Quality Assurance & Accreditation
National Quality Assurance Standards (NQAS)
The National Quality Assurance Programme (NQAS), launched by the Ministry of Health and Family Welfare, Government of India, aims to improve the quality and safety of care in public health facilities. Introduced in 2013, NQAS provides a standardized quality framework with defined checklists and benchmarks to assess and continuously enhance service delivery. NQAS is implemented across District Hospitals, Sub-District Hospitals, Community Health Centres, Primary Health Centres, and Health Sub-Centres (including urban facilities), fostering a culture of quality, patient safety, and accountability within the public health system.8
Areas of Concern
Framework of Quality of Care
Framework of Quality of Care describes the importance of the Donabedian Model in healthcare quality. It covers the aim and implementation strategies for improvement in the quality of care provided by public healthcare facilities. It also describes how uniformity, reliability, and resilience are interwoven within the quality standards and their measurement system. :contentReference[oaicite:0]{index=0}Structure of the National Quality Assurance Standards
The main pillars of Quality Measurement Systems are Quality Standards. These standards have been grouped within the eight areas of concern. :contentReference[oaicite:1]{index=1}NQAS Measures Quality Through Eight Broad Areas of Concern
A. Service Provision
B. Patient Rights
C. Inputs
D. Support Services
E. Clinical Services
F. Infection Control
G. Quality Management
H. Outcome
- Standards are the statement of requirements for critical to quality components.
- Measurable Element is a specific attribute of a standard which should be looked into for assessing the degree of compliance to a particular standard.
- Checkpoints are tangible measurable points which can be objectively observed and scored.
Summary of Standard, Measurable Element & Departmental Checklist
| Component | District hospital | CHC | PHC | UPHC | AAM-SC |
|---|---|---|---|---|---|
| Area of Concern | 8 | 8 | 8 | 8 | 8 |
| Standards | 75 | 71 | 50 | 35 | 48 [A] / 50 [B] |
| Measurable Elements | 380 | 334 | 250 | 200 | 124 [A] / 129 [B] |
| Checklists | 21 | 14/9 | 6 | 12 | 1 |
Assessment Method and Scoring
2 Marks
For full compliance when 100% of the intent of the checkpoint is met.1 Mark
For partial compliance when 50% to 99% of the intent of the checkpoint is met.0 Marks
For non-compliance when less than 50% of the intent of the checkpoint is met.Criteria for National Certification
70%
Over All Hospital Score (or More)
70%
Department Wise Score (or More)
70%
Area of Concern Wise Score (or More)
70%
Core Standards (or More)
50%
Standard Wise Scores (or More)
70%
Patient Satisfaction Score (or More)
Planning Assessment Activities
Quality assurance would be a continual and comprehensive cyclic process. The aim is to cover all public health facilities. Following set of activities should be undertaken internally by the facility: :contentReference[oaicite:3]{index=3}Step 1
Formation of Facility-Level Quality Assurance Team
Step 2
Implementation of Quality Assurance Activities
Step 3
Internal Assessment
Step 4
Gap Identification and Action Planning
Step 5
Root Cause Analysis
Step 6
Setting up the Measuring Indicators
External Certification Process
1
Internal Assessment For Certification.
2
Assessement for District-Level Certification.
3
Application for State Assessement.
4
Assessment for State-Level Certification
5
Application for National Assessment
6
NHSRC Scrutiny and Coordination
7
Certification Validity and Surveillance
8
Re-Certification After Three Years
Sustenance and Incentives
Financial Incentives
- 25% for Individual Incentives
- 75% for Patient Welfare and Improving Work Environment
- Annual Incentives of Same Amount for Maintaining the Accreditation
Non-Financial Incentives
- Facilitation at State Level
- Publication of Achievement in Media
- CMEs, Trainings and Short Courses for Staff
Physical Performance (Cumulative)
20
District Head Quarters Hospital (DH)
83
Sub-District Hospitals (SDH)
147
Community Health Centers (CHC)
667
Primary Health Centers (PHC)
198
Urban Primary Health Centers (UPHC)
1232
Health Sub-Centers (HSC)
2347
Total