Provision of healthcare is deemed essential in order to provide efficacious and healthy living standards for all and sundry. Quality Healthcare ensures and aids people in living longer, healthier and happy lives and strong clinical governance is required in achieving these healthcare goals.
The Clinical Governance and Quality strategy as laid out in various standards set out to approach to improvise quality and safety. It serves as an essential road map so as to guide in meeting the goals to provide every customer with the highest standards of accessible care.
The development of well-established clinical governance will make certain and aid in ascending towards continuous quality improvement. We should move beyond a model of accepting compliance standards as the norm and, focusing on outcomes, to a culture of innovation and excellence driven by high expectations of achieving the very best healthcare solutions for the people living in Pakistan.
Having said that it has been observed there is an impending loophole in both the provision of quality healthcare to patients as well as for the job security of healthcare professionals (HCPs). Many cases have been reported in the past where not only the patients are at the risk but the healthcare professionals’ themselves as well. These are usually categorized under medical negligence which may include several aspects: using faulty operation techniques, administration of wrong injections, making the wrong diagnosis, use of expired drugs, giving wrong treatment and non-compliance of professional laws. Such kinds of anomalies in the provision of healthcare usually result in waging war against the patients and healthcare professionals. For this, it is highly essential to establish a perpetual system which can overlook the functionalities of the healthcare sector.
This surmountable issue needs to be addressed on prior notice as this not only has posed a threat to the healthcare professionals but also to the healthcare establishments. This has also sufficiently increased with the increase in the statistics of medical negligence. Since our nation has more of a reactive approach rather than a proactive one, such kind of cases usually results in damaging the property of healthcare establishments or either violence against the healthcare professionals by the aggrieved families.
The healthcare service providers are subjected to direct violence by patients or deceased families, it is necessary to establish concrete rights of healthcare professionals so as to protect the dignity the job holds for itself. Proper laws should also be devised to take actions against healthcare professionals who are involved in medical negligence or unlawful litigation. Similarly, proper laws should be constructed for patients or deceased families, who threaten doctors or healthcare professionals without any valid facts.
Since every organized system of health has a perpetual system of overseeing the working of the healthcare system, which is governed by an autonomous body. Considering the similar kind of initiatives in other countries, a need is felt strongly to develop a regulatory body in Pakistan too. A system needs to be developed that should be empowered to inquire and investigate into maladministration, malpractice, and failures in the province of healthcare services and issue consequential orders. These orders should be governed and protected by approved guidelines and charter of rights of both patients and healthcare professionals. Pakistan Medical & Dental Council has laid out several sets of rules in this regard i.e. on medical negligence but they have not succeeded in reaching the implementation stage. For this, it was highly necessary to establish a regulatory body like the Drug Regulatory Authority of Pakistan, which solely functions for the better provision of quality healthcare systems in the country. For this, it is also necessary to have a proper set of guidelines for the transmission of efficacious healthcare provision to all and sundry.
Unfortunately, the current legislation is neither capable of protecting patients nor does it safeguard the care providers. Legislation has to be revamped along with the modern standards in order to provide justice for all. For this, Pakistan has developed special healthcare commissions for each province that overlooks and protects the rights of patients and healthcare providers’ likewise. These healthcare regulatory bodies in the different provinces’ areas are striving on the basic agenda to ban quackery and dealing with ancillary matters related to healthcare in the respective provinces. One such regulatory body that has come forward with the agenda to protect the rights of healthcare professionals is Sindh Healthcare Commission (SHCC), which strives under the banner of “Quality care for all”. SHCC is an autonomous, body corporate [U/S 3 (2)] to regulate healthcare service delivery to serve the interests of patients, clients, HCPs’ and HCEs’ in Sindh. SHCC Act 2013 was passed by the Provincial Assembly of Sindh on 24th February 2014, and notified on 20th March 2014, extending to the entire Sindh province. The enunciated laws will apply on healthcare establishments (HCEs’), public or private hospitals, non- profit organization, charitable hospitals, trust hospitals, semi-government and autonomous healthcare organizations.
Some of the clauses from the Sindh Healthcare Commission (SHCC) Act 2013, which are stated under the title of “Protection for the Healthcare Service Provider”, are as follows:
U/S 4(7); The Commission shall take cognizance of any case of harassment of healthcare service provider or damage to healthcare establishment property and may refer such a case to the competent forum.
U/S 29; No suit, prosecution or other legal proceedings related to the provision of healthcare services shall lie against a healthcare service provider except under this Act.
U/S 4(15)(16): The organizations, public or private, government, local, provincial or federal for which the doctors and Health Care Workers are working must provide them full protection, both physical and legal.
U/S 31(2): The healthcare establishment shall provide legal aid to a person, working in the healthcare establishment, pertaining to the matters related to this Act.
This clinical governance system clearly elaborates the rights of healthcare professionals and ensures that proper measures are taken against unlawful acts. If we look unto bullet point no.1, it clearly states proper defacement policies should be developed by the health departments so as to ensure the violation of rules is surcharged. Moreover, SHCC has also managed a compliant complaint management system that not only entertains valid complaints from patients but also from the Healthcare Establishments and Healthcare Professionals. So the time is near when proper healthcare measures can be followed, these complaints are often followed by investigation rounds both from the complainants and the person accused. Sindh Healthcare Commission has also made this provision of charging a substantial amount of penalty fee from the complainants if their complaint is found to be false or a mere allegation. The clause under SHCC Act 2013, is stated as:
A fine may be imposed which may extend to (PKR: 200,000) upon the complainant, if the complaint, submitted either by an aggrieved person or a healthcare service provider is proved false.
Although trends in the provision of healthcare are tampered to a great extent due to the loopholes in the system however it is heralded that very soon better measures will be followed so as to ensure better healthcare provision. For this, a collective force is required by both the government and healthcare establishments to work towards it progressively. This robust system will not only ensure the eradication of quackery in all its forms and manifestations but also will protect the rights of healthcare professionals which has always been neglected and had come under unlawful pressures.
A medical negligence was reported in Karachi a few days back in which the doctor was arrested due to the surmounting pressure from the family’s angst without any proper investigations, such cases have become a trend now where reactionary measures are taken. The establishment of such healthcare systems will, however, ensure that such unreasonable approach is curbed. For such cases, it is necessary to make proper investigations from the regulatory authorities and court orders/summons should be issued rather than making impulsive decisions just to pacify irate families.
Since the healthcare regulatory bodies have already taken its mark of existence, it is forecasted very soon a perpetual and balanced system will be established that will work for the lawful rights of patients and healthcare professionals. We are not far from being in one of the countries where safe and effective healthcare practices would be followed sans any derogatory impediment. For this it would be strongly necessary for the law enforcement agencies, healthcare establishments, healthcare professionals and patients to work in close compliance with the regulatory authorities, this would substantially reduce the “taking law in one own hand” trend that has been deep-rooted in our society.
Author: Farah Naz