ISSUES AND CHALLENGES IN
REGULATION OF PRIVATE SECTOR
Study of Private hospitals In Maharashtra
Dr Ritu Khatri and Padma Deosthali
CEHAT
Study in Maharashtra
Objectives of the study:
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To assess the physical standards and quality of care
provided by the private hospitals in Maharashtra
To understand the problems and the concerns regarding
the existing BNHRA and Accreditation among the
hospital owners in Maharashtra.
Sample and tools
Sample: 261 hospitals upto 30 beds across 10 districts and
Mumbai.
Tools: Interview of facility In-Charge and Duty Medical
Officer/Nurse Staff and Observation of the hospital were
the methods of data collection.
Semi-structured and open-ended questions were designed
to collect information on the existing physical and clinical
standards among the hospital, their awareness of the
BNHRA Act, the issues, opinions and concerns regarding
the implementation of the Act.
Through the Observation Schedule, the availability and
condition of mainly the physical aspects of care were
assessed.
Profile of the hospitals :
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89.7% (234) of the owners of the hospitals are from the
Allopathic system of medicine.
Self proprietorship is dominant with 86.2 %( 225) of the
hospitals owners being sole proprietors.
86.6 %( 226) of the hospitals are housed in self-owned
buildings
40% (105) of the doctors said that they are involved in
multiple facility practices
Most of the hospitals are providing multiple services like
maternity, surgical, medicine and other speciality.
Human resources:
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54% (141) of the hospitals do not have a DMO. Wherever
present, they are mostly from other systems of medicine.
One fourth of the hospitals do not have any qualified
doctor to provide round the clock services. Neither the
hospital in-charge is living in the hospital premises nor
there is DMO available at the hospital
The average no. of qualified nursing staff for each hospital
is 1.68 nursing staff per hospital. Rest all were either
untrained or trained in-house.
Even additional services like laboratory and X ray are being
provided by untrained staff.
Standards of care:
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Emergency Services - 87%(228) hospitals reported that they
provide emergency services but only 54.4%(124) hospitals
provide round the clock services.
51%(117) of the hospitals have staff trained for emergency
services. One hospital staff is trained for Cardio–
pulmonary resuscitation.
Availability of ambulance is 5%(13) and only 27%(70)of
the hospitals had ICU.
No functional plan followed among the hospitals.
Basic facilities like telephone line, toilets, water supply,
electricity supply and so on found to be satisfactory.
Maintenance of records: Birth records 55% (143) and death
records 69% (180)
Standards of care (cont’d)
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Information given to the Patient
Only 37.2 %( 97) of the hospitals provide information
about the services available at the hospital.
One fourth of the hospitals do not give IPD papers even on
request, and half of them do not give OPD papers.
About 9% do not give discharge papers.
One fourth of the hospitals do not maintain a file for the
patients.
Privacy and Confidentiality to the Patients
Nine hospitals (3.4 %) reported that they do not provide
any type of privacy and stated that that there is no need to
provide the same.
About 6.1% (16) of the hospitals do not have any female
present during the examination of female patients by male
doctors.
Standards of care (cont’d)
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Grievance redressal mechanism in Hospitals
Nearly 61.7% (161) of the hospitals reported that they have
some grievance handling mechanism.
Fifteen hospitals had a designated person to look into the
grievances of patients and these are large sized hospitals.
About 80% (130) of the grievance handling mechanism is
in the form of complaints registered with the doctor. There
is no independent mechanism for handling grievances
against the owner-doctor.
Case of BNHRA (Bombay Nursing Home
Regulation Act, 1949
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First of it kind
Registration of private nursing homes, to be renewed every
three years.
Still not implemented properly despite judicial intervention,
civil society campaign. Applicable to the entire state.
Non-compliance to minimum requirements
under the BNHRA
Display of registration number
Only 21.4% of the registered hospitals displayed their registration number.
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Human resources: “Qualified doctor, qualified nurse and midwife in case of
maternity home”
Only 45% of the registered hospitals had a qualified DMO.
The availability of qualified nurse in registered hospitals is 2 per
hospital which is much below the actual requirements.
Untrained nurses are present in registered as well as unregistered
hospitals and form 10% of each.
Of the 146 hospitals providing maternity services, only 11 had
midwives.
Registration and Maintenance of Birth and Death Records -In terms of
maintenance of records, no difference was found between the hospitals
that are registered and those not registered.
Adherence to other laws/guidelines:
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BMW, PCPNDT and Emergency services are governed by
separate laws. Adherence to these was found to be higher
than to the minimum requirements for BNHRA
registration.
Violation of Universal Guidelines for Prevention of
HIV/AIDS : 13% of hospitals indulge in compulsory
testing for HIV, 50% conduct HIV test compulsorily for all
operative patients and those seeking ANC.
Emerging issues:
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Rapid Growth of Private Hospitals with less than 30 beds
without any defined standards of care. BNHRA only
provides minimum requirements for registration, other
rules not yet implemented.
Inadequacy of Human Resources, especially nurses. Issue
of ‘in-house trained nurses” needs to be addressed.
Need for better monitoring of registered facilities and
stringent penalties for non compliance on an ongoing basis
Absence of grievance redressal mechanism when doctors
have asked for law for their own protection!
Bringing all Laws governing Private Hospitals under one
umbrella to ensure better implementation.
THANK YOU !