For a Punjabi like me, travelling from Lahore to Gujranwala on the GT Road is always a pleasure. Along the road one can see farms stretching for miles, industrial complexes, and vibrant small towns. But as I go through the small towns, some now large enough to be called cities one interesting thing I notice is the large number of storefronts with a sign proclaiming them to be a ‘hospital’.

Fortunately during my travels I have never needed the services of such a hospital, but I often wonder whatever makes such an establishment proclaim that it is a hospital. The first 30 years of my professional life was spent in the US where hospitals are very closely regulated and monitored. So when I see a storefront made up of one or two rooms proclaiming that it is a hospital, it always makes me wonder who or what agency of the government monitors such a claim.

Before I go any further, I want to stress the fact that there are many private hospitals in our major cities that are indeed worthy of being called real and proper hospitals. Just off the top of my head in Lahore alone I can name more than half a dozen such institutions. Even so, the only true ‘general hospitals’ that I know of that provide full service and treatment for almost all types of patients remain in the public sector. These include our great teaching hospitals attached to our public medical colleges.

Let me just enumerate what in my opinion must be available before any medical establishment can call itself a ‘hospital’. First and foremost is a fully equipped and staffed emergency room or what was once quaintly called a ‘casualty department’. An emergency room must have around the clock ability to take care of all patients seeking medical care.

This includes available medical and nursing staff capable of caring for paediatric and adult patients that arrive with medical or surgical problems. It must also have an attached laboratory that provides basic blood tests and also has diagnostic capabilities like X-Rays, ultrasounds, ECG and monitoring facilities. Also senior consultants must be available at short notice to take care of complicated medical or surgical cases.

The next obvious requirement is intensive care units (ICUs), Coronary Care Units (CCUs), Operating theatres that are fully staffed and blood banks that can provide blood for transfusions to patients in need. Of course, what then is needed is multi-specialty support. It must, however, be accepted that even some of the well equipped hospitals cannot provide the most advanced type of specialised care. For this reason, ‘tertiary’ care hospitals or specialised institutions are available that can step in with treatments that general hospitals might not have available at their premises. Even so, most general hospitals must have the capability to stabilise patients before they can be transferred to specialised centres.

However, there is one problem that most ‘private’ hospitals face. Patients who have ‘medico-legal’ problems like gunshot wounds or arrive after accidents do not receive anything but the most rudimentary care in these institutions and this includes some of the largest and very well equipped hospitals. The legal problems that arise after taking care of such patients can create a major problem. After all staff and private practice dependent physicians that are paid by the hour cannot be sent off to sit around waiting to give evidence at different courts for months and even years.

A few years ago, Government of the Punjab created a Punjab Health Care Commission (PHCC) with the purpose of licensing and overseeing hospital facilities. Unfortunately, not much has been done to close down the nominal hospitals that have minimal facilities and often even do not have qualified staff available on premises. Frankly, such ‘healthcare providers’ do more harm than good for the population in general. Substandard clinics and inadequately trained ‘quacks’ are at present the major source of the Hepatitis epidemic that is sweeping the country. The first priority of the PHCC must be to monitor and, if possible, shut down such establishments.

The next order of business must be to examine all the public hospitals and make sure that they are complying with regulations. From the perspective of the ordinary people, the quality of healthcare available in government run hospitals is most important. After all a majority of citizens seek care in these hospitals. But there is also a secondary factor that ultimately is also very important. Most of our physicians and future specialists are trained in these hospitals and what they learn here is what they will do when they go out to practice on their own or in other institutions.

If government run hospitals are not supervised and the quality of care examined, then no government or semi-government agency has the right to try and ensure rules and regulations for the private sector. That happens to be one of the major complaints of the private sector hospitals against the PHCC.

However, the focus of the PHCC seems to be on intimidating larger private hospitals and enforcing requirements that have little to do with patient care. Clearly, it is impossible for private hospitals to adhere to western standards of medical care. These hospitals would very much like to provide the sort of care available in major hospitals abroad but they have to live with the realities that exist in Pakistan.

We have a shortage of doctors, nurses, paramedical staff, and much of the advanced technology is often just too expensive to obtain and to maintain. The problem simply becomes that if these hospitals in the private sector try and keep up with the requirements that are presently being enforced by PHCC they will price themselves out of the market for the average middle class patients. That will be a disaster and will increase the burden on the already overburdened public healthcare system, deficient as it is.

It is obvious that private hospitals must be regulated and supervised but rather than enforcing unenforceable regulations about paper work and doctor’s notes, the emphasis should be on things that really matter. Equipment, adequate staffing, functioning labs, sterilisation of instruments, proper disposal of medical waste, and a system of determining quality of care including surgical and medical outcomes are the obvious priorities.

One of the important things to remember is that private hospitals are run along business lines. Unless they can show a profit, they will not survive. Over the last few years, many private hospitals are now available that provide relatively advanced care and also compete among themselves. That is one of the keys to their success. If they provide good care at a competitive price, they will succeed or else they will fail.

Such competition in the long run will allow these hospitals to improve. If the hospital is profitable, that will be an incentive for its management to invest in technology, infrastructure, and human capital to make it even more profitable. So as far as the PHCC is concerned, its primary goal besides supervising government run hospitals should be to provide a basically acceptable level of performance and make sure that the private hospitals function in a comparable fashion. In other words, it should try and provide what can be referred to as a ‘level playing field’.