Medical licensing

Regulation and quality assurance in allied healthcare systems remain a concern

Medical licensing

The state has a responsibility to define ways to ensure quality control in the medical industry. This can be achieved through committed healthcare professionals, including those working in allied health professions to improve patient satisfaction and protect patients from harm. Occupational licensure and other forms of regulation are key to exercising this authority.

Pakistan has licensed lawyers, dentists, pharmacists, physicians and nurses. The regulatory councils develop standards, protocols, norms and guidelines. They also accredit healthcare facilities.

The Pakistan Medical Commission (PMC), which oversees the register for doctors and dentists, has a good regulatory mechanism. However, it does not cover allied healthcare professionals. The Pakistan Nursing Council regulates only nurses, midwives, lady health visitors (LHVs) and nursing auxiliaries for practice in Pakistan.

Given the wide variety in type of practices, such as public and private practitioners, formal and informal healthcare providers in low- and middle-income countries (LMICs), a mechanism has to be identified to promote people-centeredness and good clinical practices.

Working towards achieving population health goals can be challenging with a mixed workforce. Dealing with clinical governance issues can also be complex and demanding in such situations.

During Covid times, measures were taken in many parts of the world to expand the capacity of the existing health workforce. Various strategies, for instance, working full time/extra hours, leave cancellations, final year medical students to graduate early, retired healthcare practitioners to return to work, etc., were applied.

In South Asia, a majority of the countries’ doctors and nurses work in urban milieu. In Pakistan, in spite of an extensive network of healthcare facilities, health status of people as a whole is below the desired level.

Large populations in our region reside in rural settings with frail public healthcare system and severe shortages of health workers. There is therefore a reliance on large informal sector. Reforms are needed to achieve an equitable and accountable health system.

To improve the quality of care and enhance clinical outcomes, the PMC has taken steps to ensure the competencies of doctors by bringing in National Licensing Examinations (NLE) and planning to implement compulsory continuing medical education.

Regulation and quality assurance in allied healthcare systems remains a concern. The scope of practice of various allied health professionals is not clearly defined and, hence, cannot be regulated.

Allied health professionals and paramedics are defined as people who assist in providing healthcare services for diagnostics, therapeutics, preventive, curative and rehabilitative fields in the healthcare delivery system.

To improve the quality of care and enhance clinical outcomes, the PMC has taken steps to ensure competencies of doctors by bringing National Licensing Examinations and planning to implement compulsory medical education. 

There is a dire need for standardising the curriculum, training and practice of these professionals to facilitate the qualified and trained professionals to deliver quality health services at par with international standards by bringing about uniformity in basic and higher qualification, registration and organisational structure of both public and private teaching institutes.

To overcome these issues, the National Assembly has passed a bill to regulate the allied healthcare professionals. It is called the Pakistan Allied Health Professionals Council Act, 2021.

The Council of Allied Health Sciences Pakistan has also been established with the objective to improve the quality and availability of trained allied healthcare professionals. It still requires a more proactive approach.

In Pakistan, like other low- and middle-income countries, there are issues in the enforcement of continuing professional development for healthcare professionals and the provision of supportive supervision in capacity building.

Non-compliance, lack of enforcement, bribery, corruption and overcharging may lead to a failure of regulation despite the good intention of the regulatory authorities.

Such failures cause a breakdown of trust between patients, service providers and the regulators. Performance is also influenced by a proliferation of low-quality private institutions due to which the regulations do not achieve the intended effect.

It is essential therefore to set standards of training and conduct of health professionals and define the scope of practice and roles and boundaries of healthcare workers.

Essentials for a good standard of practice include professional behaviour, knowledge and skills required of a doctor. Patient trust must be maintained by being honest and acting with integrity. A framework to measure quality of allied healthcare can be developed and implemented along similar lines.

This calls for the establishment of a medical register and ensuring that no healthcare worker is without a licence to practice.

In order to ensure patient safety and promote best practices, it must be made compulsory for a healthcare worker to be registered with a regulatory body. Following such registration, they must be allotted a unique number.

The register should contain information about the institution they obtained their basic medical/dental qualification from and any further degrees they obtained. This should also apply to those practising complementary or alternative medicine.

Being on a medical register has great advantages. It encourages application of clinical guidelines and monitoring of healthcare workers’ performance and maintaining high professional standards. The professional development activities (for example, courses and workshops) can be linked to appraisals and revalidation.

Dr Hina Jawaid is Assistant Professor in Family Medicine, University of Health Sciences, Lahore

Dr Abdul Jalil Khan is Assistant Professor in Family Medicine, Khyber Medical University, Peshawar

Medical licensing