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National Accreditation Board for Hospitals and Healthcare Providers

Health Security for All

Healthcare scenario in India

Source : Deloitte Report

Inspite the Indian healthcare industry is seen to be growing at a rapid pace

Quality remains a serious concern!

• Total Healthcare expenditure in India 3.9% of GDP

– Pvt share of expenditure 73.8%

– Govt. 26.2%

• Pvt Insurance penetration is around 5-7%

• Affordability 71% is out of pocket expense

• Accessibility 68.8% is rural population, unequal

distribution of facilities

Challenges : inequity in Access, affordability, quality of care and

efficiency

• Gross mismatch between demand and supply due to growing

population and ageing

• Lack of skilled, trained manpower

• Inadequate funding by public system

• Inadequate insurance coverage

• Regulatory compliances

• Gross deviation from STGs

• equivocal quality of services including Drug quality

• Lack of trainings

• Dual disease burden

• Lack of accountability

• High out of pocket expense

• Lack of awareness

Factors affecting Health care for all

Health for all

Universal Health care

National Accreditation Board for Hospitals

and Healthcare Providers

Refers to a scenario where everyone is covered for

basic healthcare services. This is a scheme, under

which all Indian citizens, regardless of their

economic, social or cultural backgrounds will have

the right to affordable, accountable and

appropriate health services of assured quality

defined in a published package of services and

benefits.

Moving towards UHC in India

•India has made rapid strides towards increasing access to health services in the past few years through a number of initiatives, including the flagship National Rural Health Mission (NRHM), launched in 2005. This was expanded to the urban population through the National Urban Health Mission (NUHM) in 2013 now as (NHM)



The Mission also adopts a synergistic

approach by relating health to determinants of

good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

Transformation of Healthcare

• High level political commitment to invest in health sector

• Sustainable Social community Health care Schemes

• Skill development and capacity building

• Reducing health care costs

– Innovations

– Use of technology

– Best Practices

– Participatory approach involving NGOs & Private sector

• Changing mindset and attitude

• Accreditation of healthcare facilities



Contd.

• Strengthening of public health infrastructure

• Improve working conditions of health staff

specially in rural areas

• Availability of medicines and supplies

• Training

• Functional efficient referral system

• Creating awareness and empowering patient



Various Government initiatives • RSBY.. It covers the cost of secondary-level hospitalization.

• States Social Community Schemes

– Yasishvani scheme of karnatka

– SAST scheme of Karnatka

– RGJAY scheme of Maharashtra

– Mukhyamantri Amrutum Yojna & Bal Sakha yojna in Gujrat

– Sarv Swasthya Mission - Health Security for All A joint

partnership between Government of Jharkhand and ILO

• ESI

• CGHS and states employee insurance schemes



Role of AccreditationQuality & Safety

Unintentional Harms being done (Medical Errors)

– HAIS

– Medication safety

– Wrong site wrong patient surgery

– Falls

– Pressure Ulcers etc

more than 50% are preventable



Why do we need to improve?In Canada and most developed countries...

Healthcare acquired infections or hospital acquired infections (HAIs) are amongst the most common complications of hospital care, leading to high morbidity and mortality. While WHO estimates about 7-12% HAI burden in hospitalized patients globally, the figures from India are alarming, with an incidence rate varying from 11% to 83% for different kinds of HAIs.

Epidemiology of healthcare acquired infection – An Indian perspective

on surgical site infection and catheter related blood stream infection

Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 46-63

Antibiotic Prescribing Practices• High number of drugs per patient encounter

– Suggests inappropriate use

• More fixed dose combinations

– Many of them are irrational

• Frequent change of antibiotics

• More number of antibiotics per hospitalized patient

Globally 20 -50% of antibiotic use is inappropriate

43 -57% patients with URI and acute diarrhea given

antibiotics (Roy Choudhury report)

For an outcome to be correct

the process needs to be correct

Characteristics of a Quality Healthcare System when the

Appropriate Systems are in Place

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1. It is safe

2. It is effective

3. It is efficient

4. It is patient centered

5. It is equitable

6. It is timelyInstitute of

Medicine

2001

Accreditation: A World Trend

• U.S., Canada, and Australia have the oldest

accreditation systems

• Germany, France, Ireland, and Spain have new

accreditation systems

• Japan, Jordan, Korea, Malaysia, India and Thailand

have new systems, with a government role

• The WHO, World Bank, and development banks

recognize the accreditation model

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“Accreditation is a self-assessment and external peer review process used by health care

organizations to accurately assess their level of

performance in relation to established standards and to implement ways to continuously improve

the health care system.”

Accreditation : Enabler of Change

Third party and usually Voluntary

Accreditation stimulates in HCO

• SAFETY CULTURE:

• COMMUNICATION:

• MEDICATION SAFETY: Ensure the safe use of high-risk medicationsPROVIDE FRAMEWORK and physical environment that supports the safe delivery of care

• INFECTION CONTROL:

• RISK ASSESSMENT:

• ACCOUNTABILITY

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Drivers



Quality Improvement Initiatives

Government initiatives (under NHRM)

IPHS standards

NQAP standards (NHSRC)

Kaya Kalp Programs

Minimum standards under CEA

NABH Accreditation

NABL accreditation

ISO

International agencies .. JCI etc

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A constituent board of

Quality Council of India

(QCI)Set up in 2005

not-for-profit organization

Accreditation program: January, 2006

Voluntary Participation

NBQP

International Linkage

•NABH is an Institutional Member of the

International Society for Quality in Health Care

(lSQua).

•NABH is represented on ISQua Accreditation

Council and provides its Chairman.

•NABH is on board of Asian Society for Quality in

Healthcare (ASQua).

•NABH hospital standards are accredited by

ISQua

NABH international started in 2010

• 4 centers in Philippines accredited

NABH Accreditation Programs

Accreditation of Hospitals

Accreditation of SHCO/ Nursing Homes

Accreditation of Dental Centers

Accreditation of Blood Banks

Accreditation of Wellness Centers

Accreditation of PHC/CHCs

Accreditation of OST Centers

Accreditation of AYUSH hospitals

Accreditation of Medical Imaging Services

Allopathic Clinics

New : Accreditation of Clinical Trial program

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Geographical Distribution of NABH HCO status as on date

Applicant HCOs

Accredited HCOs


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S.No Name of State Hospital SHCO Blood

Bank

MIS Allopathic

Clinic

PHC CHC Dental Ayush Wellness Safe I Medical

Lab

Nursing

Excellence

Pre Entry

Hospital

Pre Entry

SHCO

Progressiv

e Level

Total

1 ASSAM 2 0 1 0 0 0 0 0 0 0 0 0 0 2 0 0 5

2 ANDHRA PRADESH 52 5 2 0 1 0 0 0 0 0 1 2 3 3 0 3 72

3 BIHAR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 CHATTISGARH 3 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4

5 DELHI 44 14 10 13 15 0 0 16 1 1 0 3 0 1 0 2 120

6 GUJARAT 29 7 13 1 3 7 1 0 0 0 0 1 0 0 0 4 66

7 HIMACHAL PRADESH 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 3

8 HARYANA 19 4 3 1 1 2 0 4 0 1 0 0 1 0 1 0 37

9 JHARKHAND 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5

10 KARNATAKA 30 6 4 0 2 1 0 1 5 0 17 5 0 6 5 2 84

11 KERALA 27 5 2 2 0 0 1 0 7 0 21 24 3 6 0 1 99

12 MADHYA PRADESH 6 1 0 0 0 0 0 2 0 0 0 0 0 14 2 1 26

13 MAHARASHTRA 38 9 21 4 0 2 0 1 0 1 6 3 7 5 4 1 102

14 MANIPUR 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1

15 NAGALAND 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1

16 ORISSA 6 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 9

17 PUNJAB 27 6 2 0 0 0 0 1 0 0 12 2 2 0 0 0 52

18 RAJASTHAN 12 0 2 0 0 0 0 1 0 0 0 2 0 1 0 0 18

19 TAMIL NADU 29 7 4 3 2 0 0 1 0 1 0 4 2 40 8 8 109

20 UTTARAKHAND 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 4

21 UTTAR PRADESH 25 4 2 0 0 0 0 1 0 0 0 0 0 10 0 1 43

22 WEST BENGAL 12 0 4 0 2 0 0 0 0 1 0 1 0 0 0 0 20

TOTAL 368 70 72 25 26 12 2 29 14 6 57 47 18 89 20 25 880

Audit Cycle

• Validity of accreditation certificate 3 years

• Surveillance visit 15-18th months

• Reaccreditation visit 3 years

Surprise Visits

NABH- KPIs� Percentage of medication errors

� Percentage of transfusion reactions

� Urinary tract infection rate

� Respiratory infection rate

� Intra-vascular device infection rate

� Surgical site infection rate

� Incidence of falls

� Incidence of bed sores after admission

� Bed occupancy rate and average length of stay

� Incidence of needle stick injuries

This data should not be

used/presented without written

permission of NABH



permission of NABH

VAP

Percentile Value

25 0.00

50 2.63

75 7.30



permission of NABH

ALOS

Percentile Value

25 3.30

50 4.06

75 4.88

Updates on NABH

•Accreditation of Ethics Committee for clinical Trial

•Emergency Department standards for Hospitals

developed in collaboration with Academic College of

Emergency Experts (ACEE).

•NABH Healthcare Quality standards are being developed

separately for Eye Care Healthcare providers in

consultation with All India Ophthalmological Society.

Also Remember that Compassion ,

Human touch and Empathy existed……

Remember they MUST CONTINUE to EXIST

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