The Government has a major role to play in supporting medical facilities to enhance both quality and reach
The fire incident in a 1000-beded private hospital in Bhubaneswar that killed over 25 people, has once again highlighted the weak infrastructure in many hospitals in India. This tragedy happened in a State where public health facilities (as opposed to private facilities) play a dominant role, both in rural and urban areas, in providing hospitalised care. Public hospitals treat 81 per cent of total hospitalised cases in rural Odisha, and 58 per cent in urban Odisha.
As per the recent National Sample Survey Organisation (NSSO) health survey, this incident could have happened in any State and in any hospital, public or private. This is because many healthcare facilities across the country lack even the basic standards.
It is true that the adoption of standards such as those of National Accreditation Board for Hospitals and Healthcare Providers (NABH) would have mitigated the risk of fire tragedy, but the adoption of such standards is totally voluntary for health establishments. If an establishment decides not to go for such standards, it still ought to be safe for patients and their attendants, as well as for the staff.
It is precisely for this reason that the Union Government passed the Clinical Establishments (Registration and Regulation) Act (CEA) in 2010. The Act provides for the registration and regulation of all health establishments for certain minimum standards of facilities and services, and collection of information for public health purposes. Each State is supposed to pass the Act, frame the rules, and implement those rules. The fact is that more than half of the Indian States have still not adopted the Act.
Why have the States been tardy in adopting/implementing the ActIJ
Adopting the CEA is a tricky issue for States on at least three counts. One, States themselves get into a difficult situation as they are one of the key providers of healthcare services. The adoption of the CEA would mean that States will have to enforce the rules in public and private health facilities alike. So, adoption of the CEA, will also put State Governments in quandary with respect to its own health facilities.
Two, adoption of the CEA will necessitate States to act against the ‘informal’ healthcare providers, whose practice is deemed illegal and needs to be curbed. However, in the wake of a weak public healthcare system, some of these informal providers may actually be serving a useful role. In the face of acute shortage of health manpower, the States should be training these informal providers and offering them an ‘appropriate’ role in augmenting the supply of healthcare services.
Three, States will have to create regulatory capacity to implement the provisions of the Act. Faced with a choice between creating new regulatory capacity and improving the capacity of public healthcare providers, States would rather focus on the latter. Then why are the States not doing itIJ
Still, could the States do something about healthcare standardsIJ The States could incentivise hospitals to go for NABH accreditation which not only helps hospitals improve its infrastructure standards as well as quality of clinical care. Accreditation, for example, could be made a pre-condition for empaneling health facilities under various Government-sponsored health insurance schemes.
Similarly, health facilities that remain outside such schemes could be incentivised through other ways. Thailand, for example, provides monetary incentives by way of per-capita grants as well as part reimbursement of accreditation fee to hospitals that are outside its universal coverage programme.
Also, the Government has an important role in bringing health awareness among the people and providing health education which is ‘public’ good in nature. The Government could make the people aware of visiting ‘accredited’ health facilities only — the way, the Government is spreading awareness about energy-efficiency of consumer products denoted by ‘star’ labels.
It should be in the establishment’s own interest to go for accreditation which, if consumers pay heed, would mean more business to such establishments. Still, this is no substitute to States providing higher priority to health and getting on with the promotion of healthcare standards, full throttle.
(The writer is a development economist)