Licensing of Healthcare Establishments

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Licensing of Healthcare Establishments
So far 56,171 HCEs had been registered, 39,268
granted provincial license while 19,200
outlets of quackery had been sealed
By Durdana Najam

The Punjab Healthcare Commission (PHC) Act 2010 provides for the registration and licensing of government-owned and privately run facilities offering allopathic services or other recognized systems of treatment, as defined in the Unani, Ayurvedic and Homeopathic Practitioners Act 1965. The mandate to regulate healthcare establishments (HCEs) is one of the many ways the state exercises its responsibility to protect the health, safety and welfare of its citizens. The PHC has the administrative power to promulgate rules and regulations and develop policies and procedures to implement the PHC’s mission. 

The PHC carries out regular and special inspections at defined intervals. Inspection is an important part of the licensing process that makes a HCE legally eligible to dispense health care services. The process of licensing begins with the registration of a Healthcare Service Provider. Subsequently, an application is filed for licensing, along with relevant documents and the prescribed fee. After complete verification of the documents, the HCE is provided with the provisional license. From here onward, the HCE enters into the Minimum Service Delivery Standards (MSDS) implementation mode. Not only is the literature on MSDS handed over to the healthcare service provides, but they are also urged to assign personnel for training on the rudiments of implementing MSDS. HCEs are given reasonable time to comply with the standards during which the Commission’s surveyors visit the HCE to pre-assess the implementation process to help remove any impediment or obstacle.

At the beginning, the first challenge for the PHC was to locate and identify the HCEs in Punjab for which the services of the Punjab Urban Unit were hired to carry out population census of the HCEs. To err on the side of caution, the Commission verified the results of the census by sending its own team in the field. 

There were two purposes behind carrying out the population census of the HCEs. One, to regulate all the HCEs through registration and licensing. Two, to eliminate quackery. From 2012 to May 16, 2019, a total of 56,171 HCEs had been registered and 39,268 granted provincial licenses and 19,200 outlets of quackery had been sealed.

In spite of this large number of registered HCEs, still a considerable number of facilities are yet to be brought under Commission’s legislative cover. Most of these HCEs are either located in far-flung areas or in places that are resistant to change because of infrastructural shortcomings. The majority of these HCEs fall under category III. 

For the ease of management, PHC has divided HCEs into three categories determined by bed strengths. Category I HCEs have a bed strength of 50 and above. Category II HCEs have a bed strength of upto 49, which are further divided into three categories described as Category II A (31-49 beds), Category II B (16-30 beds), and Category II C (1-15 beds). Category III HCEs provide only outdoor services, including clinical laboratories, imaging and radiological diagnostic centers, homoeopathic clinics, matabs, clinics of general and family practitioners, basic health units, dental clinics, cosmetic clinics, nursing homes, maternity centers, family welfare centers, physiotherapy clinics, acupuncture clinics, dispensaries, etc.

The PHC is committed to registering each and every healthcare facility in Punjab by the end of 2019-20. Applying a proactive approach, the Commission will warn the unregistered facilities against their resistance to registration through a media campaign, personal visits, or issuance of a deadline, following which all the unregistered HCEs would be closed down on the allegation of providing services in violation of PHC Act. 

A licensed HCE is basically an assurance to the patients that the services being delivered meet the minimum standards of health care service delivery and are thus safe. PHC’s intervention through capacity building workshops and pre-assessment have been instrumental in attuning the healthcare service providers and the stakeholders to the concept of quality and reforms in the healthcare sector. The ultimate goal of the PHC is to bring about quality in the delivery of healthcare services through reforms. 

It is interesting to note that a high percentage of private run, healthcare facilities are recipients of the license from the PHC. It has been observed from the data collected by the PHC inspection teams that the owners and managers of category III HCEs have demonstrated an increased willingness to submit to the licensing process and therefore regular inspection at category III HCEs have been conducted with greater frequency.

It is pertinent to note that the decision to hand over a regular license to any HCE is taken by the Board of Commissioners. An HCE becomes eligible for a regular license once it has applied MSDS with a compliance rate agreeable with the Commission’s requirements. The Licensing and Accreditation Sub-Committee reviews the recommendation of the surveyors along with the inspection report, to understand the factual position of the HCE and its compliance with the MSDS. Cases eligible for licenses are duly forwarded to the Board for the final decision on the grant of the license.

Registration and licensing of the HCEs is the first step towards bringing about quality in the healthcare service delivery. The Commission is doing everything in its capacity to ensure that the healthcare facilities remain committed to the Commission’s licensing process.

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