Wednesday, October 31, 2012

Clinical Establishments- Role of government and Healthcare Market




The Kerala Clinical Establishments (Registration, Accreditation and Regulation) Bill, 2009 which was in the news recently has invited the fury of Medical practitioners, clinical institutions, labs, pharmacies, scanning centres and agencies, as it intended to curtail their freedom. The healthcare sector in Kerala which is one of the most lucrative sectors has been contributing to the state’s GDP and providing employment to many people, especially women in Kerala. This includes people who are employed in Specialised Scanning Centres to nursing homes for old aged. With huge demand and high private participation, the sector has grown exponentially in term of numbers, reach and revenue. If you take the number of nurses alone, who constitutes the major part of the sector; the numbers are quite immense, taking into account those working in Kerala or India and those working abroad. Relative figures of people employed in laboratories, Scanning/Detection Centres are not available.

With its high literacy rates and progressive education programmes, Kerala trains a nursing workforce that is highly sought-after in the global labour market. This stands true for persons who are not nurses but possess the qualification or skills to be employed in various labs, pharmacies or clinical centres.  Relatively large number of people work similarly in clinical establishments in other capacities.

In the current scenario the scope and nature of nurses and other non-nursing personnels is determined to a large extent by the situations or market existing in Kerala. The huge potential offered by the healthcare sector through hospitals, nursing homes, clinics and various agencies is the key to the large population of students graduating from various educational institutions imparting training from nursing to pharmacy. Depending on their qualifications (GNM, ANM and BSc for nurses), they are part of the market which is supposed to support the health and well being of the entire population in Kerala and also abroad.

The proposed law throws the questions on whether it will stultify the market opportunities of nurses and others associated in the sector. The legislation requires mandatory registration of all clinical establishments which includes nursing homes, clinics and agencies. Further the Health Department can conduct quality checks and take action against erring institutions. It is a fact that the Healthcare and Nursing sector has become a business which involves millions of rupees. At the same time, it has been providing employment and catering to the requirements of a considerable population, maybe at a cost. The intent of the legislation is genuine, but the manner in which it is undertaken is doubtful. While regulation is required to check lack of quality or unethical issues, mandatory registration does not suffice. This stands true with most of the regulations, especially those related to Health and Environment. The recent Shawarma issue which made headlines is the perfect example of how health authorities failed in executing their mandate of checking and improving quality standards of food. They were more active in closing and sending notices to shops than assisting them to improve the standards or comply with it. A similar situation shall exist once the proposed Bill comes is passed and comes into effect.

The Department of Health and Medical Education and the various institutions like Medical Council and Nursing Council have been involved at various levels in regulating the nursing and other establishments. However, due to lack of personnels and facilities involved, they have not been able to function effectively. This has been one of the major reasons which has caused the sprouting of spurious institutions which has been duping students and people alike. The effect is appearance of unskilled people without means of employment, lack of skilled personnels to handle technologies used in scanning centres or laboratories and overall lack of professionalism in service. This has a larger impact on the persons who take the services of these clinical establishments paying huge cost but get sub-standard service. The issue is graver in case of healthcare services which directly affect the human life such as emergency services, basic life support, infection control etc.  Mandatory registration cannot be an assured manner for preventing let alone reducing such instances, as they can very well function illegally without getting caught by law. Awareness and education of various stakeholders is required to avoid and stop the malpractices which affect the sector.

The current Bill does not address the issue of quality standards demanded by various professions, clinical establishments and those employed in such establishments. The Government can do a monitoring role of checking any malpractices, lack of standards, complaints etc. But it shall not interfere in the day to day functions of these establishments or discourage people from setting up such establishments.  

Unfortunately, the situation in India is that tighter governmental control has only detracted entrepreneurs while on the other hand has created a monopoly for few players who were able to influence the system. In an unregulated environment like healthcare, definitely competition is bound to happen, but for the good. Maybe institutions like Competition Commission can check monopolies and give strictures on unethical practices adopted by various establishments. 

Education, training and skill development of nurses or clinician's employed or seeking employment in clinical establishments is one of the most important areas which the government needs to interfere. Unless we have specialised ITI like institutions for health care professionals, it will be difficult to expect quality from them. The scope of specialised and integrated programmes for  medical practitioners, pharmacists, lab technicians etc is immense and the government should assist private entrepreneurs to impart training. The government can provide funding to such institutions and also build favourable employment opportunities for those graduating and possessing the necessary skills. It is therefore important to provide better facilities and upgrade technologies in the existing colleges or institutions imparting such training. As it has been found that those people passing out does not possess the necessary skill required by the profession. On the job training shall be made a norm with frequent exposure trips and knowledge acquisition. 

Laws like the Kerala Clinical Establishments should be focused on creating standards, educating people, and assisting establishments to build a quality environment for co-creation and co-habitation. Over the years, the healthcare market itself shall break the bad eggs with the help of the monitoring lens of the government.

Prepared by Madhu.S, Team Lead, Centre for Public Policy Research (project@cppr.in)

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