SHCC board in limbo again

Govt yet to reconstitute commission's key policy-making body months after tenure expiry

By Mukhtar Alam

KARACHI: Amid growing concerns over healthcare delivery across Sindh, the major policy-making and oversight body of the Sindh Healthcare Commission (SHCC) — the Board of Commissioners (BoCs) — has remained non-functional since the expiry of its tenure earlier this year, raising questions about regulatory governance in the health sector.

It is learnt that the statutory BoCs completed its tenure in the first week of February. However, the provincial health department has yet to initiate the process for constituting a new board in accordance with the Sindh Healthcare Commission Act, 2014, sources in the health sector said.

The law states that the general superintendence, direction and management of the affairs of the commission, along with overall policy-making in respect of its operations, vest in the Board of Commissioners.

Observers point out that such a keybody, comprising nine members with expertise in medicine, administration and law, should have been reconstituted well before the expiry of its tenure to avoid a statutory vacuum. They fear the delay could affect, among other functions, approvals of annual accounts, budgets and estimates of income and expenditure, as well as decisions relating to penalties, suspension and revocation of licences, and the sealing, resealing and de-sealing of healthcare establishments across the province.

The timely disposal of cases involving professional misconduct, public complaints against hospitals and clinics, appointments of officers and implementation of policy decisions may also be affected, according to stakeholders familiar with the matter.

Efforts were made to obtain the health department's version on the issue, but no response was received.

Given the continuing delay, the SHCC is set to enter the new fiscal year without formal approval of its financial estimates and certain other related matters. According to sources, the commission's chief executive officer had already brought the issue and its implications to the attention of senior health authorities in the government.

A source said that in the absence of the BoCs, the SHCC was unable to impose and recover financial penalties from certain non-compliant healthcare establishments (HCEs). Another source claimed that a number of public complaints against healthcare facilities remained pending despite completion of legal scrutiny and recommendations, owing to the absence of the board.

Concerns over the issue were also echoed by the Pakistan Medical Association (PMA), which recently commented on reports of a rise in HIV diagnoses among children in Sindh.

The PMA raised questions about the effectiveness of regulatory oversight in the province, particularly the role of the SHCC. The association said the commission was operating without a Board of Commissioners and argued that the absence of the board had affected its ability to carry out certain enforcement functions.

It called for the immediate appointment of a board to strengthen regulatory oversight and support action against illegal medical practice. The PMA also maintained that stronger enforcement against unqualified healthcare providers and unsafe medical practices was necessary to help prevent further HIV infections among children.

When contacted, SHCC Chief Executive Officer Dr Ahson Qavi said the commission continued to function under the leadership of its chief executive officer and directors.

"The board does not perform executive functions at a healthcare commission. It provides overall guidance for the execution of operations," he said.

According to Dr Qavi, regulations and policies framed by previous boards remain in force and continue to guide the commission's operations. He said the health department had been informed about the expiry of the last board's tenure through an official communication.

While acknowledging that an early appointment of a new board would be helpful, he stressed that the matter did not fall within the SHCC's mandate. "Last time there was an intervening period of about 12 to 13 months before a new board was constituted," he said.

Referring to recent criticism from the PMA and other quarters linking the rise in HIV cases to the commission's performance, Dr Qavi rejected the assertions.

He said such claims reflected a misunderstanding of HIV transmission, risk groups and public health dynamics. According to him, it was incorrect to portray the SHCC as the sole institution responsible for controlling all factors associated with the spread of HIV.

Dr Qavi further argued that such criticism indirectly questioned the policies adopted by previous SHCC boards and created a perception that those policies had contributed to the increase in HIV cases. He described that perception as baseless.

Regarding healthcare establishments, he said their regulation and management involved multiple stakeholders. "It is very easy to make one scapegoat," he remarked.

(Originally published in the weekly Social Track, Karachi)

Photos courtesy: SHCC