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Danger of Ineffective or 'Captured Regulation, Imperative of Social Accountability
Given this context of large and often dominant private sectors within the health systems of many LMICs, the mechanisms for regulation are often weak, under-resourced, bureaucratic and inadequately effective [1],[2]. There are major gaps in policy design and implementation, human resource constraints, problematic organizational relationships, and major risk of ‘capture’ of the regulatory bodies by private interests[3]. Regulation may be minimal, limited to addressing certain physical infrastructure issues, and standards may be influenced by either academic experts or the corporate healthcare industry. There is an emerging view that the problems with regulation of the private sector are not just narrow, technical issues of poor design, rather healthcare services have certain unique features requiring special regulatory strategies compared to other services or products. In fact regulation is a socio-political process which must address issues of quality, safety, affordability, access, transparency, accountability, equity and justice[4],[5]. Further the goal of universal health care provides a basis for taking a Health systems perspective to manage the private sector, and the main aim of government policies must be to develop a healthcare system that ensures widespread availability of good quality, free or highly affordable care, so that this system meets the needs of the population as a whole, especially working people and marginalised populations[6].
Linked with such a broader socio-political and people-oriented approach to regulation is the need to explore ‘bottom-up governance’, and related concepts of social accountability of regulators, and social regulation, related to the Health care system including the private medical sector. Social accountability refers to formal or informal mechanisms through which citizens and/or civil society organisations bring officials or service providers to account. ‘Social regulation’ refers to action-oriented approaches designed to reinvent and democratise regulation, with greater participation and accountability of the regulatory process to users and the public. This includes developing participatory oversight mechanisms for regulatory bodies, such as patient and citizen involvement in monitoring of enforcement of rules and regulations related to health care providers, from a patient-oriented and rights-based perspective.
[1]Peters, D., and Muraleedharan, V.R. (2008) Regulating India’s health services: To what end? What future? Social Science and Medicine 66:2133-44.
[2] Bloom, G., et al (2014) [3] Sheikh, K., Saligram, P., and Hort, K. (2013)What explains regulatory failure? Analysing the architecture of health care regulationin two Indian states. Health Policy and Planning 2013: 1-17. [4] Same as footnote 16 [5]Santos, F.P. and Merhy, E.E. (2006) Public Regulation of the Healthcare system in Brazil [6] Same as in footnote 5. |
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