Who will monitor compliance issues?

Mushrooming of the country's private hospitals has helped the people to get health services at their door steps. The services in the private hospitals are expensive, no doubt. Yet those have helped many patients from skipping even far more expensive treatment abroad. Private sector businesses are also making heavy investment in the healthcare services, resulting in the availability of better treatment at home. But the growth of the private hospitals is hardly benefiting the poor and low income people.
The government is also trying to facilitate the growth of the health services in private sector through offering varies incentives in the form of tax-benefit. Some 24 private hospitals of the country are enjoying the 'referral hospital' facility on import of medical and hospital equipment since 2005. Customs wing of the National Board of Revenue (NBR) has offered the incentive to reduce establishment cost of the hospitals.
Referral hospital facility is designed to put a check on the expenditure made on treatment abroad and create advanced health facility in the country.
Generally, a referral hospital is a hospital where a patient is referred to by other health-care centres because it is better equipped and has specially-trained physicians.
There are several conditions on availing the duty-related benefits by the referral hospitals. The conditions include the meeting of deadline for installation of duty-free machinery, minimum bed capacity, number of expert doctors etc.
Unfortunately, the government was reluctant, until Fiscal Year 2014-15, to tag any condition so that the referral hospitals pass on the benefit of the duty incentive on to the poor patients who can not afford the expensive treatment.
There was no condition in the Statutory Regulatory Order (SRO) to compel the hospitals to provide medical services free of cost to the poor or low income people.
In the budget for FY 2015-16, the NBR, for the first time, incorporated a condition for the private referral hospitals on keeping at least 5.0 per cent to its total seats as free-of-cost for the poor patients.
In the SRO, dated 4, 2015, signed by NBR chairman Md Nojibur Rahman, the revenue board, however, did not mention who would monitor whether the referral hospitals are keeping 5.0 per cent of their seats reserved for poor patients or offering the same to the needy people free of cost.
The definition of the 'poor patients' has also not been clearly presented in the SRO.
Thus, an unclear provision in the SRO concerned has raised a few confusions.
Under the conditions in the SRO, a referral hospital must have to install the machinery within three months from the date of duty-free import. It should have advance research facility.
A mono-disciplinary hospital with at least 100 beds or multi disciplinary one with 150 beds can be termed as referral hospital having the registration from the Ministry of Health.
According to the order, at least two experienced doctors should supervise each department of those hospitals. The hospitals should have capacities to give consultancy services to other hospitals.
A committee, comprising customs and health directorate officials, inspects the hospitals to ensure that the medical machinery and equipment are properly installed.
The NBR can revoke the tax-free facility and collect entire exempted amount if the committee finds any irregularities in installation of medical equipment.
Earlier, the customs intelligence had launched an investigation against ten referral hospitals. It has found some of the referral hospitals are not complying with the existing conditions on advance research facilities and expert doctors.   
It had instructed ten private hospitals in the city to produce necessary documents on duty-free import of medical equipment in a bid to verify their compliance.
Later, customs intelligence found the existing SRO on referral hospital faulty and initiated move to amend it.
Referral hospital has to obtain the certificate from the customs authority under the existing SRO.
The referral hospitals that are new in operation include: BIRDEM, National heart foundation, Apollo, Zainul Haque Sikder Womens medical college and hospital, Khawaja Yunous Ali Medical Collage, Ibrahim Iqbal memorial hospital, Jalalabad Rajib-Rabeya medical, United Hospital, Square, Salauddin specialised hospital, Ad-din, delta, Labaid, Green life, Enam medical, Bangabandhu memorial hospital, Sumona hospital, Monsur Ali medical college, Dr Sirajul Islam, Care specialized hospital, Samorita, Gazi medical college, Ali hospital.