This is where all the action is!!! The inspectorate department is the heart of the HPA in that this is where all the registration, inspections, renewal of all health institutions in the country takes place.
The department has a detailed database of all health institutions in the country- private and public. The Health Professions Act states that all health institutions should be registered. Section 99 of the Act states that no registrable person shall operate or carry on a health institution; and no practitioner shall practise his profession or calling in or from any health institution unless he/she knows or has reason to believe that the health institution is registered in the register of health institution. Contravening this subsection is an offence and will attract a fine and or imprisonment of up to a period of two years.
The Health Professions Authority defines a health institution as:
- "Any hospital, clinic, mobile clinic, medical laboratory, consulting rooms or other premises or part thereof which is used by a health practitioner for any purpose connected with the diagnosis, treatment, assessment, mitigation or prevention of any illness, injury or disability or abnormal physical or mental state or the symptoms thereof in human beings; or carries on business as such; or
- Any premises in or on which a pharmacist practises or carries on business as such; or
- Any premises in or which any medicine, as defined in the Medicines and Allied Substances Control Act (chapter 15:03), is stored, sold or manufactured;"
The Authority in consultation with the practitioners has come up with the Registration, Inspection and Renewal Manual which outlines the registration process, conditions of registration (i.e. sharing of rooms etc.) and the minimum requirements of the different types of health institutions. This manual is available at request from the HPA offices and can be downloaded on the HPA website under the Downloads section.
HOSPITAL/FACILITY WITH MORE THAN ONE DEPARTMENT
The hospital/facility with more than one department will be required to separately apply and pay for registration for each department. However, one certificate can be issued for the hospital/facility with the additional departments clearly indicated on the Certificate. For example, a hospital with an X-Ray unit and a Laboratory will apply for registration for the hospital; the X-Ray unit and Laboratory. The Certificate will indicate that the hospital has those other departments within it. Similarly, when a hospital/facility sublets the unit/department to an independent service provider; the unit/department will also require separate registration.
SHARING OF PREMISES
Practitioners operating from the same physical/local address may register their premises as individuals or as partners, depending on their situation as defined below:
- Health practitioners with the same qualifications sharing the premises
When two (2) or more practitioners with the same qualifications have a room each in the same premises and share the reception, their premises would be registered as one entity. The Health Institution will be issued one (1) Registration Certificate bearing the names of all the practitioners. The practitioners will share the liability of the practice. This is referred to as Group Practice and there are special fees applicable to a Group Practice.
- Health practitioners from different Councils sharing the premises
When 2 health practitioners from different Councils have rooms in the same premises and share the reception, (e.g. Medical Doctor, Nurse, Radiographer or Sonographer), their rooms are registered as separate Health Institutions.
- General Medical Practitioner and Specialist Practitioner
When a General Medical Practitioner and Specialist Practitioner have a room each in the same premises, the rooms will be registered as separate Health Institutions. Each room will be issued with own Registration Certificate.
CHANGE OF PREMISES
When the practitioner moves premises from one place to another, they have to restart the application process. Even if a practitioner moves into premises that have been previously registered, the new practitioner will have to go through the registration process.
CHANGE OF OWNERSHIP
Practitioners cannot take over the running of a facility without effecting a formal change of ownership process. The new practitioner will have to reapply for the registration of the premises in his/her name. The HPA Registration Certificate is not transferable.
CHANGES IN THE PRACTITIONER IN CHARGE
When the practitioner in charge changes and before the new practitioner can be added on to the certificate, the relevant Council must be informed about the change first. The change will only be effected at HPA when a letter has been received from the relevant Council accepting the changes.
A representative of the institution shall fill in a Material Change form indicating the changes being made, and pay the material change fee. NB- the new practitioner may not necessarily fill in the Material change form by him or herself. The new practitioner in charge's current practising certificate must be attached to the application form and submitted to the Authority together with proof of payment of fees for the material change to be effected.
VALIDITY OF HPA REGISTRATION CERTIFICATE
The HPA Registration Certificate is valid for one (1) calendar year and must be renewed on or before the 1st of January of each year.
The registration fees depend on the type of facility.
The different amounts payable to HPA are as stated in Statutory Instrument 78 of 2017 of the Health Professions Act Chapter 22:19 under Registration and Renewal.
MINIMUM REQUIREMENTS OF EACH FACILITY
The minimum requirements of each facility are available at request from the HPA office and can also be download from the HPA website under the Downloads section.
The process of registration of the health institution involves:
- Finding the premises and making all necessary renovations.
- Inspection by the local authority and getting the positive health report.
- Application through the relevant council.
- Forwarding of the papers to HPA after the consideration of application by the Practice Control Committee of the relevant council.
- Once received at HPA the practitioner must pay the relevant registration fee. The fees depend upon the category of the health institution and are inclusive of the inspection and subscription for the year in which the application is made.
- The HPA will conduct the inspection within 2 weeks of receiving the application, and the report is considered by the Registration Committee of the Authority who will either approve the registration or defer it until all requirements are met.
- Urgent inspections may be conducted for an additional fee.
- It is an offence for practitioners to start operating prior to HPA inspection and approval.
- The health institution will only be registered and issued with a registration certificate when it has met the minimum requirements of its category.
- The HPA certificate is valid for the one calendar year.
- Practitioners should ensure that the registration certificate is displayed in a prominent place within the institution (Section 106(i) of the Act). Failure to display the certificate will attract a penalty.
Types of Inspections
The Authority conducts various types of inspections, each done for a different reason:
- Initial inspections – done for all health institutions applying for registration with the HPA to assess if they meet the minimum requirements of their category.
- Routine inspections- conducted for existing health institutions to check if standards are being maintained.
- Investigative inspections- conducted following a complaint of either malpractices or substandard premises from the public or other health professionals. The inspection will be carried out to investigate on the matters raised and also check on the general condition of the health institution.
- Follow-up inspections- conducted to check on the progress made to attend to the highlighted shortcomings at the last inspection.
Depending on the criticality of the shortfalls, the practitioners are usually given from two weeks to a month in which to attend to the shortfalls. For those critical shortfalls, a shorter time frame is given to rectify the shortfalls, depending on their hazardous level.
It then becomes the practitioner in charge's responsibility to attend to the shortfalls within the given time frame; and inform the HPA in writing once all shortfalls have been attended to so that a verification visit/inspection may be conducted.
Closures of health institutions
There are only two reasons why the Authority would close health institutions.
- When the health institution poses health hazards to the pubic- such institutions will be closed with immediate effect in the interest of the public.
- When the health institution fails to meet compliance requirements. Institutions will have been advised to take steps to meet the minimum requirements of their category within a given time frame and they have not done so.
The closure of a health institution is the last resort; the authority prefers to engage in dialogue than to close health institutions. The closure of the institution/s will deprive the community of necessary care and treatment. Practitioners are therefore expected to understand and comply.
In keeping with the times, the Health Professions Authority Zimbabwe (HPA) has implemented various technological upgrades in its operating systems, thereby enhancing its overall level of service to its stakeholders.
In line with its mandate to maintain a register of all health institutions in Zimbabwe (as provided for in the Health Professions Act -Chapter 27:19), HPA now has an Electronic Register which can be viewed by both practitioners and the public, at the following website link: www.hpa.co.zw/facilities.php. The live electronic register allows members of the public to scroll through the available health-related specialities and choose their preference. The different types of health facilities can also be searched according to location, so that members of the public know which ones are situated in close proximity to themselves.
HPA is also in the process of making registration and renewal of institutions both quicker and easier for practitioners. Work is being done in conjunction with the Health Informatics Training and Research Advancement Centre (HITRAC) to have a system that will enable health practitioners to apply for new registrations, and renew existing health institutions, online. The facility will also enable practitioners to upload electronic copies of their practising certificates and proof of payment. This will mean practitioners will not have to travel to the HPA offices, or incur courier services costs, when submitting documents. This facility will be available on the HPA website, which can be accessed on www.hpa.co.zw.
As a way of improving the security of registration certificates to registered facilities, the Authority is considering having these printed directly from the computer system. The certificates will be barcoded from the system to avoid the risk of fraudulent certificates. This will also reduce the number of errors associated with printing the certificates manually, as the information is automatically taken directly from the system.
This electronic systems’ upgrade also involves the Councils, since they are using the same system for their health practitioners’ registers. HPA and the Councils’ databases will be integrated into a platform where certain information will be seamlessly shared. This data-sharing initiative will result in faster and more efficient registration and renewal processes at both levels.
In light of the current economic liquidity crisis, the Authority now provides convenient payment methods for practitioners. Practitioners are now able to make payments via the Ecocash Biller Account and the Point of Sale ‘swipe’ machines. Funds transferred via bank deposits automatically reflect on the HPA pastel system, which then feed into, and update, the Electronic Register system.
In the longer term, HPA is considering geo-coordinating all health facilities on the database. This will allow all registered health facilities to be viewed on a physical map, through cell phones, note pads or computers. Geo-coordinating will enable members of the public to obtain directions to a health institution of choice. Allowing for internet access, the physical map will conveniently highlight the institutions that are in one’s vicinity.
A further longer-term goal is for HPA to have its own mobile application, which practitioners and members of the public can download from the Google play store. This will enable practitioners to manage their HPA accounts, while members of the public will be able to search for the different health facilities and choose a practitioner of their choice, all from their mobile phones. The benefits of this initiative are that practitioners’ confidentiality issues will remain fully protected, and the service will be available to everyone at no cost.
HPA is now well on the way to fully embracing technological advancements in its systems, with a view to offering a world-class service to its stakeholders. The objective is to have the online registration on the HPA website fully operational by 2018-year end, in addition to the bar-coding of certificates, as well as the electronic sharing of information with Councils. It is also hoped that the geo-coordination of health facilities on the database will be completed in the next six months. Biller Code and swipe machine payments facilities are already now place.
The overall goal is to be the regulator of choice, offering efficient and effective service. Joint partnership in the delivery of quality health service, together with support for practitioners and members of the public, form a major part of the HPA’s core belief system.