Dr Mariam Al Jalahma, CEO, National Health Regulatory Authority (NHRA): Interview

Interview: Dr. Mariam Al Jalahma

How are regulation and licensing changing as the private sector becomes involved in health care?

MARIAM AL JALAHMA: First, we addressed the difficulty of finding qualified Bahraini employees by licensing Bahraini doctors and nurses even if they are not yet employed, so that new medical graduates can easily move to the private sector rather than having to first work at Salmaniya Medical Complex or Bahrain Defence Force Hospital. Maintaining quotas of Bahraini medical staff used to be a major concern in private hospitals; this move will make it much easier for health care facilities to hire the employees they need.

The import of medical devices has also been an issue that needed addressing. We worked with Customs and agreed to require pre-approval of all medical devices before their import to ensure that they are not waiting at the port while we certify the device. It still takes time to approve each device, but we can do it much more quickly if all of the documentation is processed before the item arrives at the port.

We proposed new regulations to the GCC to stop the flow of counterfeit medical devices in the common market, as we found false certificates on devices before importation, and these were accepted by the group with an implementation date of 2020. This is crucial to protecting patients and health care providers, both public and private, from fake equipment.

How would you rate the implementation of group purchasing of drugs in the GCC?

AL JALAHMA: The programme has been a success, and we are able to purchase medicine at much better prices as a group. By 2020 all GCC-tendered drugs will have to be centrally registered, which means that they will be approved for use in every member state.

Many of the drugs we tender as a group are bought in low quantities because they are not commonly needed and are used to treat rare conditions, so centrally registering all of these drugs will make life easier for patients with these rare conditions. Private hospitals are also welcome to buy their drugs through the national tender and benefit from the increased scale in their purchases. On drug shortages, we are working bilaterally with the Saudi Food and Drug Authority over regulatory alerts. Some shortages of drugs are due to the reluctance of pharmacies to import them because they are only bought in low qualities and do not provide enough profit to justify stocking them. We are working on this issue to keep the interests of patients as our shared top priority.

What is being done to combat the challenge of fake certifications and degrees?

AL JALAHMA: Between 2010 and 2017 we verified certificates and degrees ourselves. In 2017 we began using DataFlow, a company that verifies the authenticity of certificates for many organisations and countries in the GCC. They uncovered falsified information on our behalf, so since then we require all applicants to have their information certified before even applying.

We have also begun looking into universities and specialties to double check the credentials of people already employed. Nurses accounted for 58 of the 102 false certification holders caught in 2018, while only four were doctors and the rest were in allied health.

Why do you think there is an increase in the rate of complaints about malpractice in health care?

AL JALAHMA: Although we are keeping a close eye on it, the increase in malpractice complaints over recent years is due to the establishment of the NHRA and increased awareness, rather than due to an increase in the cases of medical error.

People continue to learn more about what we do, although we still receive complaints that are not related to medical error. Some people still go to the police rather than come to file a complaint directly with us, so there is still room for awareness to grow.