Indicator 8: How Big Is Big Enough? The Minimum Premises Standard for Your Clinic

Series: Understanding MSDS | Post 11 of 52
Standard 3 (ROM-3) | Indicator 8 | Category: YELLOW (80% required)

Eighty Patients and Two Chairs

Dr. Imran Butt’s clinic sits in a narrow bazaar in Gujranwala, between a mobile repair shop and a sweet shop. It is one room, roughly ten feet by twelve. For fifteen years it has been enough for him.

By ten in the morning the room holds his desk, his chair, an examination couch pushed against the back wall, a tall medicine rack in the corner and two plastic chairs. By eleven, it holds far more than that. Patients stand along the wall. Mothers with feverish children wait on the step outside.

Dr. Imran sees close to eighty patients a day. Nobody in the bazaar ever questioned his room.

The PHC assessor did.

She arrived at half past eleven, stepped past three people on the step, and asked a simple question.

“Doctor, if three patients arrive together, where do they sit?”

He pointed at the two plastic chairs. One was occupied by an elderly man with a walking stick. The other held a bag of medicine stock. The couch was being used by a patient waiting for an injection.

Indicator 8 was scored as not met.

What Indicator 8 Requires

The indicator reads: Premises of the clinic is as per minimum requirement.

During the survey, the assessor observes whether the clinic has the minimum required space available for three things: consultation, comfortable sitting, and dispensing or dressing if the clinic offers or portrays these services.

The manual does not prescribe square feet; it prescribes function. A practice may begin in a single consultation room with space for the practitioner, a patient and an attendant. As patient numbers grow, the space must grow with them. The guidelines state plainly that it is not desirable to make patients wait in the street while the doctor is engaged with another patient.

What “Comfortable Sitting” Means

The manual explains that comfortable sitting may include accommodating three to five patients waiting at one given time. The waiting area should allow patients and attendants to wait for ten to fifteen minutes and to move around freely without hindrance. Chairs, benches, a settee or a sofa are all acceptable, depending on affordability.

Separate rooms are not compulsory. Where separate rooms for dispensing and waiting are not available, the manual accepts that one area may be compartmentalised with suitable partitions, such as cloth, aluminium, glass or wood, within the available resources. Dispensing and sitting may be acceptable together in some settings.

If the practice is limited to prescribing only, and patients buy medicines from a store of their choice, a dispensing section is not required at all.

How It Is Scored

This is a YELLOW indicator with three possible outcomes.

Fully met: the clinic has the minimum space for consultation, comfortable sitting, and dispensing or dressing where these are offered.

Partially met: the premises are as described, but patients are not comfortably seated.

Not met: the premises are not sufficient to accommodate even three patients at a time.

Why It Matters

Crowding is not only a matter of comfort. A febrile child standing beside an elderly patient with chronic lung disease, in a room with no space between them, is a clinical concern. Crowding also pushes patients to wait in heat, dust and traffic. The manual treats space as a basic condition for safe and respectful care, not as a luxury.

What Dr. Imran Changed

He could not afford a second shop. He did not need one.

He replaced the tall floor rack with wall-mounted racks in step-ladder design, as the guidelines describe, and moved extra stock into a closed cabinet. That freed almost a third of the floor.

An aluminium and frosted glass partition now divides the room. Behind it are his desk, a patient stool and the examination couch with a curtain. In front of it are a wooden bench and three chairs, enough for five patients, with the dispensing counter along the side wall. The medicine bag no longer sits on a patient’s chair.

At reassessment, the assessor counted the seats, looked behind the partition, and scored Indicator 8 as fully met.

“The room was never too small,” Dr. Imran said later. “I had simply filled it with the wrong things.”

A Quick Self-Check

• Can at least three to five patients sit comfortably in your clinic at one time?
• Is any seat being used for storage, files or stock?
• Is there a defined consultation area where the doctor, patient and attendant fit without crowding?
• If you dispense medicines or do dressings, is there a defined space for this, even if separated only by a partition?
• On your busiest day, are patients waiting outside in the street?

Series so far: Post 1, The Inspector | Post 2, 18 Standards, 47 Indicators | Post 3, Red, Yellow and the Score | Post 4, Signboard | Post 5, Easy Access | Post 6, PHC License | Post 7, Door Plate | Post 8, Consultation Hours | Post 9, Qualified Manager | Post 10, PM&DC Certificate | Post 11, Minimum Premises

About this series: Educational content on MSDS compliance for clinics under the Punjab Healthcare Commission, based on the PHC MSDS Reference Manual 2017.