Hospitals and Healthcare Providers (NABH) under the Quality Council of India. Universally, the quality of health services is ensured either through legislation, or through health financing / health insurance mechanisms or a combination of the two. In India, however, health is a State subject and, as such, there is no nationally applicable legislation to regulate and monitor the quality of service delivery in both the private and public healthcare sectors. Some States have enacted a medical establishment Act. However, the provisions of these do not apply to public hospitals. More so such Acts are related to ‘structure’ component of the healthcare organization only. To bridge this gap, bringing uniformity and assigning accountability, Government of India has enacted Central Clinical Establishment Act 2010. The Rules and Standards for the purpose are being framed. However, it does not guarantee that all healthcare facilities would be covered as again States would be deciding.
In the private sector, attention to promotion of quality of care has been mainly driven by the business interest. In the public sector, such initiatives in the past have been undertaken under the aegis of projects sponsored by Development Partners. Attention to promotion of quality of care has been one of the key strategies under the National Rural Health Mission (NRHM) and, over the last few years, several initiatives have been taken in this regard by almost every State. These range from ISO certification for hospitals [e.g. National Health Systems Resource Centre (NHSRC) supported ISO certification of district hospitals in the so called Empowered Action Group (EAG) States] to facilitated quality improvement with reference to hospitals (e.g. Himachal Pradesh and West Bengal) or selected services (e.g. for RCH services in West Bengal and Assam) to NABH accreditation (e.g. Gujarat, Kerala, MP, Tamilnadu, Uttar Pradesh, Delhi, Andhra Pradesh, Karnataka, Jammu & Kashmir and Haryana ).
As the awareness increased amongst the healthcare organizations about quality, and dialogue initiated between NABH and government, industry and organizations, scenario started changing. Department of AIDS Control, Ministry of Health and Family Welfare relied on NABH to start an accreditation program for Opioid Substitution Therapy (OST) Centres after getting convinced that this will lead to better care and safety of patients visiting such centres. Central Government Health Scheme of Government of India and Ex-Servicemen Contributory Health Scheme of Ministry of Defence requires private hospitals to gain accreditation in order to be empanelled with them. It has helped boosting the concept of quality and patient safety across such hospitals. Recently, officials of Government Sponsored Health Insurance Schemes (Rajiv Aarogyasri, Vajpayee Aarogyasri, Chief Minister’s Comprehensive Health Insurance Scheme, Jeevandayi Aarogya Yojana, Rashtrya Swasthya Bima Yojana) have initiated discussion on improving quality of care in hospitals empanelled under these schemes. There are thousands of hospitals covered under these schemes and therefore, this move may bring drastic change in the care delivery. It is important to note that major discussion points were defining Standard Treatment Protocols, alignment of empanelment criteria with NABH accreditation standards and role of NABH in improving quality. There are number of workshops on Infection Control and Patient Safety being organised by hospitals and industry. In variably, NABH remains a partner/ organiser in all such events. A very unique and innovative program “Safe-I” has recently been started which focuses on infection control and prevention in hospitals. To strengthen patient care and safety, another innovative program on “Nursing Excellence:” is going to be launched soon. Strong need has already been felt about collecting data and analysis in order to gain insight on what is happening after implementing accreditation/ quality improvement activities in relation to care and safety. NABH has recently started collecting quarterly data from accredited organizations on select indicators, however a robust analysis and feedback mechanism is lacking. They are in the process of developing better tools to collect, analyse and disseminate data to the participating organizations. Need for a research/study in this area is to be emphasized.
In India, ISQua has played a vital role in the journey of healthcare quality and patient safety. NABH standards for hospital accreditation and entire organization follow ISQua International Principles and Standards. This has helped Indian accreditation program to convince people and stakeholders about the role and importance of quality and safety.