7 june 2024 Health regulations and ICU fire deaths

 Health regulations need a base to top approach

Health regulations are essential but their implementation in India needs to be nuanced and calibrated

incident of fire in a private neonatal care nursing home in New Delhi 

 1 Political parties began a blame game and the media coverage was intense, going overboard and reporting incorrectly that a number of nursing homes in Delhi function without a licence. 

2 failure of health-care regulations

Such tragedies are often followed by a question of who should be blamed, completely missing the point that these are almost always the outcome of a systemic failure — in this case, the failure of health-care regulations.

reality in india 

1 Over regulations in private hospitals 

Some States have over 50 approvals under multiple regulations, which need to be followed and complied with by every health-care facility. Still, many officials in government, as well as others, believe that the private health sector in India has insufficient regulation.

2 unrealistic health-care quality standards

Governments at every level in India — national and States — are known to draft policies which are near perfect. 

3 Clinical Establishments Registration 2010

One such case is the Clinical Establishments (Registration and Regulation) Act, 2010, enacted 14 years ago, but not adopted by States.

 This is because State governments, in discussions with stakeholders, have realised that many provisions in the Act are impossible to implement. 

4 Indian Public Health Standards, or IPHS

Another example is the Indian Public Health Standards, or IPHS, drafted by the government for its own health-care facilities and proposed as essential in order to deliver quality health services. 

The IPHS were first released in 2007 and have been revised twice since then.

only 15% to 18% of government primary health-care facilities in India meet the government’s own standards. 

India has a mixed health-care system

1 private sector always violates ? 

 The fact is that India has a mixed health-care system, where private health-care facilities and providers deliver nearly 70% of outpatient and 50% of hospital-based services.

 2 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.

Private vs Gov hospital

1 infants as dead; but they were alive 

 In 2017, two separate but near identical incidents in two large hospitals in Delhi (a tertiary-care government hospital and a large corporate hospital), had allegedly declared newborn infants as dead; they were alive. 

2 This resulted in a temporary suspension of licence in the case of the private hospital, while in the case of the government hospital there was just the setting up of an inquiry committee.

3  burden of responsibility is more on providers and facility owners.

 4 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.

 In many examples, applications submitted well on time for renewal (two to three months before the due date), are granted approval months later.

Affordable care is one need

Single doctor clinics and small nursing homes 

are often the first point of contact for access and utilisation of health services in India by middle-income and low-income populations, and are the real lifeline of health services. 

They deliver a large share of health services at a fraction of cost of that of the big corporate hospitals.

 Why the parents  go to a private nursing home despite government health facilities with free health services is an issue we must reflect on. 

The single doctor clinics and nursing homes play a key role in health service delivery in India and make services accessible and affordable. 

calm assessment of fire accidents and some concrete plans

First, ensuring quality of health services is essential and the joint responsibility of all stakeholders

overzealous attempt to ensure having a ‘world class tag’ or being ‘swayed by the lure of medical tourism’, the government should not end up making health-care regulations unrealistic. 

There is a need to formulate guidelines that can be practised and implemented. There is a need to harmonise multiple health regulations and simplifying the application process. Such applications need to be disposed of in a time-bound manner.

Second not same for big and small hospitals 

 1 what is possible for large corporate hospitals may not be feasible for smaller clinics and nursing homes, without escalated cost. 

2 Expecting smaller facilities to meet the same standard would make it expensive for the smaller facilities — a cost that is likely to be transferred to patients, making health services unaffordable. 

3 there should be essential and desirable points in each category overseen by regular self-assessment and regulatory visits. 

4  equal emphasis on fire and other safety measures in health facilities?  

If thousands of buildings in the city can have safe elevators, why cannot there be equal emphasis on fire and other safety measures in health facilities? 

For effective adherence and implementation, the government should consider subsidies and funding to increase adherence to regulations.

Third, 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.

Fourth, 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.

Focus on the primary-care givers

Fifth India needs to promote single doctor clinics

apart from smaller health-care facilities, and nursing homes.

 These are what deliver primary care and contribute to keeping the cost of health care low. Every such facility and its doctors need to be supported rather than burdened with excess regulations.

In the fire tragedy in Delhi, we should not just treat the symptoms but also aim to find and eliminate the root causes. It is a reminder of the need to have simplified and implementable regulations that have been developed with the collaboration and coordination of key stakeholders.

 There is a need for fairness in implementations, time-bound decisions and the disposal of applications for renewal of licences, promoting smaller health-care facilities with subsidies, and support for increased quality and safety.

 India’s health-care system is already becoming skewed towards admission based in-patient services. It needs to promote providers and facilities that deliver out-patient care at lower costs. 

This would contribute to the goal of the National Health Policy, 2017 — to deliver health services that should be people-centric, accessible, available, affordable, and have quality. This requires health regulations being drafted from bottom up and not top down, and implemented in a nuanced and calibrated manner.

source the hindu