ as

compared to only 20 percent respondents in case of PSSHMC hospitals. 43.4 percent

beneficiaries of PESSI hospitals ranked their hospitals as ‘Good’ as against 32.3 percent


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respondents in case of PSSHMC hospitals. It is important to note that 34.3 percent and 13.7

percent beneficiaries of PSSHMC hospitals ranked their hospital as ‘Average’ and ‘Poor’

respectively, while the corresponding figures for PESSI beneficiaries were 8.0 percent and 1.6

percent this reflected that about 50 percent of the beneficiaries of PSSHMC hospitals were not

satisfied with the overall performance of their hospitals.

Conclusion and Recommendations

The conclusions derived from the above described results were briefly discussed as follows;-

It was observed that PSSHMC hospitals have generally better infrastructure, properly

equipped with latest machinery/equipment and laboratory facilities but their performance

was not as good as it should have been, when compared to the PESSI hospitals . Overall

performance of PESSI hospitals was better as compared to PSSHMC hospitals.

The doctors/paramedics and other staff of PESSI hospitals generally were more

qualified, experienced, better paid, have job security, pension benefits and other facilities.

Therefore, they are more satisfied with their jobs and performance. The PSSHMC staff

performed their duties with less pay package, lack of job security and pension benefits,

which obviously affected their performance adversely.

PSSHMC Hospital Manga – Raiwind Road referred 7321 patients to Nawaz Sharif Social

Security Hospital, Lahore during 2007-08 to 2009-10. The number of patients referred by

PSSHMC hospitals, Muzaffargarh to Khawaja Fareed Hospital / Nishter Hospital, Multan

during this period was 3097. One of the reasons for referring the patients to PESSI

hospitals was better treatment in the hospitals of the PESSI. It was interesting to observe

that the PSSHMC hospitals referred a large number of patients to PESSI hospitals even

for those diseases whose departments were functioning in the Company’s hospitals. This

also reflected adverse effects on performance of PSSHMC hospitals.

The PESSI hospitals patients have a choice for their treatment. If they want to visit their

allocated / registered PSSHMC hospital they may go there, otherwise they can go to


17


PESSI hospital for their free medical treatment and PESSI hospital does not charge any

amount from PSSHMC hospital. A large number of patients who were registered in the

Company’s hospital Manga-Raiwind Road for treatment have preferred / chosen Nawaz

Sharif Social Security Hospital, Multan Road, Lahore. This reflected the confidence of

the secured workers in PESSI hospitals due to better medical treatment/facilities. It was

reported by the doctors of Nawaz Sharif Hospital that the Manga-Raiwind Road hospital

referred the patients to their hospital at the stage when their condition was very critical

due to improper treatment and mishandling by the doctors of Manga – Raiwind Road

hospital.

The PSSHMC hospitals are 150 bedded hospitals with more infrastructural facilities

when compared with the PESSI 100 bedded hospitals. The number of doctors and other

staff is insufficient in the company hospitals. The result is that the daily workload of

checking / treating the patients is much more as compared to PESSI doctors / professional

staff. For instance, 29 percent PSSHMC doctors have to check more than 70 patients

daily as compared to 6 percent in case of PESSI doctors.

The PSSHMC hospitals at Manga-Riawind Road and Muzaffargarh have been

functioning for the last 3 years. Despite their good office buildings, better cleanliness and

working environments, equipped with latest machinery and above all financial autonomy

(in comparison with the PESSI hospitals), these hospitals could not perform their duties

as efficiently and effectively as they should have been. Rather, their performance was

much lower as compared to the PESSI hospitals.

The significant proportion of PSSHMC hospitals staff (57 percent) did not prefer Public

Private Partnership (PPP) because of job insecurity, lack of pension benefits and other

service conditions. The corresponding figure in case of PESSI hospitals was 98 percent.

About 94 percent, 98 percent, 89 percent and 95.5 percent of outdoor patients of PESSI

hospitals were satisfied with the behavior / guidance provided by the receptionist,

facilities available in waiting area of OPD, checkup by the doctors and quantity / quality


18


of medicines provided, respectively. The corresponding figures in case of PSSHMC

hospital were 76, 97, 60 and 92 percent respectively.

Around 95.5, 96.8, 97 and 98 percent in-door patients of PESSI hospitals were satisfied

about the frequency of specialist visits, visits of the doctors, availability / behaviour of

nurses, and quantity / quality of medicines provided, respectively. The corresponding

figures for the PSSHMC hospitals were 84, 89, 89 and 95 percent respectively.

About 44 percent staff of PSSHMC hospitals on the basis of overall working /

performance of the hospitals ranked their hospitals as ‘Good’ as compared to 74 percent

staff of PESSI hospitals. Moreover, 8 percent staff of Company hospitals ranked their

hospitals as ‘Poor’ to Average’ but none of the PESSI staff ranked their hospitals in this

category.

From the findings of the study, it was concluded that the overall performance and service

delivery of PESSI hospitals was better as compared to the PSSHMC hospitals.

6.2 Recommendations

Considering the prevalent circumstances the following options are suggested to be followed for

the better performance to win the favor of the people to make this public –

private partnership venture successful.

The PSSHMC was a company by its present set-up and status. In a company structure,

the salaries of the employees’ of hospitals were assumed generally higher than the

Government hospitals. But the salaries of the doctors / other staff of PSSHMC hospitals

were much lower as compared to the staff of PESSI hospitals. Moreover, there was no

job security, pension benefits and other benefits as in case of Government service. The

result is that the doctors / paramedical staff and other staff of PSSHMC hospitals were

not satisfied with their jobs which affect their efficiency adversely.


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1. The company structure of organizations in our country had not proved effective as also

experienced in case of other companies such as PAMCO, Punjab Transport Company,

Punjab Entertainment Company and Rice / Cotton Companies etc. It would be more

appropriate that the Government should restructure / strengthen the existing government

organizations instead of converting them into company mode and increasing their budget

manifold.

2. The working of our society was generally not company setup-oriented psychologically.

Public sector job was relatively secured having more short-time financial benefits as well

as long time pension benefits. The pay was less in the case of the doctors / other staff of

PSSHMC hospitals, which was merely past service phenomenon. With the result that the

staff was not satisfied with their jobs which is affecting their efficiency and consequently

the patients were dissatisfied with the service delivery of PSSHMC hospitals.

3. The PSSHMC hospitals lacked the trained and experienced doctors / other staff, since the

hospitals were newly established and fresh qualified staff was recruited and appointed

there, they lacked the proper capacity and competency to deal with the complicated cases.

In – brief it was finally concluded, that the structure of the company with the salary of the public

sector institutions without job security, pension benefits and other benefits could not be

justifiable. Thus, the explored option of Public- private partnership would remain beyond

acceptance under the prevalent environment. The following alternatives are, therefore,

proposed:-

a. The Punjab Social Security Health Management Company

(PSSHMC) may be wound up and their staff may be adjusted in the hospitals of

Punjab Employees’ Social Security Institution. The PESSI may, however, be

reformed/ strengthened for the purpose.

b. PSSHMC hospitals at Manga – Raiwind Road and

Muzaffargarh may be

c. converted to the status of autonomous bodies.

d. Salary package of the staff of PSSHMC hospitals may be

increased significantly and their service structure improved so as to attract and


20


retain the experienced and qualified staff in the organization and minimize the

turnover of the doctors/professional staff.

Table-1:- Basic Information of Both of PESSI and PSSHMC Hospitals (Nos.)

Items PESSI PSSHMC

Number of Wards 36 50Number of Rooms for:Doctors in OPD 36 23Operation Theaters 6 10Admin Staff 16 21Laboratory 6 14Waiting Areas 21 16 Pharmacy Stores 8 6 Other Stores 7 9Total Hospital Beds 200 300

Table-2:- Staff Strength in Both PESSI and PSSHMC Hospitals(Nos.)

ItemsPESSI PSSHMC

Sanctioned Filled-in Vacant Sanctioned Filled-in VacantChief Executive Officer - - - 1 1 -Medical Superintendent/ Administrator 2 2 - 2 2 -

Deputy Medical Superintendent 2 2 - - - -

Specialist Doctors 43 35 8 29 26 3Medical Officer 85 75 10 39 37 2Paramedical Staff 248 239 9 153 147 6Lab- Technician 3 3 - 13 11 2Supporting Staff 260 259 1 175 171 4Daily Wages Staff - - - 20 20 -Total 643 615 28 412* 395* 17Exclusive to Daily wages Staff


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Table-3:- Availability of Laboratory Facilities Average Number of Tests Performed in both PESSI and PSSHMC Hospitals During 2007-08 to 2009-10.

Lab/ Diagnostic Test

PESSI PSSHMC

2007-08 2008-09 2209-10 2007-08 2008-09 2009-10

Radiology

Plain-X-Rays 7173 8241 10187(25601)* 4261 3550 4751

(12562)*

Dye- Induced X-rays ( IVP BariumMeals) 357 468 608

(1433)* 42 51 53(146)*

Ultrasonograph 6424 7243 8154(21821)* - - -

Memography - - - 838 558 1628(3024)*

Pathology

Clinical Pathology 10436 17262 17836(45534)* 2551 12130 12738

(27419)*

Chemical Pathology 20144 48016 31654(99814)* 7011 26919 35621

(69551)*Histo-pathologyElisa Test:(H. HIV. –etc.) 506 842 905

(2253)* 50 36 68(154)*

P.C.R Tests 118 145 175(438)* - - -

Bone Marrow 20 29 46(95) - - -

Other TestsECG 2107 2195 2292

(6594)* 907 1690 2391(4988)*

Hematology 1665 5618 4276(11559)* - - -

Total 48950 90059 76133(215142)* 15660 44934 57259

(117853)**3 years total of respective rows


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Table-4: Total Patients Referred by the Sample Hospitals to other Hospitals

DepartmentsPESSI PSSHMC

Shahdara Multan Manga Muzaffargarh2007-8 2008-9 2009-10 2007-8 2008-9 2009-10 2007-8 2008-9 2009-10 2007-8 2008-9 2009-10

Medical 15 35 25 - - - 60 111 59 49 115 204Renal Dialysis

10 12 18 - - - - - - - - -

Psychiatry 31 60 50 - - - - 7 16 - - -Oncology 6 7 13 - - - - 5 23 - - -Urology 160 226 269 108 88 62 - 39 113 - - -Orthopedic 35 45 25 - - - 85 223 165 50 108 180Gynae & Obs 20 25 60 - - - 15 129 141 10 50 98ENT 4 10 7 78 58 43 65 23 - - -Dental Surgery

2 7 5 - - - - 12 7 - - -

Eye 25 35 28 - - - 51 154 164 37 116 170Cardiology 446 543 600 1059 958 636 45 209 226 40 115 199Cardiac Surgery

8 10 15 192 164 108 - 11 15 - - -

Neurology 29 55 70 231 208 136 - 16 77 - - -Neurosurgery 60 90 105 113 98 63 - 63 50Child 20 30 40 - - - 23 66 101 18 40 80Surgical 10 15 30 - - - 15 145 122 15 30 35T. B. & Chest 25 15 25 - - - - - - - - -Radiology - - - - - - 182 163 - - -Total 906 1220 1385 1781 1574 1048 294 1437 1465 219 574 966


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Table -5: Total Patients Treated in PESSI Hospitals Referred by PSSHMC

Department

Referred by PSSHMC, Manga to Nawaz Sharif SSH, Lahore (2009-10)

Referred by PSSHMC, Muzaffargarh to KFSSH, Multan

Admission On ChoiceNo

BindingBinding 2007-8 2008-9 2009-10

Eye 38 254 152 55 19 12ENT 32 152 18 - - -Skin 4 165 16 23 12 9Urology 78 291 148 - 165 27 17Surgical 83 293 148 - 189 108 55Medical 164 1166 486 - 547 247 126Dental - 46 8 - 1 2 1Child 47 134 62 - 183 70 47Cardiac 77 493 235 - - - -Gynae 103 231 83 - 218 124 56Orthopedic 98 546 207 - 224 135 84NNN 33 - - - -Oncology 46 45 44 - - - -Nephrology 9 - - - - - -Psychiatry 14 - - - - - -C. Surgery 19 - - 73 - - -Dialysis 312 68 177 - - -ICU 9 - - - - - -TB 19 - 146 37 12 11Psychiatry - 183 66 187 69 25Total 1185 4067 1737 332(7321) 1829 825 443 (3097)*

Indicate Total Nos. of Patients

Table-6:- Budget of the Concerned Hospitals in 2009-10

HospitalTotal Expenditure

(Rs.)

Expenditure on (%)

Medicine Pay & Allowances

Shahdara 116,186,447 24.2 55.8

KFSSH 104,268,392 15.8 62.0

Manga (PSSHMC) 113,705,796 36.7 40.8

Muzaffargarh (PSSHMC)

85,361811 39.2 38.1


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Table-7:- On the Job Experience, Monthly Remuneration and Satisfaction Status of theProfessional staff in the Concerned Hospitals

DesignationJob Experience Average Monthly Salary

(RS/month) Dissatisfaction

PESSI PSSHMC PESSI PSSHMC PESSI PSSHMCConsultants/ Specialists 16.9 14.5 46244 43929 - 42.9

DMS 16.4 16.0 52600 35000 - -MOs /WMOs 10.9 4.2 38175 24978 12.5 55.6Lab Tech. 3.0 15.3 27900 20133 - 66.7Nurses 8.3 2.9 20543 14462 - 50.0

Table-8:- Assessment of Work Performance of the Concerned Hospital

Items PESSI PSSHMC

Complete

Satisfied

Some Extent

SatisfiedNot Satisfied

Complete

Satisfied

Some Extent

SatisfiedNot Satisfied

Work Load of Doctors

84.8 9.1 6.1 44.1 20.6 35.3

Nurses’ Performance Competency

88.6 11.4 - 48.5 39.4 12.1

Hospital Administration Performance

97.4 2.6 - 75.7 8.1 16.2

Table -9: Overall Ranking of the Hospitals by Staff(Percent)

Rank PESSI PSSHMCVery Good 73.8 44.4Good 26.2 47.2Average - 5.6

Poor - 2.8


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Table-10-: Preference of Staff of PSSHMC and PESSI Regarding Public – Private Partnership

(Percent)Description PSSHMC PESSIPreference about Public- Private Partnership

Preferred Public-Private Partnership 37.8 2.4Not Preferred the Partnership 56.8 97.6Preferred the Partnership to Some Extent 5.4 -

If Preferred public – Private Partnership, ReasonsBetter Infrastructure 21.4Problems Can be Solved 57.1 100.0Better atmosphere and Working Condition in PPP Set up 21.4 100.0

If not preferred Public – Private Partnership, Then ReasonsNo Job Security 76.2 65.9 Lack of Pension benefit 33.3 22.0Better Atmosphere and Working Condition in Govt. Set up 23.8 26.8Personal Respect in Govt. setup 4.8 12.2Better Medical Facilities for Patients in Govt. Setup 19.0 36.6

Table -11: Satisfaction Level of Outdoor Patients regarding their Check Up, Behavior of Doctor and Waiting Time in OPD.

(Percent)

Item PESSI PSSHMC

Availability of Specialist / MO/WMO 99.0 99.0Checked by Specialist / MO/WMO 98.5 99.5Satisfaction About Check Up

Satisfied 88.7 59.9Satisfied to some extent 3.4 18.8Dissatisfied 7.9 21.3

Satisfaction Level about Doctor’s Behaviour Satisfied 92.6 60.8Satisfied to some extent 4.5 17.6Dissatisfied 3.0 21.6

Waiting Time (Minutes) Above Half an Hour 10.5 40.8


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Table 12: Respondents Views about Availability of Medicines for Outdoor Patients

(Percent)

Item PESSI PSSHMC

Respondents received full quantity of medicinesYes 95.6 92.1No 3.4 7.9Do not know 1.0 -

If no, who purchased / arranged the medicines for you? Hospital Staff purchased the medicines 75.0 25.0Patient Purchased the medicines 25.0 50.0Others - 25.0

Was the Quality of Medicines according to the Prescription? Yes 95.5 92.5No 3.0 4.5Do not know 1.5 3.0

Table -13: Respondents Response about Medical Treatment and Availability of Medicines in the Emergency Unit

(Percent)Item PESSI PSSHMCTime Taken by Staff for giving treatment to the patients (Minutes)

1 – 5 85.3 50.06 – 10 5.9 25.0Above 10 8.8 25.0

Whether the patient was checked by the Doctor? Yes 100.0 92.3No - 7.7

Did the respondents receive full quantity of medicines?

Yes 100.0 84.6No - 12.8Do not know - 2.6


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Table-14: Respondents Response of Indoor Patients(Percent)

Item PESSI PSSHMCStay in the Hospital (Days)

Up to 2 38.1 40.03 – 4 20.7 15.05 – 6 7.6 20.0More than 6 33.7 25.0

Satisfaction Level about Frequency of Specialist Visits Satisfied 95.6 84.2Satisfied to some extent 1.1 8.8Dissatisfied 3.3 7.0

Satisfaction Level about Behavior of Specialist Satisfied 94.5 87.5Satisfied to some extent 2.2 8.9Dissatisfied 3.3 3.6

Satisfaction Level about Frequency of MOs / WMOs Visits Satisfied 96.8 89.1Satisfied to some extent 1.1 7.3Dissatisfied 2.2 3.6

Satisfaction Level about Behavior of MOs / WMOs. Satisfied 95.7 89.3Satisfied to some extent 2.2 8.9Dissatisfied 2.2 1.8

Satisfaction Level about Availability of Nurses Satisfied 96.8 87.7Satisfied to some extent 2.2 8.8Dissatisfied 1.1 3.5

Satisfaction Level about Behaviour of NursesSatisfied 96.8 90.0Satisfied to some extent 3.2 8.3Dissatisfied - 1.7

Table -15: Respondents Response of Indoor Patients for Quantity and Quality of Medicines July 2-3, 2013Cambridge, UK

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(Percent)Did the Respondents Received Full Quantity of Medicines

Yes 98.9 94.9No 1.1 -Do not know - 5.1

Was the Quality of Medicines according to the PrescriptionYes 97.8 94.9No 2.2 -Do not know - 5.1

Table-16: Respondents Views / Satisfaction about Operations Performed in the Hospitals(Percent)

Item PESSI PSSHMC

Were you /your Family Member Operated in the Hospital?

Yes 31.4 36.2No 68.6 63.8

Satisfaction Level about the Services in the Operation Theater

Satisfied 86.4 95.5Satisfied to some extent - 4.5Dissatisfied 13.6 -

Was the Blood required for Operation?

Yes 48.0 37.5No 52.0 62.5

Were Post- Operation Facilities Provided?

Yes 88.0 66.7No - 9.5Not Applicable 12.0 23.8

Table -17: Respondents Response about Complaint Cell in the Hospital

(Percent)July 2-3, 2013Cambridge, UK

29


Item PESSI PSSHMC

Was there any Complaint Cell? Yes 78.5 23.2No 15.7 62.7

Not Applicable / Don't know 5.8 14.1Was the Complaint Cell Efficient?

Efficient 73.5 42.9To Some Extent Efficient 8.2 23.2Not Efficient 17.9 33.9Don't know 0.5 -

Table-18: Satisfaction about Hospital Administration and Overall Ranking of the Hospital According the Respondents

(Percent)Item PESSI PSSHMCSatisfaction Level about Behavior of Administration

Satisfied 90.0 58.7Satisfied to some extent 7.2 31.2Dissatisfied 2.8 10.1

Overall Ranking of the Hospital Excellent 47.0 19.8Good 43.4 32.3Average 8.0 34.3Poor 1.6 13.7

Annexure-1: Medical Wards / Departments Functioning

(Nos.)Departments PESSI PSSHMCJuly 2-3, 2013Cambridge, UK

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Shahdara Multan Manga MuzaffargarhENT * Eye Gynae & Obs. T. B. & Chest Urology * * *Oncology * * * *Medical Skin *Radiology

Pathology / Blood Bank

Gastroenterologist * * * *Surgical

Orthopedic

Pediatrics/Child

Cardiology * *

Dental Care

Psychiatry * *

Physiotherapy

Anesthesia

ICU

CCU * *

Burn Unit X x

Hypertension/Diabetes x x xHepatitis-C Clinic x x xGastroscopy x x xAsthma Clinic x x xSatellite Clinic (Milk Pak) x x xPsychology x x x

Functional =, Exist but Non-Functional = *, Not Existed = x


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Documents

Possibilities Exploration for Public –Private Partnership A. Quddus, Mazhar Ul... · Web viewDr.Muhammad A. Quddus * Dr. Mazhar Ul Haq Baluch** Khawar Ata*** * Director, Punjab

Possibilities Exploration for Public –Private Partnership A. Quddus, Mazhar Ul... · Web viewDr.Muhammad A. Quddus * Dr. Mazhar Ul Haq Baluch Khawar Ata* * Director, Punjab