Editorial: Balancing care regulation

Why Sindh’s healthcare oversight struggles to align standards, authority and support?

A recent report published in this newspaper has drawn attention to a troubling paradox at the heart of Sindh’s healthcare regulation i.e. despite having a legal mandate for over a decade, the Sindh Healthcare Commission (SHCC) remains unable to effectively regulate public-sector hospitals and clinics. What was envisaged as an independent watchdog for patient safety continues to struggle with delayed administrative backing, overlapping authority, and a lack of sustained political urgency.

The law itself is unambiguous. Registration and licensing are mandatory for all healthcare establishments, whether public or private. Yet, as highlighted in the report, while many private facilities—often reluctantly—enter the regulatory net, a vast majority of government-run hospitals and clinics remain outside it. This imbalance not only weakens regulatory credibility but also violates the principle of equal accountability.

At the core of the impasse is a structural contradiction. Although the SHCC is legally autonomous, compliance by public-sector facilities depends largely on the Sindh Health Department’s administrative will. This unresolved “locus-of-control dilemma” has created a regulatory vacuum: public hospitals neither feel compelled to comply nor face meaningful consequences for non-compliance. Correspondence continues, but enforcement rarely follows.

The Commission’s own data, cited in the report, underscores the scale of the problem. Since 2018, only four public-sector institutions have secured regular licences. Thousands of government facilities continue to operate without formal certification of safety and service standards, even as they serve the province’s most vulnerable populations. Meanwhile, private healthcare providers—subject to market pressures—are more likely to comply, entrenching a two-tier accountability system.

As experts quoted in the report point out, the difficulty is not the absence of a regulatory framework but the failure to translate it into practice. Standards have been notified, yet remain incomplete. Inspections occur, but follow-up is inconsistent. Public hospitals, already burdened by staffing and funding shortages, struggle to meet requirements—but exemption is neither a legal nor a moral solution. Patients in public facilities deserve the same protections as those treated elsewhere.

Equally damaging is the perception that regulation functions more as a revenue-driven exercise than a mechanism for quality improvement. When oversight is viewed as punitive rather than supportive, resistance deepens and compliance becomes superficial. A regulator cannot raise standards through policing alone—particularly in a health system weakened by chronic underinvestment.

The remedies, notably, are neither novel nor disputed. They are already embedded in law or repeatedly recommended by experts: a province-wide census of healthcare establishments; transparent public dashboards on registrations and inspections; incentives for compliance; third-party audits; and partial linkage of funding to valid SHCC licences. Above all, the Health Department must issue clear, binding directives requiring all public facilities to comply—ending the ambiguity that has stalled progress.

The SHCC faces real constraints, including staffing shortages and limited resources. But regulatory credibility rests on outcomes, not intent. Digitisation, collaboration and phased enforcement can help—but only if matched by political will.

It is high time stakeholders recognise that healthcare regulation is not a bureaucratic formality but a patient-safety imperative. Until public hospitals are held to the same standards they are meant to uphold, Sindh’s regulatory promise will remain incomplete—setting standards on paper, while falling short where it matters most: at the bedside.

Courtesy: Social Track, Karachi