Sindh Healthcare Commission struggles to reach public hospitals — II

Prof D r Farhat Jafri

By Mukhtar Alam

KARACHI: Beyond the numbers, senior medical professionals argue that SHCC’s struggles reflect deeper systemic and governance failures that continue to undermine effective regulation in Sindh’s healthcare sector.

Systemic Blind Spots: Prof D r Farhat Jafri, Dean of the Faculty of Community Sciences at Karachi Metropolitan University, says the SHCC has made “a solid start” in creating a regulatory framework but its impact on service quality “remains uneven.” The rollout of service delivery standards, he notes, has at least provided hospitals, clinics and primary-care providers with a clear benchmark.

Progress beyond this point, he argues, “stalls.” Several key standards—covering diagnostic centres, dental clinics and nursing homes—are still pending, and registration remains incomplete. “The foundation is there,” he says, “but day-to-day improvement in care is inconsistent.”

He attributes much of the compliance gap, especially in public facilities, to “deep systemic blind spots.” Sindh lacks a credible census of healthcare establishments, leaving many facilities outside SHCC’s regulatory orbit. Enforcement and follow-up are also weak: after seven years, only three public hospitals have secured regular licences. Many public facilities, he adds, simply lack the staff or financial capacity to meet SHCC requirements.

A perception that SHCC works “more as a fee-collecting body than a partner in quality improvement” further fuels resistance, he adds.

To rebuild trust, Prof Jafri recommends shifting from policing to collaboration, with transparent dashboards on registrations and inspections, incentives such as fast-track licensing or public recognition, and provider-led workshops where trained assessors work directly with district hospitals. The planned one-stop digital portal, he says, will also reduce bureaucratic friction.

For structural reform, he calls for a province-wide census anchored in Pakistan Medical and Dental Council (PMDC) data, partial linkage of health-sector funding to valid SHCC licences, a stronger Board with independent experts, a more empowered Technical Advisory Committee, and regular third-party audits—provisions already in the law but seldom executed.

Ultimately, he says, the SHCC must strengthen data systems, align incentives and present itself as a genuine partner if it hopes to move from “setting standards to raising the standard.”

Prof Dr Abdul Malik

Quality bottlenecks: Senior neurologist Dr Abdul Malik echoes some of these concerns, saying the Commission’s implementation of standards remains in its “infancy.” Frameworks exist, he notes, but their influence on ground-level service quality is limited.

Public-sector compliance, he argues, suffers from familiar problems: weak will, poor regulatory attitudes, and no practical mechanism to translate standards into routine practice. To build credibility, SHCC must ensure transparent processes and deploy trained staff capable of real engagement.

Dr Malik says structural reforms are “already in the books” but undermined by an entrenched office-bound “babu culture.” A functioning, on-ground check-and-balance system, he insists, is essential for basic standards to take root. He also stresses that SHCC still lacks traction not only in public facilities but across much of the private sector.

Adding to these concerns, former director general Health Services (Sindh) Dr Masood Ahmed Solangi voiced serious reservations about SHCC’s performance. He said the Commission has so far failed to deliver meaningful results, particularly in registering and overseeing government facilities. “Letters have been sent, but district health offices are not responding,” he noted, pointing to limited on-ground impact.

Dr Masood Ahmed Solangi

Dr Solangi questioned SHCC’s structure, saying an ostensibly independent regulator remains functionally under the Health Department’s control. He further criticised leadership appointments, arguing that the CEO lacks a background in health administration—experience he believes is essential for running a regulatory organisation with field-level responsibilities.

He suggested devolving certain powers back to district health offices, as was done previously, arguing that local accountability once produced better outcomes.

SHCC’s position: In response to these concerns, SHCC CEO Dr Ahson Qavi Siddiqi outlined the Commission’s efforts, progress, and ongoing plans to strengthen regulatory oversight across Sindh.

Dr Siddiqi defended the Commission’s performance, noting steady progress since operations began in 2018 despite limited resources. “We are satisfied with the trajectory of our progress,” he said, outlining early efforts focused on registering healthcare establishments, conducting anti-quackery drives, developing quality standards and training staff. Nearly 8,000 facilities were registered in this phase, and hospital and clinic standards were notified after stakeholder consultations. By 2019, standards for Homeopathy and Tibb were added, along with provisional licence inspections.

He acknowledged that Covid-19 shifted priorities toward pandemic-specific standards and licensing for hospitals, High Dependency Units (HDUs), labs and vaccination centres. “Other activities were paused, but in 2022 we reviewed earlier work to identify practical issues and solutions,” he said, adding that complaints—some diverted from courts—also began arriving, underscoring SHCC’s growing regulatory role.

Dr Ahson Qavi Siddiqi

On public-sector licensing gaps, he said many government facilities were registered but did not move forward due to assumptions that they were exempt, combined with HR and equipment shortages. SHCC has since facilitated inclusion of licensing fees in hospital budgets, prompting applications from major tertiary hospitals. A number of primary healthcare units under PPHI, he noted, have already been registered.

Dr Siddiqi admitted the Commission lacks the staff needed to monitor an estimated 25,000 health facilities across Sindh. “Our team is highly technical, with more doctors than any other commission, but the numbers are too small, and budget constraints limit hiring,” he said. Digitisation is planned to expand coverage, though financial limitations persist.

He added that SHCC follows a collaborative approach—working with Health Department wings, regulators, administrative authorities and law enforcement to support enforcement, offer training and connect private facilities with government initiatives to ensure uniform implementation.

Responding to another question, Dr Siddiqi said SHCC will soon begin registering and licensing diagnostic laboratories under newly prepared rules and standards. “Once the process starts, diagnostic labs attached to licensed tertiary hospitals—public or private—will need to apply afresh,” he noted. He also cited the fast-track registration of PPHI-managed units, clarifying that these are recorded as public-sector entities.

(Originally published by Social Track, Karachi)