Many private hospitals have applied for licence renewal and have been pursuing the health directorate for years, but to no avail. The licences are yet to be renewed.

The hospital authorities say that the application process is complicated and also that the health directorate’s administration lacks efficiency.

The health ministry, on the other hand, has been declaring that innumerable hospitals have been running without licences.

Facing a volley of criticism regarding COVID-19 treatment during the prevailing pandemic, the health ministry gave the private hospitals a month’s time, hurriedly setting 23 August as the deadline to apply for licence renewal.

However, the president of the private clinic and diagnostic owners association, Moniruzzaman Bhuiyan, has said it is simply not possible for all hospitals to renew the licences within this time.

After all, he pointed out, the Directorate General Health Services (DGHS) only had 9 officials designated to carry out the renewal procedures.

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Director of DGHS, Fariduddin Miah, speaking to Prothom Alo, said that till Wednesday, a total of 11,773 applications for licence renewal had been submitted online. Of these, the licences of 4,516 hospitals had been renewed and the rest is being processed.

According to DGHS records of 2018, there are around 17,000 hospitals, clinics and diagnostic centres in the country. This number has not been updated since then.

Many have complained about the complicated renewal procedure. Founder of Gonoshasthaya Kendra, Zafrullah Chowdhury, has termed this as extortion.

He told Prothom Alo that licences are essential but the manner in which one has to run around for this, pay at every step, it is nothing short of extortion.

He said, “Gonoshasthaya applied for licence renewal three years ago. We paid a ‘toll’ of Tk 1 million. The fee they have fixed is like a donation. Other than big businesses, not one can pay such exorbitant fees. The bottom line is, nothing moves in the health sector without money. Unless the prevailing regulations and procedures are revised, hospitals will continue to run without renewed licences. And we will continue to pay toll.”

Health minister Zahid Maleque said he had given a one-month deadline to renew the licences, no matter how. But the health secretary had said that the applications for licence renewal have to be submitted by 23 August. Which is correct? The minister said, “As the minister, what I said must be correct. That is my order.”

On the question of the licences of the larger private hospitals, the High Court last month observed that the licences of some of the bigger hospitals like BIRDEM have not been renewed. Regarding how such institutions will now run, the president of Bangladesh Diabetic Association, AK Azad Khan, told Prothom Alo, “BIRDEM applied for its licence long ago. The problem is with the owner. The name of the owner is to be given on the form, but the owner of BIRDEM is the public. Whose name will we write? The application could not be submitted without a name. Then again, BIRDEM’s building was constructed by PWD and they did not take any environment clearance. More importantly, why does BIRDEM even need a licence? It is a social welfare institution and runs on government grant.”

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The previous system of renewal has been replaced. From 2018, hospitals are to apply online, with various documents and following certain conditions. If any of the conditions are not met, the application is not accepted online. This has created a hitch in licence renewal. In the meantime, the ministry has said that if the applications are not submitted by 23 August, legal action will be taken.

Chattogram civil surgeon Fazle Rabbi said, the process is very complicated. It takes a year to get environment and narcotics clearance. He feels that the licences should be renewed every three years, not every year.

The health minister and the health secretary have made contradictory statements. The health minister Zahid Maleque told Prothom Alo that he had given a one-month deadline to renew the licences, no matter how. But the health secretary had said that the applications for licence renewal have to be submitted by 23 August. Which is correct? The minister said, “As the minister of the ministry, what I said must be taken as correct. That is my order.”

Renewal fees

The annual renewal fee was previously Tk 5000. From 2018 the online application system was introduced and the annual fee was increased to a minimum Tk 50,000 to a maximum Tk 250,000. The renewal fee for any hospital in divisional towns and city corporation area, regardless of the number of beds, was Tk 5000. The revised fee is Tk 50,000 for 10-bed to 50-bed hospitals, Tk 100,000 for 51-bed to 100-bed hospitals, Tk 150,000 for 101-bed to 249-bed hospitals, and Tk 200,000 for 250-bed hospitals.

At a district level the minimum fee is Tk 40,000 and maximum Tk 150,000. At the upazila level it is from Tk 25,000 up to Tk 100,000. The fees for hospitals with over 250 beds are even more. With the addition of VAT, the fees are even higher.

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Complicated application forms

Speaking to Prothom Alo, several officials of the health ministry and directorate said, basically the complications have arisen over filling out the application forms. The applications are not accepted if the forms are not correctly filled out, if all the required documents are not submitted and if any incorrect information is spotted during scrutiny.

The hospital authorities are in a fix providing information while filling out the forms. If the names of the physicians or nurses are used in any other application, this will not be accepted. The physicians’ registration has to be renewed. Many physicians have renewed their registration 10 years ago and have not done so since. Then the application will not be accepted. Most hospitals cannot provide environment or narcotics clearance certificates.

Speaking to Prothom Alo, Chattogram civil surgeon Fazle Rabbi said, the process is very complicated. It takes a year to get environment and narcotics clearance. He feels that the licences should be renewed every three years, not every year.

Khulna civil surgeon Sujat Ahmed said, “Our task is to inspect and report. The renewal should be done at the districts too. That would speed up the process.”

The prime minister’s personal physician, ABM Abdullah, advised that the licence renewal process be simplified. He said no sudden decision should be taken about the hospitals. People come here for treatment so any decision should first be given due consideration.

Waiting for years

The owners and other authorities of several hospitals, speaking to Prothom Alo, said the process of renewing licences became complicated since 2018. A lot of time is wasted in following the rules for online registration. Several clearance certificates are asked for, which takes a year to collect. And even if everything is submitted properly, no official comes to inspect the hospital before one and a half years. If anyone has applied in 2017 and the licence isn’t renewed, it will just lie like that for years. But every year the renewal fees must be deposited in the bank.

CEO of Japan Bangladesh Friendship Hospital, Samiul Hasan, told Prothom Alo there is no way that the renewal can be done in the time given by the ministry. He said that his hospital applied for licence renewal in July 2019 and the application was even submitted in December, but so far no one has come on inspection. They contacted the directorate repeatedly, but have received no response.

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Requirements for licence renewal

In order to get a licence, a hospital owner must submit a national ID card, updated trade licence, TIN (for new establishments) or income tax certificate (for old establishments),VAT registration number, environment clearance, narcotics clearance, waste management (hazardous and non-hazardous) contract and scanned ‘challan’ copy. While inspecting the hospitals, the DGHS officials are to check these papers. Also to be submitted are details on the number of beds, the names, addresses and photographs of the specialist physicians, the physicians on duty, the nurses, their BMDC registration, specialist certificates, appointment and joining letters. Also required is a list of assistants, and list of surgical and other equipment. All this is to be signed by the head of the hospital.

The prime minister’s personal physician, ABM Abdullah, advised that the licence renewal process be simplified. He told Prothom Alo, no sudden decision should be taken about the hospitals. People come here for treatment so any decision should first be given due consideration.

*This report appeared in the print and online edition of Prothom Alo and has been rewritten for the English online edition by Ayesha Kabir