INTRODUCTION

• Incident: Devastating fire in a private neonatal care nursing home in New Delhi (May 2021)
• Key Issue: Systemic failure in health-care regulations

SYSTEMIC FAILURES IN HEALTH REGULATIONS

Excessive and Unrealistic Regulations

• Problem: Excessive regulations in some States
• Example: Over 50 approvals required for health-care facilities
• Quality Standards: Unrealistic and difficult to implement
  • Clinical Establishments Act, 2010: Not adopted by many States
  • Indian Public Health Standards (IPHS): Only 15-18% of primary health-care facilities meet these standards

Mixed Health-Care System

• Perception vs Reality: Both government and private sectors have compliance issues
• Private Sector: Delivers 70% of outpatient and 50% of hospital-based services
• Regulation Bias: More stringent enforcement on private facilities

CHALLENGES IN THE PRIVATE SECTOR

Delays and Bureaucracy

• Approval Delays: Applications for renewals often delayed by months
• Impact: Burdens facility owners and impacts service delivery

Heterogeneity in the Private Sector

• Types: Single doctor clinics, small nursing homes, medium-sized hospitals, large corporate hospitals
• Importance: Single doctor clinics and small nursing homes serve middle- and low-income populations
• Cost Efficiency: Provide services at lower costs compared to corporate hospitals

RECOMMENDATIONS FOR EFFECTIVE HEALTH-CARE REGULATION

Ensuring Feasible Regulations

• Guidelines: Need practical and implementable guidelines
• Harmonization: Simplify and harmonize multiple regulations
• Time-bound Processing: Expedite application processing

Differential Approach

• Standards: Different standards for different types of facilities
• Cost Impact: Avoid escalating costs for smaller facilities
• Support: Government subsidies and funding for adherence

Inclusive Formulation of Regulations

• Stakeholder Involvement: Include doctors’ associations, facility representatives, and community members

Mitigating Mistrust and Sensationalism

• Media and Political Influence: Avoid sensational headlines and political blame games

Focus on Primary Care Providers

• Support Single Doctor Clinics: Promote smaller health-care facilities
• Primary Care: Key to affordable health care

CONCLUSION

• Root Cause Analysis: Address systemic issues, not just symptoms
• Simplified Regulations: Develop with stakeholder collaboration
• Fair Implementation: Ensure fairness and timeliness in regulation enforcement
• Support for Smaller Facilities: Promote affordable and accessible health services
• National Health Policy Goal: Deliver people-centric, accessible, affordable, and quality health services through bottom-up regulation approach