Sindh Healthcare Commission struggles to reach public hospitals — I

Limited compliance, staffing gaps, and overlapping authority impede effective regulation

By Mukhtar Alam

KARACHI: Despite a decade-old mandate to regulate all healthcare providers, the Sindh Healthcare Commission (SHCC) has been struggling to bring public-sector hospitals and clinics into its licensing net — largely due to delayed administrative buy-in from the Sindh Health Department, a situation that has lately come to light.

The Commission, an autonomous body established under the Sindh Healthcare Commission Act, 2013, is tasked with strengthening healthcare quality, safety, and accountability across the province. The law and its accompanying rules envisage that SHCC will ensure minimum service delivery standards and patient-centred care in both public and private sectors.

However, observers say the Commission continues to face persistent challenges in securing compliance from healthcare providers across the board. Registration and licensing are legally mandatory for all healthcare establishments (HCEs), yet many private facilities remain outside the system—often due to fears of inspections, penalties, and the financial burden of meeting standards. “Some providers simply avoid registration to dodge compliance costs,” a senior practitioner noted.

At the same time, government-run facilities—ranging from dispensaries and Rural Health Centres to major teaching hospitals—remain caught in what insiders describe as a “locus-of-control dilemma,” with overlapping functions between SHCC and the Health Department leading to confusion over authority. Chronic underfunding, staffing shortages, and weak administrative urgency further dampen public-sector compliance, experts added. Unlike private facilities, they face little external pressure or risk of losing patients, contributing to the inertia.

Compliance barriers
During background interviews, several experts stressed that SHCC must prioritise deeper engagement with public-sector establishments, which account for a significant portion of essential health services yet remain the hardest to bring under regulatory oversight.

When contacted, SHCC Chairman Dr Khalid Shaikh said the Health Department has been approached repeatedly—verbally and in writing—to direct government facilities to complete mandatory registration and licensing, but a formal response is still awaited. Despite multiple requests, the Sindh Health Department did not issue any statement for this news report.

A data review shows that since 2018, SHCC has registered an average of 19 public/semi-government and 139 private HCEs per month, while issuing around two public and 16 private provisional licences monthly. Between July 2018 and October 2025, only four public-sector institutions received regular licences—three dental colleges affiliated with Dow University in Karachi and the Sindh Institute of Ophthalmology & Visual Sciences in Hyderabad.

The Commission’s database also includes 1,350 People’s Primary Healthcare Initiative (PPHI)–managed facilities, classified as part of the government cadre, of which 200 have received provisional licences.

While the data highlights SHCC’s limited reach across both public and private sectors, it also exposes critical gaps in enforcement and oversight. To understand the reasons behind these gaps and the challenges facing SHCC, several senior experts and former officials shared their assessments and recommendations.

(Originally published by Social Track, Karachi)

Part II of this report examines expert assessments of SHCC’s performance and the Commission’s response to these concerns.