It has been one-and-a-half years since the government introduced a digital licensing system for private hospitals and diagnostic centres.
Yet, about one-third of the players in the health sector – both big and small – seem to be irresponsive to the new mechanism, causing a headache for the regulators.
The technological tool is aimed at bringing discipline to the sector and facilitating the monitoring process.
As many as 5,000 entities across the country have not yet applied online for a licence. This means that they have been operating with expired licences since June 30, 2018 when the new mechanism was put in place.
About 15,000 healthcare facilities got permission till 2018 to operate in the country under a 1982-ordinance aimed at regulating medical practices and private healthcare facilities.
It is mandatory for all healthcare entities to (apply for and) renew their licences online.
The Directorate General of Health Services (DGHS) provides licences for one year and private entities have to renew them every year.
One of the big hospitals not having a valid licence now is BIRDEM General Hospital at the Shahbagh intersection in the capital. It submitted an incomplete document online and the DG Health notified the hospital of the inadequacy thrice – August last year being the latest.
Nazimul Islam, joint director of the hospital who is now the director in-charge, said the online procedure is quite complex for a big hospital like Birdem that employs a lot of people.
"All their appointment letters have to be uploaded. It is a huge task."
Nazimul explained that it is very difficult to take new measures like setting up a fire exit in a 35-year-old building which is beside a major thoroughfare. There are new requirements to get clearance certificates from other agencies as well, for example the one from the Department of the Environment.
According to the DGHS, the licensing form requires the professional registration numbers of doctors and nurses, and the national ID numbers and contact numbers of other staff members.
About the environment clearance certificate, an official who requested anonymity because he is not authorised to talk to the media, said the health directorate gives licences even if hospitals submit a document showing that they have already submitted an application for the environment clearance certificate.
Like Birdem, the National Heart Foundation Hospital and Research Institute also does not have a valid licence now.
When contacted, Col Shamsul Alam, director of the National Heart Foundation Hospital, told The Business Standard that he would look into the matter and tell us later, but later he refused to say anything because of what he said was illness.
An official told The Business Standard that they would submit an application for licence next week.
Before the new system was introduced, licences were issued and renewed manually. It was a tedious task for both the licence issuer and the applicant to get the job done.
Private healthcare facilities often blamed the lengthy process of getting a licence for encouraging them to continue operations without a valid document.
With a pending application for licence renewal, many entities even violated legal provisions, for instance, by keeping a blood bank that requires separate permission to operate.
The manual process allowed many other corrupt practices, and the authorities were unable to check them, according to sources at the DGHS. There was also a risk of getting a fake licence.
Against this backdrop, the health directorate devised modern solutions, for example the online licensing system, so that monitoring could become easier.
With the new system coming into effect, nearly 3,000 facilities have got a licence so far. Another 3,000 licence applications are incomplete. Around 1,400 facilities are waiting for an inspection by the regulators before getting a licence, while about 1,000 others have been cleared for one.
Aminul Hasan, the director (hospital and clinics) of the DGHS, said hospitals are reluctant to follow the new system. "Even after we identify gaps in applications and issue a reminder to hospitals and diagnostic centres, they do not follow up."
He said the DGHS would give the reluctant entities some time before it goes for any action. "I believe the system will be fully functional by 2020 with the records of all private hospitals and diagnostic facilities updated."
The health directorate has already sat with members of the clinic owners' association to emphasise the use of the digital licensing mechanism. It will eventually discuss the matter with others.
Meanwhile, the health directorate has divided Dhaka into four zones – east, west, north and south – and constituted four separate teams to run inspections and mobile court drives there. Three teams will be given the responsibility at the district level.
A complete database coupled with strict monitoring will help regulate the private healthcare sector efficiently, Aminul said.