Two Clinics. Same Street. Very Different Outcomes.
Dr. Faisal Mahmood and Dr. Ahsan Raza had known each other since their house job days at Allied Hospital in Faisalabad. They had graduated the same year, started their practices around the same time, and, by some coincidence of real estate, ended up running family physician clinics within three blocks of each other in the same busy commercial area of Gulberg, Faisalabad.
When both received PHC assessment notices in the same week of November, they did what they had always done when faced with a shared problem: they called each other.
“Saath mein tayari karte hain,” Ahsan suggested — let’s prepare together. Faisal agreed.
For three weeks, they worked in parallel. Ahsan, who had an eye for presentation, repainted his clinic walls, bought new furniture for the waiting area, replaced his old signboard with a gleaming new one, and installed better lighting throughout. His clinic, already functional, now looked genuinely impressive. He was quietly confident.
Faisal took a different approach. He printed the MSDS document and read it from cover to cover. Then he read it again. He made a checklist of all forty-seven indicators, noted which ones were RED and which were YELLOW, and worked through them one at a time. His clinic did not look dramatically different when he was done — but it functioned differently.
The assessors visited both clinics on the same Friday, two hours apart.
Ahsan’s clinic looked beautiful. It smelled of fresh paint. The waiting area had comfortable chairs and potted plants. The signboard outside was crisp and large. The assessors appreciated it. And then they began working through their forms.
They noted that the signboard, though large and beautiful, did not display the PM&DC registration number. They noted that consultation hours were not posted. They asked the dispenser about fire emergency procedures — he had not been briefed. They found two expired medicines at the back of the dispensary drawer. They observed that the dispenser — a pleasant young man who had been working at the clinic for four years — had no formal authorization as a qualified dispensing person.
Ahsan passed twenty-nine of forty-seven indicators. He failed four RED indicators.
Faisal passed forty-one.
That evening, when Ahsan called to compare notes, there was a long silence on the line after Faisal explained his score. Then Ahsan asked, carefully: “Yaar, what exactly is the difference between a RED indicator and a YELLOW one?”
The Question That Changes Everything
It is, in fact, the most important question in the entire MSDS framework. And the answer is simpler — and more consequential — than most clinic owners realise.
Every one of the forty-seven indicators in the MSDS is assigned a colour: RED or YELLOW. This colour does not describe the subject matter of the indicator. It describes the tolerance for noncompliance.
Let us be precise about what that means.
RED Indicators: Zero Tolerance
There are 25 RED indicators in the MSDS for GPs, Family Physicians and Specialist Clinics.
On a RED indicator, the PHC requires a score of 10 out of 10. Full compliance. Complete implementation. Not mostly done, not nearly there, not 9 out of 10.
Here is the practical implication of that requirement: if you score a 9 on a RED indicator, you have failed that indicator. A score of 9 out of 10 — which represents 90% compliance, which would be considered excellent in almost any other context — is a failing score on a RED indicator under PHC’s system.
This is not arbitrary harshness. RED indicators are things the Commission considers fundamental to patient safety and clinic legitimacy. They are not aspirational targets. They are minimum floors. The logic is: if you cannot meet this completely, you are not ready to hold a license.
When Ahsan’s signboard lacked a PM&DC registration number, that was a RED indicator of failure. It did not matter that the signboard was large and professional and clearly labelled with the clinic name. The one missing element—the registration number— resulted in a score of zero on that indicator. Not seven. Not eight. Zero.
When the dispenser could not explain the fire emergency procedure, that was a RED indicator failure. When expired medicines were found in the dispensary, that was a RED indicator failure. When an unqualified person was found to be dispensing medicines, that was a RED indicator failure.
Four RED failures. Beautiful paint job notwithstanding.
YELLOW Indicators: Substantial Compliance Required
There are 22 YELLOW indicators in the MSDS.
On a YELLOW indicator, the PHC requires a score of at least 8 out of 10, which represents 80% compliance. This threshold acknowledges that some requirements exist on a spectrum. A clinic may genuinely be working toward full compliance, may have partial systems in place, or may face contextual constraints. An 8 or above on YELLOW is a pass.
This does not mean YELLOW indicators are optional. It means they allow for graduated assessment. An indicator requiring easy wheelchair access might score 8 if the entry has a ramp, but the washroom door is slightly narrow. An indicator in patient records might score 8 if records are well maintained, but the unique identifier system is not yet fully standardised.
What YELLOW indicators do not permit: neglect. A score of 5 or 6 on a YELLOW indicator is still a failure. The 80% threshold is not generous — it simply acknowledges the real-world complexity of implementation.
The 0 to 10 Scale: What Each Number Actually Means
The scoring scale runs from 0 to 10 for every indicator. Understanding what these numbers represent in practice is essential for any clinic owner preparing for an assessment.
- A score of 10means fully met. The requirement is completely in place, observable, and consistent. No exceptions or gaps.
- A score of 8 or 9 on a YELLOW indicator means substantially met. Most elements are in place; minor gaps exist, but do not compromise the intent of the requirement.
- A score of 5 to 7 means partially met. Some elements are present, but significant gaps exist. This is a failure on both RED and YELLOW indicators.
- A score of 1 to 4 means minimally met. Almost nothing is in place. The intent of the requirement is largely unfulfilled.
- A score of 0 means not met at all. The requirement is entirely absent.
For RED indicators, only a score of 10 passes. For YELLOW indicators, a score of 8 or above passes. Every other score, on every indicator of either colour, is a failure.
The Self-Assessment Trap — And Why Ahsan Fell Into It
Here is what Ahsan had done, without realising it: he had conducted a self-assessment based on general impression rather than specific indicators.
He walked through his clinic and thought, “This looks good.” The signboard is big. The waiting area is comfortable. The dispensary is organised. And it did look good. By any casual inspection, his clinic was well-maintained and professional.
But PHC assessors do not evaluate the general impression. They evaluate forty-seven specific observable items. A signboard without a PM&DC number is a failed indicator — regardless of how impressive it looks. A dispenser without a qualification certificate is a failed indicator — regardless of how competent he seems. Expired medicines in a drawer are a clear indicator of failure — regardless of how well everything else in the dispensary is organised.
The shift Ahsan needed to make — the shift every clinic owner must make — is from”how does this look overall?” to”does this specific indicator exist, exactly as described, right now?”
Faisal had made that shift. He had read the indicator for the signboard, noted that it required the PM&DC registration number to be clearly displayed, checked his signboard, found it was missing, and added it. He had read the fire emergency indicator, noted it required staff to be able to answer questions about early detection and containment, and spent fifteen minutes briefing his staff. He had checked every medicine in his dispensary against its expiry date, disposed of two expired items, and created a simple monthly check system.
None of these was a dramatic intervention. None required a significant expense. All of them required knowing exactly what the indicator said.
One Failing RED Indicator: What Actually Happens
This needs to be stated plainly, because it is the part of the framework that catches people by surprise.
A clinic that scores 10 on all forty-six other indicators — 100% compliance across everything else — but fails a single RED indicator has not passed its PHC assessment.
The RED indicators are not averaged in with everything else. They are not diluted by strong performance elsewhere. Each one must individually reach 100%. A perfect score everywhere else does not compensate for a failure on any RED indicator.
This is why Ahsan’s fresh paint and new furniture were ultimately irrelevant to his outcome. His overall clinic environment was excellent. But four of his RED indicators were not met. On each of those four, the score was not 8, 9, or 7 — it was a failure. And no number of tens elsewhere could change that.
Understanding this is not meant to be discouraging. It is meant to direct your attention precisely. You do not need to achieve perfection across forty-seven indicators simultaneously. You need to achieve a score of 10 on twenty-five specific indicators, and a score of at least 8 on twenty-two others. That is a very different kind of preparation from trying to make your clinic look generally impressive.
The Reassessment and What It Taught Ahsan
Ahsan spent two weeks after his assessment addressing the deficiencies. The four RED failures — the signboard, the staff briefing on fire emergencies, the expired medicines, and the dispenser authorisation — were each fixable within days. He also addressed the YELLOW indicators where he had fallen short.
His reassessment score was forty-four out of forty-seven. He passed.
But he later said that the first assessment, despite the failure, had been the more valuable one.
“I thought compliance was about appearance,” he told Faisal over chai the week his license was confirmed. “I thought if the clinic looked professional, it was professional. But the MSDS doesn’t ask how things look. It asks whether specific things are in place. Those are different questions.”
They are different questions. And this series will help you answer the right ones.
You can also connect with the writer of this blog post series to share or receive suggestions: Dr. Junaid Rashid (Founder of UPMED) at 03042397393 (WhatsApp).
List of all the posts in this journey.