Pakistan’s health minister has reignited a fierce debate over how public hospitals should be run, arguing that permanent hospital staff are part of the problem rather than the solution. Speaking days after a fire at a major Islamabad hospital killed 14 newborns, Mustafa Kamal said government-run facilities should scrap permanent government-scale jobs altogether in favor of contract-based hiring.
“There should be no permanent government scale employees in hospitals, they should all be employed on contract basis, and a CEO should be brought in from the private sector to run things effectively,” Kamal said in an interview with Geo News, framing the shift away from permanent hospital staff as the only lasting fix for what he called a broken system.
Why the Minister Wants to End Permanent Hospital Staff
Kamal argued that it is not a health minister’s job to run the day-to-day operations of a hospital, suggesting instead that an elected mayor or a dedicated management team should oversee facilities like the Pakistan Institute of Medical Sciences, or Pims, where the fatal fire occurred. He said permanent employees had grown so powerful within their departments that dismissing underperforming staff routinely triggered lengthy litigation, tying the hands of hospital administrators.
“Whoever performs and works should remain, everyone else should be let go. A CEO should be brought in who should have full hiring-and-firing authority. They should get their annual budget approved from us and then be responsible for managing their affairs and ensuring accountability,” Kamal said, describing a model closer to how private hospitals and corporations typically operate.
The Fire That Reshaped the Debate
Opposition lawmakers have accused the health ministry of using the tragedy to push through a long-standing ideological preference for privatized management rather than addressing the more immediate failures identified in the inquiry, such as inadequate fire suppression systems and insufficient staff training on emergency evacuation procedures.
The proposal lands against the backdrop of the deadly Pims fire, which claimed 14 newborn lives in the hospital’s gynae ward. An inquiry into the blaze found that only about two minutes passed between the first spark and the fire engulfing the entire ward, a detail Kamal cited as evidence that the current staffing and accountability structure had failed at every level.
Kamal maintains that removing permanent hospital staff protections is not about punishing workers but about creating a system where competent staff can be retained and rewarded while underperformers can actually be removed, something he says is nearly impossible under current civil-service rules governing public hospitals.
A Proposal Facing Fierce Pushback
Union representatives argue that contract-based staffing, far from improving accountability, could make hospitals more vulnerable to understaffing during public health emergencies, since workers without job security may be less willing to take on additional risk during crises like disease outbreaks or mass-casualty events.
Nurses’ associations have gone further, warning of possible strikes if the government moves ahead without negotiating transition terms for the tens of thousands of employees who would lose their current civil-service protections.
Public health economists note that similar contract-based models have been tried in other developing countries with mixed results, delivering efficiency gains in some cases while in others leading to high staff turnover that ultimately undermined continuity of care for patients with chronic conditions.
Whether Kamal’s proposal moves beyond a television interview into actual policy remains uncertain, and it would likely require legislative and administrative changes far beyond his ministry’s authority alone. As Dawn reported, the new Pims executive director has already vowed to prioritize patient safety as the inquiry into the fire continues, even as the broader staffing debate plays out in public.
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