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
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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