The friendly neighbourhood physician, as well as the small husband-wife run nursing home, is soon to be phased out. These clinical establishments dotting the country in every nook and corner and providing 70 per cent of the total healthcare services are now becoming history. The medical scene in the country is about to change drastically and we only have our own lethargy to blame. The Ministry of Health and Family Welfare has put on its website the Draft Minimum Standards under the Clinical Establishments Act (CEA). Not only are some of these outright hilarious, they are mostly out of sync with the reality.

Dr Neeraj Nagpal

Need for a (building) completion certificate in legal requirements is an example. Completion certificates are commonly refused for minor building byelaw violations and in any city this may include upwards of 60 per cent buildings. Also need of dependence on landlord for this requirement under the CEA will close many healthcare facilities, as the level 1 or 2 hospital may not be in a self-owned premises. How the clinical standards of a facility are to be determined on the fact whether or not the building has completion certificate is a mystery. What this effectively means is that the facility has to apply to the Estates office for the completion certificate, inspection of the premises by inspector, objections, removal of these objections by any means (usually unfair) and overall wait of average one year for the certificate. Meanwhile, the healthcare facility should close down awaiting its certificate.

This, however, is also not in isolation, the NOC from the fire department, now under the new rules for hospitals whether level 1 or tertiary care, has extremely stringent requirements of roof top water tanks, sprinkler systems and smoke detectors. To get this NOC is going to be another formidable challenge for the establishments already in existence in older buildings. Under the draft rules one has to provide 24-hour power backup but you need a diesel storage license, DG (Diesel Generator) set approval for commissioning, air and water pollution control certification etc. Each of these licences can be a 2-3 year plan for the doctors.

Surprisingly none of these requirements are necessary for AYUSH facilities even of 100-bed strength. All the legal requirements, so far mentioned, relate to the allopathic level 1 and level 2 hospitals. Despite operation theatres and labour rooms in AYUSH facilities there is no requirement for such building and legal certifications for them. How can two facilities of similar size providing treatment to general public need to fulfil two different types of certifications. There is a bias against allopathic healthcare facilities in these draft minimum standards published.

There is also a need for Spirit license, medical gases / explosive Act license, boiler license and a wireless operation certificate from the Department of Posts and Telegraph to operate wireless equipments like nurse call systems or monitors. It does not require high intellect to know how these licences are to be obtained and what the procedure entails. An individual or couple managing a small nursing home or level 2 hospital will find it impossible to comply with the requirements of all these certifications. This will leave no option but for these units to close down. Only the corporate hospitals with their deep pockets and required administrative staff will be in a position to satisfy all these requirements. Unfortunately corporate penetration in India is limited to less than two per cent. Should the remaining 98 per cent Government as well as Private hospitals shut shop.

The Govt clinics/dispensaries, Primary Health Centres, Community Health Centres and Civil Hospitals will be hard pressed for these certifications. Where is the need for a four-wheel drive vehicle in a city based level 2 hospital? Even tertiary care institutions like PGI will be hard pressed to explain 2 or 3 patients on one bed, which is the norm in the obstetric wards. These standards have been prepared without adequate and appropriate consultation with stakeholders. There appears to have been a group within the MOHFW which is out to promote corporatization of healthcare which cannot be in overall good for the country.

We request the Government to be sensible and practical. Minimum standards should mean minimum standards necessary for a clinic/hospital to provide adequately satisfactory healthcare to its consumers. CO2 monitors and Endoscopy washers are not minimum standards. But more importantly minimum standards have to be uniform across government, private, allopathic, ayurvedic, homeopathic, naturopathy, siddha, sowa-rigpa, unani, yoga or physiotherapy. A level 2 allopathic hospital with 10 beds and surgical facility cannot have different and highly stringent requirements from a 100-bed ayurvedic hospital with OT and labour room.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh