Regulatory update: A new authority boosts efficiency and speeds up the licensing process

A new regulatory institution – the National Health Regulatory Authority (NHRA) – has the potential to significantly alter the health care landscape in Bahrain. As of early 2011, the authority has assumed certain responsibilities that were previously held by the Ministry of Health (MoH), including licensing of medical professionals and institutions, monitoring hospitals and other facilities to ensure they comply with regulations, handling patient complaints and regulating the distribution of pharmaceuticals. The establishment of this new institution will likely improve the quality of health care provision and facilitate private-sector expansion.

HISTORY: Traditionally the MoH held the dual role of provider and regulator, which made sense when the private sector was still relatively small. However, as the market for private health care services has expanded, it has created a potential conflict of interest. As Dr Bahaa Eldin Fateha, the CEO of the NHRA told OBG, “If you want to encourage the private sector to enter, it is necessary to have an independent regulator.”

Recognising the need for a new institution to oversee the sector, in 2009 Bahrain established the NHRA by royal decree. The authority’s seven-member board was set up in 2010, comprising representatives from the MoH, the private sector and the Bahrain Defence Force Hospital. In early 2011 regulatory functions of the MoH were transferred to the NHRA. As of January 2012 the authority was still relying in part on ministry staff to carry out its duties, but the NHRA has full financial and administrative independence from the MoH.

FACILITATE ENTRY: One of the primary roles of the new regulator is to license new hospitals and other medical facilities. For companies that would like to enter the market, typically an initial exploratory meeting occurs between the applicant and the NHRA. At this point, the authority can express any concerns that it might hold, such as avoiding duplication in the market. For example, if two firms are applying to offer the same, or very similar, services, it might share this information with the applicant. Following this initial meeting, the NHRA can then issue a provisional licence within a short period of time, usually within two months. The potential entrant can then meet with other authorities, such as the Ministry of Industry and Commerce and the Ministry of Municipalities Affairs and Urban Planning, to procure any additional necessary approvals.

LICENSING STAFF: The NHRA is also responsible for licensing doctors and nurses. According to Fateha, when the MoH issued these licences, it could take more than half a year to process an application, and a substantial backlog had built up. The authority has taken important steps to streamline the licensing process, for example by accepting application materials by email and fax rather than requiring that they be submitted by mail. This is an important new feature for doctors and nurses coming from other countries.

The NHRA has also taken steps to avoid duplication. For example, for doctors who have received fellowships to work in Bahrain’s hospitals, the organisation granting the fellowship has already verified the applicant’s primary medical school information. Therefore, the authority no longer re-checks this information. In the future, processing time may be further reduced through the introduction of online licensing exams, a high priority for NHRA, Fateha told OBG.

The new licensing system has been welcomed by private hospital officials. Dr George Cheriyan, the CEO of American Mission Hospital, told OBG that in the past the MoH’s licensing board was considered a “stumbling block”, adding that the new system will simplify procedures. One additional step that would further streamline the licensing process would be to extend the length of the licence. At present, they last one year, but this will likely be extended to three years.

The new licensing system will make it easier for private hospitals to meet their staffing needs, which is likely to pave the way for expansion in the sector. At the same time, fast and efficient processing of new applications suggests that Bahrain could soon benefit from the presence of additional private sector facilities.