The tragic fire in a private neonatal care nursing home in New Delhi has reignited the debate on healthcare regulations in India. This incident exposed the systemic failures that often lead to such tragedies, particularly the failure of health-care regulations. While there is no shortage of health regulations in Indian states, the problem lies in their excess and unrealistic nature. Some states have over 50 approvals under multiple regulations that healthcare facilities must comply with. This regulatory burden often hinders the smooth functioning of healthcare providers, especially smaller facilities.
Unrealistic healthcare quality standards further compound the issue. Governments at all levels draft policies that are aspirational but impractical to implement. The Clinical Establishments (Registration and Regulation) Act, 2010, enacted 14 years ago, is a case in point. Many provisions in the Act are impossible to implement, as realized by state governments during discussions with stakeholders. The Indian Public Health Standards (IPHS), drafted by the government for its health-care facilities, is another example. Despite being released in 2007 and revised twice since then, only 15% to 18% of government primary health-care facilities in India meet these standards.
There is a misperception that the government health sector always adheres to regulations while the private sector violates them. However, India has a mixed health-care system where private healthcare facilities and providers deliver nearly 70% of outpatient and 50% of hospital-based services. In states like Maharashtra and Kerala, the health indicators are better not because of outstanding government facilities but due to the private sector fulfilling the health needs of the people.
Yet, when it comes to healthcare regulation, there seems to be an unfairness and overzealous attempt to enforce the regulations in the private sector. In 2017, two identical incidents occurred in two large hospitals in Delhi, where newborn infants were declared dead but were actually alive. The private hospital faced a temporary suspension of its license, while the government hospital only set up an inquiry committee. This disparity highlights the need for fairness in regulation and adherence.
The burden of responsibility in healthcare regulation currently falls more heavily on providers and facility owners. Private nursing homes and clinics often face delays in approvals by authorities, even for renewals applied well in advance. This sluggish approval process is a significant concern for facility owners.
The private sector in healthcare is not homogeneous, ranging from single-doctor clinics to large corporate hospitals. Single-doctor clinics and small nursing homes are often the first point of contact for health services for middle-income and low-income populations. They provide a substantial portion of health services at a fraction of the cost of large corporate hospitals. The recent incident raises questions about why parents opted for a private nursing home despite free health services in government facilities.
Single-doctor clinics and nursing homes play a crucial role in delivering accessible and affordable healthcare services. They need supportive regulations that keep healthcare costs low. The tragic incident in Delhi should not be swept under the rug but should prompt calm assessment and concrete plans.
Ensuring quality health services is essential, but the pursuit of ‘world class’ standards should not lead to unrealistic regulations. Guidelines should be practical and implementable. Harmonizing multiple health regulations and simplifying the application process will streamline the regulatory landscape. Time-bound disposal of applications is also crucial.
Different types of healthcare facilities have varying capabilities. Expecting smaller facilities to meet the same standards as large corporate hospitals would escalate their costs, which could be passed on to patients, making healthcare unaffordable. A differential approach is needed for different facility types, with essential and desirable standards overseen by regular self-assessment and regulatory visits. Fire and safety measures should be prioritized in all health facilities. The government could consider subsidies and funding to increase adherence to regulations.
Involving representatives of doctors’ associations, healthcare facilities, and community members in regulation formulation is essential to ensure inclusivity. Loose political talk and sensational media headlines can erode trust in healthcare providers and lead to violence against them.
Promoting single-doctor clinics and smaller healthcare facilities is vital for delivering primary care and keeping healthcare costs low. These facilities need support rather than excessive regulation.
In the aftermath of the Delhi fire tragedy, it is crucial to identify and address the root causes. Simplified and implementable regulations, developed through collaboration and coordination with key stakeholders, are essential. Fairness in implementation, time-bound decisions, and support for smaller healthcare facilities with subsidies are equally important.
India’s healthcare system should focus on promoting providers and facilities that deliver outpatient care at lower costs. This aligns with the goal of the National Health Policy, 2017, to provide people-centric, accessible, available, affordable, and quality health services. This requires a bottom-up approach to regulation development and nuanced implementation.
