On Wednesday morning, a Facebook post announced the death of Dr Nausherwan Burki in America. I could not independently confirm the announcement. The post also celebrated his role in transforming Khyber Pakhtunkhwa’s hospitals. That larger claim deserves examination. In July 2026, a third-party audit of medical teaching institutions reportedly identified irregularities. Meanwhile, the provincial allocation for MTIs rose to Rs80 billion for 2026–27. What did eleven years of reform actually deliver?
The 2015 transfer of power
After PTI took office in KP in 2013, its government sought to loosen the Health Department’s administrative control over teaching hospitals. The Medical Teaching Institutions Reforms Act of 2015 gave designated hospitals and medical colleges greater autonomy through boards of governors. Burki, a US-based physician and relative of Imran Khan, helped shape the programme. Hospital managers could make decisions more quickly, including on recruitment and services. That could solve genuine delays. But shifting power away from the department did not remove the need for independent oversight.
The improvements hospitals reported
A July 2026 Dawn report quoted the director of Bacha Khan Medical Complex in Swabi saying the institution expanded from 14 to 24 specialties and improved neonatal services. Burki has also cited overseas specialist recruitment and stronger clinical training. These are important hospital-level accounts, not independently established results for the whole province. A serious evaluation would examine case mix, patient outcomes and the cost of providing those services.
What Rs80 billion means
The government allocated Rs80 billion to MTIs for 2026–27, compared with Rs65.7 billion a year earlier, an increase of roughly 21.8 per cent. An allocation is not actual expenditure. Hospitals may also receive Sehat Card Plus payments and income from private practice. The June budget reporting raised questions about consolidated accounts. The right comparison must show funds released, funds spent and the services patients received. Major teaching hospitals treat costly cases; their budgets cannot be compared casually with those of primary clinics.
The completed audit
Earlier controversy centred on whether MTIs would face independent scrutiny. By July, a third-party audit had been completed, and officials told Dawn that it identified irregularities and recommended action. Burki said the Policy Board was reviewing the findings and would make them public. An audit finding is not a criminal conviction. The nature of each irregularity and the response matter. I could not independently establish that a complete public report and action-taken record had been released by 14 October 2026. That gap deserves follow-up, rather than an assumption of guilt.
Who answers for decisions?
Boards control important operational choices while the provincial government provides substantial funding. In June, Dawn reported Health Department concerns about appointments and finances. Burki disputed the suggestion that a formal departmental complaint had been made to him and requested evidence for allegations. The institutional issue remains: what records can the department examine, who investigates a board, and how are findings resolved without political interference?
The staffing dispute
In September, doctors’ groups opposed the decision to abolish trainee registrar positions. Burki defended the change on professional training grounds, arguing that the posts lacked a clear purpose. The disagreement should be tested against ward staffing, duty rosters and training standards. A position can be poorly designed yet still cover necessary clinical work. Neither side settles that issue through a press statement.
What patients can measure
Patients travelling to Peshawar from distant districts care about the availability of specialists, the price of medicines and waiting time for treatment. Their experience should anchor the evaluation. Comparable hospital data could show emergency waiting times, surgical delays, medicine stock-outs and clinical outcomes, adjusted for the severity of cases. Other policies, including Sehat Card Plus and higher funding, may also affect those results. Autonomy alone cannot be credited for every improvement or blamed for every shortcoming. The concerns resemble those discussed in my earlier article, Why Pakistani Patients Struggle to Get Clear Answers From Hospitals. Another investigation into medical accountability shows why regulatory enforcement must extend beyond individual practitioners.
The reform cannot depend on one man
Burki’s professional background helps explain his influence, and his political connections warrant scrutiny of appointment processes. Neither proves misconduct. A lasting reform should work without its best-known advocate. The MTI Policy Board and the KP government should release the audit findings, audited accounts that include all major revenue streams, and a dated record of corrective action. They should also publish consistent hospital performance data. I began with an unverified Facebook tribute. Eleven years after the legislation, an audit trail and patient outcomes would tell us much more than either praise or denunciation.
Sources and further reading
KP Medical Teaching Institutions Reforms Act, 2015; Dawn, July 2026 audit reporting; Dawn, June 2026 budget reporting; Dawn, June 2026 governance reporting.