Editorial: Lesson from PIMS
The fire at the Pakistan Institute of Medical Sciences (PIMS), in which 14 newborn babies lost their lives, has understandably brought hospital safety and institutional accountability into sharp focus. But beyond the immediate questions of how the fire started and who may be responsible lie a larger question: what happens when the regulatory framework designed to prevent such failures does not function with the consistency and authority intended by law?
The reported absence of a fire-safety clearance at PIMS, followed
by questions about the performance of the Islamabad Healthcare Regulatory
Authority (IHRA), has made the role of healthcare regulators part of the
national conversation. The issue is not simply whether a hospital possesses a
licence. A licence, at its most meaningfulness, should signify that minimum
standards of safety, infrastructure, staffing, emergency preparedness and
patient care have actually been assessed and met.
That is precisely where the experience of Sindh deserves closer
attention.
As reported in Social Track recently, the Board
of Commissioners of the Sindh Healthcare Commission (SHCC), its principal
policy-making and oversight body, has remained non-functional since the expiry
of its tenure earlier this year. The SHCC chief executive has maintained that
the commission continues to function through its executive structure and that
existing policies and regulations remain operative. That may be
administratively correct. But it does not make the institutional question
irrelevant.
A regulatory system is only as credible as its ability to enforce
the standards it has prescribed.
The SHCC's own regulatory framework makes no distinction between
public and private healthcare establishments when it comes to licensing. Its
standards apply to hospitals and other healthcare facilities across the
province. Yet the continued existence of large numbers of public-sector
facilities outside the effective licensing and inspection framework raises an
obvious concern: can the provincial government credibly demand compliance from
the private sector while public-sector healthcare facilities under its oversight
remain beyond the full reach of the regulator?
This is not an argument for blaming the SHCC for every weakness in
Sindh's healthcare system. Nor can a regulator substitute for the health
department, hospital management, fire authorities, professional councils or
other institutions with defined responsibilities. Healthcare safety is
inherently a shared institutional responsibility.
But shared responsibility cannot become diffused responsibility.
The real test of regulation comes before a tragedy, not after it.
It lies in identifying an unsafe electrical system, an inadequate emergency
exit, a non-functional alarm, deficient oxygen safety arrangements,
overcrowding or an unprepared emergency team — and requiring corrective action
while there is still time to act.
The PIMS tragedy therefore offers Sindh an opportunity for
preventive introspection rather than reactive alarm. The province need not wait
for a comparable disaster to ask whether its public hospitals are registered,
whether their licences are current, whether inspections are being conducted
against defined standards and whether deficiencies identified during those
inspections are actually corrected.
The question ultimately is larger than the SHCC or any individual
regulator. It concerns the credibility of the healthcare delivery system
itself.
Regulation that remains confined to legislation, notifications and
registers may create the appearance of oversight. Regulation that reaches the
hospital floor, verifies compliance and acts when standards are breached is
what protects patients.
For Sindh, the lesson from Islamabad should therefore not be
simply to investigate after a tragedy. It should be to examine the regulatory
gaps while there is still no tragedy to investigate.
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