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Well maintained infrastructure, adequate & skilled human resource, functional equipment & instruments and sufficient drugs & consumables ensure the fulfilment of the ‘Structural’ requirements for establishing a well-functional health facility. However, for attaining enhanced satisfaction with improved clinical outcomes, it becomes equally pertinent to ensure ‘Quality’ in the ‘Processes’ of the care within a health facility.

As a healthcare provider, while it is important to ensure provision of safe and evidence based clinical care, it is equally fundamental to provide the care that makes patients’ and visitors’ experiences rewarding. Ensuring ‘Quality of Care’ as a key component would require undertaking conscious and concerted efforts to identify the ‘Gaps’ by measuring the Quality of Care (QoC) in all its three dimensions, namely structure, process and outcome (Donabedian Model of QoC).

Subsequently, available resources are channelized, and efforts undertaken for closing the gaps and bringing about the ‘Improvement’ in the services.

For ensuring provision of ‘Quality of Care’, ISQua (International Society for Quality in Healthcare) accredited National Quality Assurance Standards (NQAS) for District Hospitals, CHCs, PHCs and UPHCs, HWC-SHCs and UHWCs have been formulated by the Ministry of Health & Family Welfare, GOI. Setting standards is a dynamic process, and the standards provide roadmap for the health facilities to improve the care.

NQAS are arranged broadly into eight (8) broad themes, named as area of concerns. For micro detailing of each standard, they are divided into Measurable Elements (ME) and further categorized into Checkpoints.

These checkpoints are objective components and together they constitute a checklist which are scored to achieve a score (Figure Measurement system under NQAS). Health care facilities should refer to NQAS Assessors’ guidebook and take initiative for the implementation.

Under the ambit of National Quality Assurance Programme, various other initiatives like Kayakalp, LaQshya, MusQan and Mera Aspataal (My Hospital) have also been initiated to work on specific domains of quality improvement. These domains together support the implementation of National Quality Assurance Programme.

  • Kayakalp aims to promote Cleanliness, Hygiene, and Infection Prevention. It is an award scheme in which facilities are assessed at three-levels (Internal, Peer, External) using objective checklist covering eight thematic

areas (a) Hospital Upkeep, (b)Sanitation & Hygiene, (c) Waste Management, (d) Infection control, (e) Support Services (f) Hygiene Promotion, and (g) Beyond the hospital boundary.

Facilities scoring 70% and above after external assessment are recognized and incentivized.

  • LaQshya is a quality improvement initiative, which aims to improve facility-based quality of care around birth, which normally takes place in the Labour Room and Maternity OT of a high case-load facility.
  • Mera Aspataal (My Hospital) an ICT based platform which captures ‘Voice of Patients’ visiting and receiving care from the healthcare facilities. Inputs received on Mera Aspataal support facilities to identify the Dissatisfiers” and to take up further actions to mitigate them.