Healthcare Landscape in Pakistan – Regulatory Structure – Asrar Qureshi’s Blog Post 981

Healthcare Landscape in Pakistan – Regulatory Structure – Asrar Qureshi’s Blog Post 981

Dear Colleagues! This is Asrar Qureshi’s Blog Post 981 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

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As is the case in other government functions, there are several institutions who are supposed to regulate various components of healthcare. After 18th Amendment, health was devolved to provinces. So, now there are federal and provincial bodies supposed to regulate healthcare. The state of healthcare, however, is anything but satisfactory. The major reason is that the regulatory bodies do not coordinate with one another and keep blowing their own trumpets without achieving anything concrete.

The biggest problem with government agencies and particularly regulatory bodies is that they do not interact with relevant stakeholders. In fact, they prefer to stay away and work in isolation. Due to this aloofness, their decisions are not grounded.

Key Regulatory Bodies – Federal

Ministry of National Health Services, Regulations, and Coordination (NHSRC)

The NHSRC is the primary federal agency responsible for national health policy, planning, and regulatory oversight. Its functions include: formulating health policies and strategies; coordinating with provincial health departments; and implementing national health programs. The Ministry does not have any power over the provinces to get anything done, and that is what happens.

Drug Regulatory Authority of Pakistan (DRAP)

DRAP is the central regulatory body for pharmaceuticals and medical devices. Its functions include registration and licensing of drugs, medical devices, and health products; ensuring compliance with Good Manufacturing Practices (GMP); regulating drug prices; monitoring the quality, safety, and efficacy of medicines; and conducting inspections and audits of manufacturing facilities.

DRAP was formed under DRAP Act 2012 with above mandates. Till date, it has not been able to hire required staff and therefore the list of pending work/ applications has been piling up. DRAP increased fees for all its services manifold, but the services are still elusive. Another major issue is that DRAP does not interact with stakeholders frequently to understand and resolve their issues.

DRAP is located in Islamabad and has offices in all provincial capitals which carry out specific field-related functions.

Pakistan Medical and Dental Council (PMDC)

PMDC regulates medical education and the practice of medical and dental professionals. Its functions include: accrediting medical and dental schools; registering and licensing medical and dental practitioners; and setting standards for medical and dental education.

Pakistan Nursing Council (PNC)

PNC is an autonomous body which issues licenses of practice to nurses, midwives, lady health visitors, and nursing auxiliaries. It is also responsible for inspecting nursing education institutes for purposes of accreditation and maintaining education standards.

College of Physicians & Surgeons Pakistan (CPSP)

CPSP is responsible for postgraduate medical education and specialization in various specializations. It sets standards, conducts exams, and notifies successful candidates. Their postgraduate degrees – FCPS/ MCPS – are recognized in all medical institutes across Pakistan and few countries abroad.

Islamabad Healthcare Regulatory Authority (IHRA)

Established in 2018, UHRA aims to improve the quality, efficiency, and safety of healthcare services delivery by adopting evidence-based regulatory standards for registration and licensing of healthcare establishments, health professionals & equipment, and developing and enforcing minimum standards of safety for patients, healthcare professionals, and other staff in healthcare establishments in the Islamabad Capital Territory.

National Institute of Health (NIH)

The idea of establishing a National Health Center (NHC) was conceived in early 1960’s, which started functioning in 1965 at Islamabad. Directorate of Nutrition Survey and some other health related research organizations were shifted to NHC. Later, all these independently working departments were integrated and designated as National Health Laboratories (NHL – Islamabad).

This organization was given the status of an autonomous organization as National Institutes of Health (NIH) under the Ministry of Health (MoH) through a presidential ordinance XLIII of 1980, to facilitate international and regional collaboration, seek technical assistance and participate in global disease control programs more effectively.

The institute is a WHO collaborating center for viral diagnostics and regional reference laboratory for polio, in addition to being a national reference center for diagnosis of Influenza. It also works as the National Appellate Laboratory for quality control of drugs and is the public analyst laboratory for the quality control of food for the federal territory, Islamabad. NIH also conducts numerous international, regional and national seminars, symposia and other related activities.

Key Regulatory Bodies - Provincial

Each province in Pakistan has a large health department headed by the Secretary Health, responsible for healthcare delivery and implementation of health policies at the provincial level. 

Provincial Health Secretariat

Their functions include: managing public health services; implementing provincial health policies and programs; and monitoring and regulating healthcare facilities within the province.

Directorate Health Services

Headed by a Director General, the department controls sale of medicines through issuing licenses to pharmacies and through visits by their drug inspectors. 

Punjab province, during the last several years has established few more institutions to regulate healthcare. 

Punjab Health Initiative Management Company (PHIMC)

PHIMC is registered under Companies Act 2017. The main task of PHIMC is to execute social health protection initiatives, demand side financing schemes, including pro-poor health insurance schemes, and collaboration with private sector to provide universal health coverage.

The company is also working on different arrangements within stipulated legislative and policy frameworks to further strengthen the health service delivery in Punjab.

Primary & Secondary Healthcare Department (P&SHD)

Primary and Secondary Healthcare Department (P&SHD) delivers quality healthcare services to the community through an efficient and effective service delivery system that is accessible, equitable, culturally acceptable, affordable and sustainable. P&SHD aims to improve the health and quality of life of all, particularly women and children, through access to essential health services.

The Primary and Secondary Healthcare Department strives to reform and strengthen the critical aspects of the health systems and enable it to:

• Provide and deliver a basic package of quality essential health care services

• Develop and manage competent and committed health care providers

• Generate reliable health information to manage and evaluate health services

• Adopt appropriate health technology to deliver quality services

• Finance the costs of providing basic health care to all

• Reform the health administration to make it accountable to the public

Specialized Healthcare & Medical Education Department (SH&MED)

According to Rule of Business 2016, Functions of Specialized Healthcare & Medical Education Department are as under:

• Health management, planning and policy.

• Policy or guidelines relating to Specialized Healthcare & Medical Education Department.

• Medical profession:

o Regulation of medical and other professional qualifications and standards.

o Medical practitioners (National Service) Act, 1950.

o Medical registration including Medical and Dental Council.

o Medical attendance of government servants.

o Guidelines regarding levy of fee by medical officers.

o Medical Treatment of Government employees officers.

o Medical Treatment of public.

• Medical and Nursing Council.

• Medical education including Medical Schools and Colleges and institution of Dentistry.

• Medical institutions, blood transfusion services.

• Collection, compilation, registration and analysis of vital health statistics and estimation of population for future projections.

• Matters relating to nursing:

o Administrative control of the entire nursing cadre in the province in respect of those working under the department or in the teaching hospitals.

o Education (local and foreign) service and pay structure of nursing cadre.

• Preparation of development schemes, budget, schedule of new expenditure and annual development program proposals.

• Service matters except those entrusted to Services and General Administration Department.

• Administration of the related laws and the rules framed there-under.

Punjab Health Commission (PHC)

The Punjab Healthcare Commission aims to improve the quality of healthcare service delivery for the people of Punjab through implementation of Minimum Service Delivery Standards (MSDS) in both public and private sector healthcare establishments including allopathic system of medicine & surgery, alternate systems of medicine like Homoeopathy and Tibb.

KEY FUNCTIONS

• Develop and notify Minimum Service Delivery Standards (MSDS) for all categories of Healthcare Establishments

• Inspect HCEs – Healthcare Establishments – to ensure compliance with the PHC standards

• License HCEs that meet the standards. A HCE that does not meet the minimum service delivery requirements will not be licensed and will not be allowed to operate.

• Suspend or revoke licenses in part or in full on non-compliance with standards, maladministration, mal-practice or medical negligence

• Charge fees from healthcare establishments for licensing/provisional licensing

• Levy fines on HCEs for non-compliance with MSDS

• Investigate serious system failures in service provision

Sum Up

If, after reading the above, you think that the healthcare regulatory system is very robust, it is not so. It is a complex system with many overlapping responsibilities where no one is finally responsible. There are too many bodies, and entirely too many officials either warming their seats or running around to show efficiency. Another serious problem is that the healthcare budget, which is already meagre, is further squandered by the presence of too many people. Serious reforms are needed urgently.

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

References:

https://dra.gov.pk

https://ihra.gov.pk/

https://phimc.punjab.gov.pk/

https://www.nih.org.pk/

https://pshealthpunjab.gov.pk/