Standardizing Punjab’s health sector

According to health experts, there are six important components of a healthcare system that provides quality care to individuals.

The Punjab Healthcare Commission (PHC) is an independent regulatory body. Founded in 2011 for the implementation of the PHC Act 2010, the Commission is geared towards bringing quality in the Punjab health sector through clinical governance aimed at standardizing healthcare services at all healthcare establishments (HCEs) in Punjab.

Healthcare standards are advocated as an important means of improving clinical practice and organizational performance. The PHC has documented methodologies to promote open, transparent, inclusive development processes, where standards are developed by the experts in consultation with stakeholders at all levels. The methodologies adopted by the PHC are effective and efficient at formulating standards appropriate for the domestic health industry.

A health standard is “a desired and achievable level of performance against which actual performance is measured.” Standards enable “health service organizations, large and small, to embed practical and effective quality improvement and patient safety initiatives into their daily operations.” In health accreditation, organizational and clinical accreditation standards are considered necessary to promote high quality, reliable and safe products and services. There are over 70 healthcare accreditation agencies worldwide that develop or apply standards, or both, specifically for health services and organizations. Quality management has become a major concern in the delivery of healthcare. The rising cost of treatment, coupled with variation in the health delivery practices has necessitated the development of strategies to standardize healthcare delivery. A hospital’s quality system depends on the philosophy, vision and corporate strategies that satisfy patients’ requirements.

The PHC has a unique standing in the Pakistan health sector for two reasons. One, it is the first regulatory body to have the power to inspect and regulate HCEs. Two, it is also the first organization to develop Minimum Service Delivery Standards (MSDS) identifying processes sine qua non for the achievement of quality at any HCE. Obtaining a regular license with the PHC is therefore a hallmark for a HCE providing quality healthcare. In this pursuit of raising the standards of care, the PHC has shown zero tolerance towards quackery. The Commission has operationalized an Anti-Quackery Department to clamp down on quackery and has fielded Inspection teams to assess the prescribed standards through prescribed quality indicators achieved by HCEs registered with the PHC. Monitoring and Evaluation is followed to assess the sustenance of the achieved standards by the HCEs.

According to health experts, there are six important components of a healthcare system that provides quality care to individuals. The first is a safe system for all patients, across all processes and at all times. According to this component, a patient’s medical history is neither overlooked, nor ignored or misplaced, and the HCE provides consistent care irrespective of any constraints. Two, a system that provides effective care, which means that all possible determinants----preventive, diagnostic, curative and rehabilitative services or no intervention----are practiced as applicable, to produce the best result. Three, a patient-centric system, which comprises respect for patients’ values, preferences, expressed needs, coordination, integration of care and emotional support. Four, a system that delivers care in a timely manner, wherein care is dispensed in time without delays, because delayed care is not only wasteful but also provokes anxiety among patients and families and can lead to harms that are irreversible. Five, an efficient system, where a HCE uses resources to obtain best value for the money spent. Six, a healthcare system that is equitable. Care should be based on an individual’s need, not on their personal characteristics, such as gender, race, etc.

We can assume safely that nearly all health practitioners and the hospital staff have an understanding about the above cited components and the necessity to practice those. However, the quality of healthcare in Pakistan is often sub-optimal and at times alarmingly poor, an indication that quality is compromised and healthcare standards ignored blatantly. It is in this context that the role of the PHC becomes instrumental. The PHC sees to it that the MSDS it has defined are followed through in letter and spirit. It has a stringent licensing process which includes the inspection of HCEs to assess compliance with MSDS.

All said and done, we may write copies after copies on standards and quality, but unless the behavior of people towards quality is changed, systems and processes will keep churning out old, dated, and rotten practices, because either it suits those benefiting from the status quo or because change demands cost and accountability, which are not liked by many.

Many HCEs, now out of compulsion, have gotten themselves registered with the PHC. As part of the process to acquire a license, they spend considerable time with the Commission to learn the essentials of the MSDS for its effective implementation. To become eligible for the regular license, a HCE is required to demonstrate full implementation of the prescribed standards.

When the PHC began its operations, the biggest challenge was posed by the private sector. A natural resistance to law enforcement was expected though, because of the years of free hand given to the sector to not only mint money, but to flout laws. Another challenge faced by the Commission has been to ensure that public run hospitals abide by the MSDS. It is here that the poorest segments of society access the health care services. However, the PHC cannot single handedly change the system. The Government’s spending pattern on the health sector, the quality of education given at the medical colleges, the training doctors receive from seniors, the rules and regulations followed by other medical regulatory bodies, such as Pakistan Medical and Dental Council, and the weight society gives to ethical work practices collectively determines the character and productivity of the healthcare sector. Often, money budgeted for healthcare has been diverted on politically motivated developmental projects, while doctors took advantage of governmental negligence to step-up private practice. This trend would have to be arrested if the health sector is to produce optimal results.

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