14% of private hospitals never filed for registration: Study

Around 14% of private hospitals in Bangladesh have never filed for registration since licensing comes with many challenges, such as short validity, requirement for multiple clearances from authorities, long wait for approval and high fees, notes the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in a study.

Besides, of those registered, a large number of hospitals' licences have expired, but they are not going for renewal because of many such hassles, icddr,b has found. 

On Tuesday icddr,b and Data for Impact (D4I) jointly organised an evidence-sharing session with journalists at icddr,b's Mohakhali campus, focusing on licensing challenges in private health facilities in Bangladesh. Findings from an assessment done by icddr,b were revealed at the session. 

icddr,b conducted an assessment from 2019 to 2020 and explored the licensing practices of private health facilities in Bangladesh.

Presenting this research data, Dr Shams El Arifeen, Senior Director of Maternal and Child Health Division of icddr'b, said a research survey was conducted in 29 upazilas of 10 districts. In the course of the research, 1,189 private hospitals were asked to cooperate in an assessment of conditions, but 40 of them declined. Finally, 1,117 private hospitals were assessed.

Of the 1,117 private hospitals surveyed, 956 hospitals (86%) had come under registration at some point, he added.

As for the remaining 161 private hospitals, or about 14% of the number, they never went for registration, Dr Arifeen noted.

He further said out of 956 private hospitals that had once registered, the licences of 886 hospitals (79%) had expired, 66 hospitals (6%) had valid licences and the remaining four hospitals did not provide any information on the matter.

There was variation in the availability of documents necessary to obtain a licence. Facility owners also highlighted their reasons, including tax certificates and VAT certificates, for licensing delays.

Environmental clearance certificates and narcotic licences were reported to be difficult to obtain, and smaller facilities had greater difficulties obtaining both.

The Private Clinics and Laboratories (Regulation) Ordinance, 1982, outlined seven mandatory conditions to licence private facilities. Nearly 90% of the facilities assessed met three of these conditions: adequate floor space for each patient, air-conditioned operating theatre available, and at least one specialist available. 

However, there were poor compliances with some of the conditions identified partly due to unclear definitions and rules when assessed against standardised measures. Compliances against some mandatory conditions, such as infection control, essential equipment, and medicine were found to be of poor standard.

However, the study was conducted in 2019-20, so the situation may have changed within this time, informed icddr,b.

The Health Services Division has been conducting a strict campaign to close down illegal and unregistered clinic diagnostic centres in the country. 

This assessment took place in 2019 and the findings were shared with stakeholders in 2020. Based on the findings, many steps were taken by the hospital services management (HSM) unit of the Directorate General of Health Services (DGHS).

Dr Supriya Sarker, program manager of HSM, DGHS, outlined the steps taken by the DGHS based on this 2019 assessment. 

The DGHS official said, "Taking the application process online has streamlined licensing applications, but incorporating the existing system online has created different challenges, which need to be looked into for better implementation of the online system." 

Dr Sheikh Dawud Adnan, deputy director (hospital) of hospital services management, DGHS, shared the future initiatives of the unit. 

"To improve services of private health clinic facilities, there should be some indicators to measure the performance of such facilities. Self-inspections, regulatory inspections by third parties, and survey of consumer experiences can also assist in this," he said.