Formulating Rules under the Bombay Nursing Home (2006 onwards)

The Bombay Nursing Home Registration Act, (Amendment), 2005 (BNHRA, 2005) is the only Act for registration and inspection of private nursing homes in the state of Maharashtra. It was first enacted in 1949 and some amendments were made in December 2005. Rules under the Act were first drafted as late as in the 1970s and these were not comprehensive. Framing of comprehensive rules under the Act is essential for its implementation, ensuring minimum standards and some regulation for private nursing homes.

CEHAT was invited by the Government of Maharashtra to facilitate the process of formulating Rules for the Bombay Nursing Home Registration Act (Amendment) 2005.

• Formation of rules involving the representatives from medical associations, consumer groups and health rights organizations
• Framework for accreditation of nursing homes.

A working group of representatives from medical associations, consumer groups and health rights organisations was formed to deliberate on the rules document. After three consultations with them, one consultation with the Rural Surgeon’s Association in Dhule to learn about problems faced by nursing home owners in rural areas, and a consultation especially with consumer groups and health rights groups, the draft rules to the BNHRA, 2005 were drafted.

The draft rules submitted to the government in June 2006 contain the following-
i.Minimum standards of physical infrastructure, equipment and staffing. Detailed standards were submitted only for 10 bedded hospitals.
ii.Standards regarding human resources, their qualifications and training
iii.Procedure to implement minimum standards as part of implementation of BNHR Act (amendment), 2005
iv.Patients’ rights and specific expectations from the nursing homes in order to fulfill these.
v.A provision of committees to detail standards for other facilities and multiple specialties.

The Jan Swasthya Abhiyan has supported the rule making process and effective implementation of the BNHRA, 2005 has been taken up as a Maharashtra-wide demand. The government, however has not shown much interest in the early finalisation of the rules.

In October 2006, the Health Minister called for a meeting, in which the Directorate of Health Services presented their own draft of the rules document, which is posted on their website http://maha-arogya.gov.in/actsrules/nursing/BombayNursingHome.pdf

Though most of our suggestions seem to have been incorporated, some crucial differences can be noted-

• Old establishments are totally exempt from physical space standards of any kind and it is left to the local government to draft bye-laws for the same.
• District level Nursing Home Registration Board to work along with the Local Supervisory Body suggested to bring transparency to the process has not been taken
• Expert committees to make standards for various sizes and specialities of nursing homes were not accepted.

Though there are shortcomings in the government proposed draft, there is an urgent need to finalise the rules. The Act has already come into force in the entire State by a government notification in June 2005 itself, but the absence of finalised rules under the Act is hampering its implementation.
Supported by: The Government of Maharashtra
Team: Amita Pitre, Aparna Joshi, Pankaja Dhande and Varsha Zende
Consultant: Dr Anant Phadke