In the last week of May, an incident of a devastating fire in a private neonatal care nursing home in New Delhi brought the issue of Health regulations into limelight.

What are Health regulations?

Health regulations is a set of procedures that helps the health care professionals to deliver their full services to patients.

• These are generally issued by  national and State governments to uphold the quality of healthcare services.
• For Example: Clinical Establishments (Registration and Regulation) Act, 2010,Indian Public Health Standards.

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Challenges

• Excess or Unrealistic Regulations: 
  • Clinical Establishments (Registration and Regulation) Act, 2010: It was enacted 14 years ago, but not adopted by States. This is because State governments, in discussions with stakeholders, have realized that many provisions in the Act are impossible to implement.
  • Indian Public Health Standards: These were drafted by the government for its own health-care facilities in 2007. 
    • Yet, in 17 years of existence, only 15% to 18% of government primary health-care facilities in India meet the government’s own standards.
• Overzealous attempt to enforce the regulations: There seems to be an unfairness and overzealous attempt to enforce the regulations in the private sector.
• • For Example: In 2017, two large Delhi hospitals, a tertiary-care government hospital and a corporate hospital, mistakenly declared newborns as dead. The corporate hospital faced a temporary license suspension, while the government hospital only set up an inquiry committee.
• Burden of responsibility on Owners: In health-care regulation, in the current scheme of things, the burden of responsibility is more on providers and facility owners.

• • Most private nursing homes and clinics have often flagged the issue of approvals being delayed by the authorities for months even when these facilities apply for renewal well in advance.
• Diversity in Private sector: The private sector is also not a homogenous entity as there is everything from single doctor clinics, small nursing homes and medium-sized hospitals to large corporate hospitals.

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India’s Mixed health-care system

India has a mixed health-care system which means that private health-care facilities and providers deliver nearly 70% of outpatient and 50% of hospital-based services.

• Role of Private Sector in Health Care: States such as Maharashtra or Kerala, the health indicators are better not because these States have outstanding government facilities but because the facilities and clinics in the private sector are fulfilling the health needs of the people.

Way Forward

• Involve Stakeholders: Ensure quality of health services is essential and the joint responsibility of all stakeholders. 
  • For example: Representatives of doctors’ associations and the types of facilities for which regulations are being formed as well as community members should be involved in the process of the formulation of such regulation.
• Differential regulations:  In regulatory aspects, what is possible for large corporate hospitals may not be feasible for smaller clinics and nursing homes, without escalated cost.
• Building Trust: Political loose talk and sensational media headlines might worsen the mistrust of the common man about doctors and nursing homes and may result in increased violence against health-care providers.
• Promotion of Single Doctor Clinics: India needs to promote single doctor clinics apart from smaller health-care facilities, and nursing homes.

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