Key Points
- Controversy spans appointments, re-employment, and financial management disputes.
- 11 MTIs operate under autonomy model across KP.
- HMC and KGMC controversies seen as potential systemic issue.
- Informants and records suggest irregular upgradations in faculty promotions.
- Courts declared some promotions illegal and ordered their reversal.
- Questions raised over dual salaries and administrative remuneration structures.
PESHAWAR, Pakistan: What was launched by the Pakistan Tehreek-e-Insaf (PTI) government in 2015 with promises of transparency, merit, efficiency and freedom from political interference is now facing serious questions over whether the reforms merely shifted power from government bureaucracies to autonomous administrators with limited external oversight.
More than a decade after the introduction of the Medical Teaching Institutions (MTI) system in Khyber Pakhtunkhwa (KP), official records, court proceedings and accounts from well-placed sources suggest that the reform model has created fresh controversies in appointments, promotions, re-employment and financial management — areas where the government had promised corruption-free governance.
Far from an isolated case
The significance extends beyond a couple of institutions. Khyber Pakhtunkhwa currently has 11 MTIs operating under the same autonomy model. The issues identified at Hayatabad Medical Complex (HMC) and Khyber Girls Medical College (KGMC), officials familiar with the matter say, could represent only the tip of the iceberg.
At the centre of the storm are some of the most influential figures in Pakistan’s health bureaucracy — senior administrators, deans, medical directors and members of autonomous governing boards reportedly manipulating promotion systems, stretching regulatory interpretations and retrospectively legitimising disputed decisions already challenged before the courts.
The allegations span successive administrations from 2015 to 2026, implicating both retired and serving officials, including individuals who helped design the very autonomy framework now under scrutiny.
The MTI debate
The MTI reforms were introduced with considerable political fanfare by the PTI government, which presented institutional autonomy as the solution to decades of bureaucratic inefficiency, political interference and corruption in the public health sector.
However, people aware of the proceedings argue that while the model may have improved certain administrative functions, it simultaneously created governance structures where accountability mechanisms failed to keep pace with expanding institutional powers.
At the centre of the controversy are decisions taken during the tenures of former deans — Dr Noor Wazir and Dr Zahid Aman — interim dean Dr Shiraz Jamal, and current dean Dr Shehzad Akbar, who also previously served as Medical Director of HMC.
Faculty members and petitioners in ongoing litigation believe that these administrations oversaw disputed promotions, reappointments, and regulatory interpretations that were later challenged before the Peshawar High Court and the MTI Tribunal.
The autonomy model
The Khyber Pakhtunkhwa Medical Teaching Institutions Reforms Act, 2015, was introduced with the stated objective of providing “autonomy to the Government-owned Medical Teaching Institutions and their affiliated teaching hospitals in the Province of Khyber Pakhtunkhwa and to improve performance, enhance effectiveness, efficiency and responsiveness for the provision of quality healthcare services to the people of Khyber Pakhtunkhwa.”
Under the law, major hospitals and medical colleges were granted administrative and financial autonomy through independent Boards of Governors (BoGs).
KGMC and HMC became part of the MTI structure in January 2015.
Authority and influence
The first chairman of the Hayatabad Medical Complex (HMC) Board of Governors (BoG) — which oversees administrative and strategic matters across HMC, KGMC, the Khyber Pakhtunkhwa Institute of Child Health, Institute of Kidney Diseases, Pakistan Institute of Community Ophthalmology, and the Burns and Plastic Surgery Unit — was Sahibzada Saeed, who remained in office from 2015 to 2023.
Under the MTI governance structure, the KGMC dean is responsible for academic affairs across these institutions, while the HMC medical director oversees administrative functions. Both the dean and the medical director also serve as permanent members of the BoG.
During this period, the leadership of the academic and clinical administration also evolved through multiple tenures. Dr Noor Wazir served as dean from 2015 to 2019, followed by Dr Zahid Aman from 2019 to 2024. Dr Shiraz Jamal briefly served as interim dean between November 2024 and June 2025 before Dr Shehzad Akbar assumed the office.
The Policy Board — chaired by Dr Nausherwan Burki since 2015 — was established under Section 4(A) of the Khyber Pakhtunkhwa Medical Teaching Institutions Reforms Act, 2015, primarily as an advisory and policy coordination body for MTIs across the province.
The upgradation controversy
One of the most contentious issues concerns promotions made between 2015 and February 2020. According to documents and officials familiar with the matter, around 100 faculty members in grades 19 and 20 were reportedly promoted through what was termed “upgradation against own posts.”
Under this mechanism, faculty members were elevated in rank without the existence of sanctioned vacancies in the government-approved structure. Assistant Professors in BPS-18 were promoted to Associate Professors in BPS-19, while Associate Professors were elevated to Professors in BPS-20.
These promotions bypassed mandatory approvals from the provincial government and the Health Department. Sources informed WE News English that the promotions also lacked proper budgetary sanction.
These decisions did not remain confined to institutional files. Some of the aggrieved persons later challenged these promotions before the Peshawar High Court. In one such petition filed by Dr Yasir Khattak of the HMC, the court held certain promotions illegal and ordered reversal of the disputed upgradations.
However, despite the court’s ruling, insider sources confided to WE News English that implementation of the judgment remains incomplete and many of those promoted continue to serve in upgraded positions while drawing higher salaries.
The second phase of promotions
Following growing legal scrutiny over upgradation-based promotions, a second phase of promotions emerged after February 2020 under the title of “accelerated promotions.”
In January 2026, newly appointed BoG Chairman Prof Noorul Iman ordered an inquiry into promotions made after February 2020. According to officials familiar with the inquiry, an initial review reportedly identified irregularities in 57 out of 64 cases examined.
However, a subsequent inquiry report, later presented before the 47th BoG meeting on February 17, 2026, “cleared the same cases under the category of Clarification and Compliance.”
The controversy deepened further during the 48th BoG meeting held on April 2, 2026. According to the meeting details reviewed by this scribe, promotion criteria were formally approved under Section 25 of the MTI Act. The move effectively provided legal cover to practices already challenged before the court.
Questionable appointments, reappointments
Another major controversy relates to the interpretation of Pakistan Medical and Dental Council (PMDC) Regulation 2018.
Sources within the institution assert that the PMDC regulations were selectively interpreted to facilitate the reemployment or promotion of certain individuals “who lacked mandatory qualifications.”
Among those named in internal disputes are Dr Aminul Haq, Dr Arshad Pervaiz Malik, Dr Amir Muhammad, and Dr Abdul Hameed Khan of the KGMC.
The sources contend that some individuals had already availed one-time promotion concessions available under PMDC rules and were therefore ineligible for further advancement.
Concerns were also raised regarding advertisements that allegedly omitted complete eligibility requirements, facilitating appointments and reappointments that might otherwise have faced objections.
According to officials familiar with the matter, Dr Naheed Mehsud was serving as Assistant Professor of Medical Education at KGMC in 2022 when she was appointed through a special advertisement rather than through standard promotion channels.
Sources say that at the time of her appointment, she did not fulfil requirements related to experience and did not possess a PhD qualification. She later obtained a PhD degree in February 2026.
The salary question
The institutional records and officials familiar with the administrative structure reveal that individuals serving in administrative positions such as dean and medical director continued drawing salaries linked to their academic positions as professors while also receiving administrative remuneration.
Officials assert that the additional payment was Rs385,000 per month until December 2022, which was increased to Rs850,000 thereafter.
Sources told WE News English that salaries linked to disputed promotions were drawn through the government’s one-line budget mechanism routed via the Accountant General’s office despite the absence of formal regularisation from the provincial government.
Further questions have been raised about the eligibility of certain senior officials serving in key administrative positions.
For instance, sources say that the former Medical Director of HMC Dr Mushtaq Khattak did not fulfil PMDC criteria for professorship at the time of his promotion in 2019.
Questions were also raised regarding the reemployment of Dr Abdul Hameed Khan in 2023, who remained eligible only for the rank of Associate Professor rather than Professor.
Tip of the iceberg
The controversy has triggered multiple legal challenges before the Peshawar High Court and the MTI Tribunal.
Among those who have challenged promotion and appointment practices are Dr Yasir Khattak from Maxillofacial Surgery at HMC, Dr Ambreen Ahmed from Paediatrics at HMC, Dr Ain ul Hadi from Surgery at HMC, along with gynaecologists and Robina Akhtar, Dr Kishwar Naheed, and Dr Shazia.
The ongoing controversies have reignited wider debate regarding the implementation of the MTI model in Khyber Pakhtunkhwa.
The broader concern is that HMC and KGMC may not be unique cases. With 11 MTIs functioning under similar governance structures across Khyber Pakhtunkhwa, they argue that the controversies emerging from one institution raise legitimate questions about whether similar appointment, promotion and regulatory issues may exist elsewhere.
No comprehensive province-wide audit of promotions, reappointments or governance practices across all MTIs has yet been made public.
Transparency on trial
For many faculty members, the dispute is no longer merely about promotions, appointments or individual administrators. Instead, it has evolved into a broader examination of whether the MTI system has delivered on its founding promises of merit, transparency and corruption-free governance.
More than a decade after its introduction, the controversy surrounding HMC and KGMC raises a larger question: did the MTI model solve the governance problems of the old health system, or did it simply create a new set of challenges under the banner of institutional autonomy?
Despite repeated requests for comment, Dr Noorul Iman and Dr Shahzad Akbar did not respond.
