View Full Version : A good beginning By Arif Azad - 21st September 2014

21st September 2014, 08:49 AM
THE Punjab Healthcare Act was passed by the provincial assembly in 2010. The Act enshrined the establishment of the Punjab Healthcare Commission (PHC). The commission was to be charged with broader functions of improving the quality of healthcare service provision, clinical governance and controlling quackery.

These aims are to be achieved through the registration of all types of healthcare service providers, monitoring quality and standards in healthcare service establishments, investigating malpractice and failures in the provision of healthcare delivery. The PHC can also issue guidelines and directives to those working in the healthcare establishment.

Four years down the road, the PHC is up and running with its mandate and functions further elaborated in detailed rules and regulations, staffed with required expertise, human resources and with a board and chief operating officer in place.

The Punjab Healthcare Commission has made a good start but can do better.
It has produced two basic documents: a patients’ charter and minimum service delivery standards for healthcare service providers and establishments. These documents lie at the heart of the PHC’s mission. It has also issued guidelines on dengue.

The establishment of the PHC is a long-felt need in view of the unwieldy growth of the healthcare provision sector, particularly the private sector in recent years. The PHC has got on with the appointed job with some commendable actions, probing cases of medical negligence in some hospitals. Those found guilty of negligence have been duly fined.

However, despite this, the PHC requires clarity of purpose regarding its role in the investigation of cases of medical malpractice. For example, in the case of the Punjab cardiology centre tragedy, where scores died as a result of the administration of expired or substandard drugs, PHC did not investigate the matter. The reason, according to press reports, was that no complaint was lodged with it.

This is quite tricky because, in most cases, the majority of patients using public hospitals are hardly in a social or economic position to come forward as complainants. This leaves major medical disasters uninvestigated. More importantly, the government has to be clear about the role of the commission in such situations.

In recent years, the government has instituted hospital-based inquiries while PHC has stood by idly waiting to be called in. If the government accords it the status of a first-resort investigative body in medical calamities, it can considerably add to the weight of the body as an effective regulatory body.

The other function of the PHC is the registration of all healthcare establishments. This is a tall order given the fast proliferation of such establishments. It is not clear how these will be registered, licensed and monitored. This leads to the next big question of how the PHC is going to go about enforcing minimum standards given the large number of healthcare centres and presumably a limited PHC staff.

As for the broader regulatory thrust of the PHC, the Pakistan Medical Association has been a dissenting voice. The PMA, if press reports are any guide, has expressed its reservations about regulating the health sector as a whole and the licensing and registration role of the PHC.

Whatever the reservations of the PMA, an important stakeholder, there is no denying that the healthcare sector is in need of some form of regulation. The current system of self-regulation of doctors has not worked, and the quality of healthcare provision has deteriorated year after year. The PMA and PHC need to be on the same page regarding the regulation of all aspects of health service provision.

Another associated issue is of the lack of clarification between the roles of the Pakistan Medical and Dental Council and the PHC. Although the role of the PMDC is limited to ensuring the quality of medical education, the body also acts as a licensing body for practising doctors. As such, the PMDC also has some role in cases of medical negligence where they question the ability of a doctor to remain in practice. In this regard, it has an investigative role though weak and poorly defined. Here again, there needs to be a clear-cut division between the roles of the PMDC and PHC.

Both bodies need to work concertedly on the issue of medical negligence, withdrawing the licences of those found negligent. In addition, there is a need for further collaboration between the PHC and PMDC where the issue of weeding out unqualified quacks posing as doctors is concerned. The PHC is in its infancy but these considerations can be factored in to make it an effective body with real teeth and with broader support among its stakeholders. An empowered and effective PHC can also best serve the interests of those using healthcare units.

The writer is an Islamabad-based development consultant and policy analyst.


Published in Dawn, September 21th, 2014