ertiary hospitals across the Punjab are increasingly being pushed to function as the first point of care for patients who should be treated at primary and secondary facilities. This has exposed a healthcare system weakened not by a lack of institutions but by its failure to function as an integrated network.

In Out-Patient Departments and Emergency Rooms of many teaching hospitals, long queueus, overburdened medical staff and patients struggling to navigate a fragmented system are a common sight. Patients who should be treated at basic health units, rural health centres, tehsil or district headquarter hospitals are frequently seen visiting Lahore’s teaching hospitals, turning specialised facilities into overcrowded first points of contact.

Dr Salman Kazmi, a senior medical consultant at Mayo Hospital, says that technology must play a central role in healthcare governance. Tracking disease spread, patient outcomes and mortality rates enables timely interventions and allows medicines, staff and funds to be allocated according to actual need.

Software developed by the Punjab Information Technology Board to achieve this was installed in 22 teaching hospitals but failed to deliver expected results due to system discrepancies and inadequate involvement of end-users during its development.

Dr Kazmi says that effective health policies depend on information regarding the prevalence and outcomes of diseases. “Until you know what diseases are spreading in the province, how many patients are presenting with them, what their outcomes are and how many people are dying from, say, gastroenteritis, chronic liver disease or tetanus, you cannot make effective health policies.”

Data on diseases such as stroke and myocardial infarction, he says, could help determine where resources are required, what preventive programmes should be introduced and what health education should be provided in schools. “To improve healthcare, we need a multidimensional strategy. IT-based initiatives have a very important role to play here,” he adds.

However, digitisation efforts by government have failed to prioritise building integrated digital health systems. Instead, promotional videos—often featuring medical staff being publicly reprimanded by ministers, secretaries or heads of institutions—on social media platforms are, at times, used as measures of performance. While these manage to generate online engagement, they do not resolve ground challenges: staff shortages, inadequate resources, weak referrals and poor hospital management.

The weaknesses at lower healthcare tiers directly cause long waiting times for specialised treatment. Patients at the Punjab Institute of Cardiology, the Punjab Institute of Neurosciences, Children’s Hospital and Mayo Hospital face surgical delays of up to six months. Diagnostic services at all hospitals, including Services Hospital, Jinnah Hospital and Sir Ganga Ram Hospital, also involve multi-week waiting periods.

The province has an extensive public healthcare network but the system lacks functional integration.

At the primary level, patients require reliable staff, essential medicines, basic diagnostics and preventive care. Secondary hospitals require functional emergency departments, specialists and diagnostic tools. Tertiary hospitals are normally reserved for complex cases, specialised treatment, teaching and research.

Dr Omer M Naeem, head of the Pulmonology Department at Sharif Medical City Hospital, notes that too much work leaves junior doctors exhausted and compromises patient safety. 

A weak referral process breaks this chain. Patients either bypass lower-level facilities entirely or are referred without adequate documentation or follow-up, shifting the primary care load onto tertiary centres.

Lahore’s teaching institutions—including Mayo Hospital, Services Hospital, Lahore General Hospital, Jinnah Hospital and Shaikh Zayed Hospital—draw patients from acrossthe the Punjab. While their specialised services remain a major asset, their excessive patient volume reflects failures in healthcare delivery elsewhere.

Prof Dr Shahid Malik, the Pakistan Medical Association Lahore president, proposes replicating the structures of teaching hospitals at the district and tehsil levels to bridge the gap between primary, secondary and tertiary care. He advocates linking every THQ hospital to a 50-student medical college so that professors and clinical teachers contribute directly to local service delivery. Aligning postgraduate medical education with district healthcare needs, he says, would further integrate teaching institutions into front-line service delivery offices.

There are examples of model initiatives in both public and private sector that could be replicated in all public sector hospitals to expand services and set up a uniform hospital management system across the province.

For instance, the Indus Hospital and Health Network demonstrates the efficacy of structured public-private partnerships, incorporating strict performance monitoring, staff training, accountability and standardised systems.

The Pakistan Kidney and Liver Institute utilises an integrated Hospital Information Management System to digitise registrations, appointments, electronic medical records, laboratory investigations, pharmacy inventory and administrative workflows.

Mayo Hospital has used telemedicine to connect urban specialists with remote patients. The Punjab has begun rolling out digital patient-referral tracking. A province-wide network will allow doctors at BHUs, RHCs, THQs and DHQs to consult specialists and refer cases electronically before patients travel.

Lahore General Hospital’s recognised infection-prevention model—utilising dedicated hospital-wide infection control committees, continuous monitoring and mandatory staff training—provides a blueprint for standardising hygiene protocols across public facilities.

Private sector frameworks, such as those implemented at Shaukat Khanum Memorial Cancer Hospital, offer lessons in standardised clinical protocols, medication safety and continuous quality monitoring that can be adapted to public hospital administration.

Digital queue management tools introduced in government and social security hospitals reduce registration, consultation and pharmacy wait times.

Dr Omer M Naeem, head of the Pulmonology Department at Sharif Medical City Hospital, identifies manageable shift lengths, proper staffing and decentralised patient care as critical priorities. He notes that overwork leaves junior doctors exhausted and compromises patient safety. He advocates for structured duty shifts of 12 to 18 hours. He also calls for clear emergency-response planning, regular staff training and geographically distributed healthcare infrastructure so that patients do not have to travel long distances for basic care.

“Strengthening primary and secondary facilities will relieve tertiary pressure. Government-funded health insurance could help patients manage the costs of complex care,” he adds.

Minister for Specialised Healthcare and Medical Education Khawaja Salman Rafique has highlighted public-private partnerships as an essential mechanism to achieving quality, accessibility, affordability and accountability in state healthcare strategy.

With concerns regarding a 58 percent (over Rs 100 billion) reduction in this year’s development budget for health, Rafique says that Chief Minister Maryam Nawaz Sharif is working on compensating for the same with discretionary funding for new medical facilities. He says that approximately Rs 550 billion—10 percent of the Punjab’s Rs 5 trillion budget—is dedicated to the health sector. The province is establishing new specialised cancer, cardiac and children’s hospitals in various cities, alongside primary care initiatives like clinic-on-wheels.

The underlying challenge remains system integration. The Punjab has functioning components of effective management, infection control, digital records, telemedicine and public-private cooperation. Establishing a unified management framework across BHUs, RHCs, THQs, DHQs and teaching hospitals will ensure that patients receive appropriate care at the correct tier without unnecessary delays, allowing tertiary hospitals to focus on specialised medicine.

The writer is an investigative journalist associated with The News International. An EWC and GIJN fellow, he contributes to various international media outlets. His X handle: @AmerMalik3.