The Punjab Healthcare Commission (PHC) was created to implement the PHC Act 2010, with an objective to develop a culture of responsibility and quality in the Punjab health sector. The Act provides a framework for the development of Minimum Service Delivery Standards (MSDS) under the purview of Clinical Governance and Standardisation. Once the focal person of a Healthcare Establishment (HCE) is registered, he is invited to attend capacity building workshops to get informed and trained on the implementation process of the relevant MSDS. Upon the successful completion of training, the HCE is given a provisional license. Once the HCE is done with the implementation of the MSDS, having scored a reasonable percentage, with full compliance in certain areas critical to patient safety, it is awarded the regular licence. Intervening activities comprise pre-assessment and inspections that give the HCE space and qualified assistance to achieve a decent compliance rate.

In health accreditation, a standard is “a desired and achievable level of performance against which actual performance is measured.” Standards enable “health service organisations, large and small, to embed practical and effective quality improvement and patient safety initiatives into their daily operations.” External organisational and clinical accreditation standards are considered necessary to promote high quality, reliable and safe products and services. There are over 70 national healthcare accreditation agencies worldwide that develop or apply standards, or both, specifically for health services and organisations.

In order not to operate in isolation, and to keep seeking light from other organisations about their service delivery standards, the Commission has worked closely with the Armed Forces Medical Services with an aim to benefit from each other’s health care delivery standards. Similarly, in collaboration with the United Nations Children’s Fund (UNICEF) including the UNFPA, Pakistan Nursing Council, Population Welfare Department, etc., the Commission has developed MSDS for midwifery centres. As of now, the initial preparatory work for the MSDS for cosmetic surgery/hair transplant centres is underway.

Because Punjab had taken a lead in implementing a full-fledged healthcare commission and has created a benchmark of quality and effectiveness through the rigorous implementation of MSDS, the Commission is looked up for replication by other provinces and regions. The PHC has a unique standing in the Pakistan health sector because it is the first health regulatory body of its sort in the country. Prior to the establishment of PHC, different legislations informed the health sector about responsible healthcare services. In its pursuit of quality healthcare, the PHC as a policy follows attitude of facilitation when inspecting HCEs.

The Punjab health sector has been under stress because of budget constraints and the unprofessional attitude of the health service providers due to the ease of performing in an unmonitored and unregulated work environment. The temptation, to exploit this ‘easy to manipulate’ work environment grew even stronger as the windfall from the exorbitant fees charged by the private HCEs and health service providers bloated their bottom line. Between the ineffective public and unscrupulous private health sectors, the unqualified health practitioners created a niche for themselves to further fleece and dupe the poor, illiterate and even the well to do segments of the society. Over the decades each one of these protagonists has become powerful and audacious. Initially, when the Commission was formed it was taken as any other regulatory body formed to put a superficial façade on a decaying system. Having understood this pulse, the Commission decided to assert carefully and to err on the side of caution.

The PHC Act, 2010, empowers the Commission to make the HCEs both in the public and the private sector perform with minimum human and operational errors. The Commission acts on behalf of the society to find out and control malpractices in the health sector. With the arrival of the Commission, if on the one hand the HCEs are convinced that their survival depends on bringing certain level of standardization to their workflow, on the other the quacks are on the run

Though the issues mentioned above have not been fully resolved, efforts are underway to at least reduce their intensity and nuisance value. The health sector does not operate in a vacuum. Unless there is a revamping in other institutions such as the education system, the law enforcement mechanism, the judiciary, improvement in health sector will remain patchy and slow to come by. It is therefore that the focus of regulation is not to improve the processes of an HCE but to improve its performance. Unless there is a visible change in the way HCE does its everyday business, the success of regulation remain elusive. And PHC is putting all its efforts to get this response.

In a nutshell the simplification and standardisation, where possible, are a precursor to high reliability, better care and an improved patient experience. Process is standardised with an aim to minimise the prospect of human error. It has been qualified through research that human errors in an HCE is usually the effect of a poor management system, poorly performed work standards, no training or poorly conducted training, lack of control, and lack of audit after training. All these areas and performance issues are thoroughly addressed in MSDS, and are emphasised for a serious follow up during the capacity building workshops.

The writer is a freelance journalist based in Lahore.

Because Punjab had taken a lead in implementing a
full-fledged healthcare commission and has created a benchmark of quality and effectiveness through the rigorous implementation of MSDS, the Commission is looked up for replication by other provinces and regions.