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Essential Standards

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The pernicious licence-permit raj culture of the ‘Socialist’ dark ages in India continues to haunt the system even as the economy struggles to modernise along market-oriented lines. From having a finger in every pie, the government needs to confine itself to a regulatory role that ensures healthy competition between market entities and curb monopolistic tendencies as well as illegalities. Standards have to be established so that the competitive edge is not achieved through cheating and poor quality products. This applies also to the services sector.
It is easier said than done, because those whose business models are archaic find it difficult to make the shift into the new economic model. This requires, of course, phased implementation in consultation with domain experts and all stake-holders, including the consumer of the product or service. It must be understood, however, that it is absolutely not possible to modernise without undertaking these reforms.
The primary phase of any reform involves data collection. Without information and compilation of records, it is simply not possible to plan and implement policies properly. At the same time, though, there has also to be a gold standard to be applied to practices so that the deficiencies can be identified. In India, this requires core legislation (Model Acts) by the Centre along which the states can implement regulations in accordance with their grassroots realities. As such, a timeline needs to be designed by which quality upgrades can be done to achieve, first, the minimum level and then move on to the desired maximum. It is not easy in a country unused to disciplined behaviour – decades have passed since legislation was passed on wearing helmets while riding two-wheelers, but except for a few cities, the rule is followed more in the breach.
It is quite obvious that these are the elements that are complicating the implementation in Uttarakhand of the Clinical Establishments (Regulation and Registration) Act which was passed as long ago as 2010. While it is imperative that certain elements of the law be implemented without any delay – such as medical waste management – all stakeholders need to prepare a timeline, together, so that the objectives can be achieved. There can be no excuse, however, for continuing with practices that – in this day and age – do not meet the minimum requirements of healthcare. The state needs to, first, prepare a register of all medical establishments and, then, grade them along certain parameters. To begin with, signage outside each establishment should inform patients about the standard it maintains. As such, they would take informed decisions. All those establishments that wish to be graded higher would improve facilities and be provided recognition accordingly by the Government. The grading should be based on the model act, such as number of employees, their qualifications, technology used, fees, etc. Also, a reasonable cut-off date should be set for each establishment to upgrade to the next level, or have its recognition cancelled. Recent events have shown that failure to impose the minimum standards leads to major tragedies and it is the government that is put in the dock for not enforcing the regulations. There is no way in this day and age that reforms can be dodged or avoided.