Licensing is the gateway to improving quality of services at private health facilities: finds an icddr,b assessment

Dhaka, 30 August 2022

Today, icddr,b and Data for Impact (D4I) jointly organised an evidence-sharing session with journalists at icddr,b’s Mohakhali Campus that discussed licensing challenges in private health facilities in Bangladesh. Findings from an assessment done by icddr,b were presented in the seminar.

Since the 1970s, Bangladesh has seen remarkable improvements in health and many social indicators. A key driver of its success has been increased access to healthcare services across the country, provided by the government, non-government, and private providers. Since the 1980s, the private sector's provision of healthcare services has grown rapidly, including maternal and newborn health (MNH) services. Currently, about 80% of hospitals in Bangladesh are private facilities. Due to rapidly increasing numbers of facilities, many of these operate with little regulation. With support from the United States Agency for International Development (USAID), icddr,b conducted an assessment from 2019 to 2020 and explored the licensing practices of private health facilities in Bangladesh.

The assessment found that on the day of the survey only 6% of the private health facilities had a valid license, while 59% applied for a new/renewal of the license. It also found that there were several challenges to licensing. The 1982 Ordinance does not specify a validity period, nor penalties for delays. Facility owners also highlighted their reasons for licensing delays, including i) Short validity of license; ii) Multiple clearances requirement from authorities; iii) Limited technical capacity of smaller facilities to process applications; iv) Long wait times for application approval; v) Lack of feedback on application submissions; and vi) For small clinics, high license fees are most challenging.

The 1982 Ordinance outlined seven mandatory conditions to license 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 – found to be of poor standard.

Additionally, there were variation in the availability of documents necessary to obtain a license: Facility owners also highlighted their reasons for licensing delays, including Tax certificates (86%) and VAT certificates (58%) were widely available (86%) across small and large facilities.

Environmental clearance certificates (32%) and narcotic licenses (25%) were reported to be difficult to obtain, and smaller facilities had greater difficulties obtaining both.

This assessment took place in 2019 and the findings were shared with the 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 presented the steps taken by the DGHS based on this 2019 assessment. Followed by that Dr. Sheikh Dawud Adnan, Deputy Director (Hospital) of HSM, DGHS shared the future initiatives of the unit in this regard. He mentioned that “To improve services of private health clinic facilities there should be some indicators to measure the performance of such facilities. Self inspections, regulartory inspections by third parties, and survey of consumer experiences can also assit in this.”

The assessment findings were presented by Dr. Shams El Arifeen, Chief of Party, Research for Decision Makers Activity and Senior Director, MCHD, icddr,b and the event was graced by Dr. Kanta Jamil, Senior Research, Monitoring, Evaluation and Leaning Advisor, USAID; Dr. Fida Mehran; Dr. Samina Chowdhury; Dr. Riad Mahmud and Dr. Umme Salma Jahan Meena from USAID. Among others Dr. Quamrun Nahar, Head of Research (MCHD), icddrb; Dr. Mizanur Rahman, Country Lead of Data for Impact; Shusmita Khan, Knowledge Management and Communications Specialist of Data for Impact; Dr. Sharif Uddin Lotus, Research Investigator, icddrb also attended the event.

The experts stressed on addressing the challenge by i) revising and approving the draft 2016 guidelines, which add rules and procedures to the 1982 Ordinance. ii) estimating human resource requirements for inspection of all private facilities; iii) developing alternative modalities of compliance tracking and monitoring, e.g. sample auditing. iii) coordinating organizing dialogues with different government departments led by DGHS.

The event was jointly organised by icddr,b and Data for Impact (D4I), a data driven initiative of the University of North Carolina at Chapel Hill; and was supported by the United States Agency for International Development (USAID).

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For further information, please contact: Shusmita Khan, Knowledge Management and Communications Specialist of Data for Impact (D4I), University of North Carolina at Chapel Hill. shusmita@email.unc.edu or 01713209091