Raise The ‘Bar’ of Healthcare Quality in India

Dr. Vijay Agarwal, President, CAHO

  • How has the quality and accreditation (Hospitals) scenario changed in the past few years?

We have been late starters for adopting quality and accreditation standards in the country. Even considering that we started National Accreditation Board in 2005, quality and the accreditation scenario is far from satisfactory in our country. During the last 13 years we have been able to accredit ​approximately 2.5​ per cent of the hospitals by ​NABH

  • How does accreditation contribute to improved and higher quality care?

​Accreditation does contribute to improved quality as it forces hospital to adopt many steps to enhance patient safety. The maximum benefit will be seen in institutions where there is constant monitoring of standards and good practices.​

  • Why are there so few hospitals opting for accreditation?

Accreditation is a voluntary process. Better infrastru​cture, equipment and more numbers of trained personnel needed for accreditation requires more finances. Most hospitals are financially stressed and inadequate reimbursement from the government schemes adds to their woes. World over, incentives have been given to the hospitals for achieving accreditation.

In India two recent developments will pave way for more uptake of accreditation. First step is taken by NABH to come out with Pre- accreditation Entry Level Certification where the standards for assessment have been significantly diluted. Second is that IRDA has mandated that hospitals wanting to provide cashless treatment must obtain at least this certification by June 2018

  • What factors impede the wide spread uptake of accreditation facilities available in India?

​There is very limited information available to the public about usefulness of NABH hospitals. Government is also dragging its feet on this issue as the total numbers of accredited hospitals are less and the number of accredited hospitals in the government sector are even fewer.

We have a significant percentage of population who pay out of pocket for treatment. For this category, increasing cost of healthcare delivery in accredited hospitals is becoming an issue.

  • What are the challenges faced by accredited hospitals ?

​Some of the important challenges are:

  • Healthcare delivery is now a team work. Doctors have been traditionally working in solo style. They have to become the captain of the team and hold regular meetings with their team. Their reluctance to understand this change is a big challenge. Huge shortage of specialists in the country adds to this problem.
  • Nurses are the backbone of healthcare delivery. Their numbers are inadequate and training very deficient.  There is an urgent need to empower them and increase their emoluments. Same is true for other para-medical staff.
  • Biggest challenge is to survive economically especially if hospitals follow best practices. Inadequate reimbursement and delayed payment by government schemes   is a big ​
  • A recent study done in Karnataka has shown that payment done by government schemes was hardly 50 per cent of the cost of the procedures!!
  • Failure of top management to understand the quality parameters is another challenge.


  • What role is CAHO playing to help hospital understand quality and accreditation?

CAHO is a non-profit organization, which is a common platform for all NABH and NABL Accredited Hospitals. CAHO works closely with the two bodies of the Quality Council of India- NABH and NABL. This Forum has been created to:

  • To Continuously Raise The ‘Bar’ Of Healthcare Quality. This is being done by training doctors, nurses, and administrators as quality implementer for hospitals and labs. A number of other training programs are being conducted and regular webinars are being held.
  • To Support NABH & NABL: CAHO has created the mechanism for HCOs to understand the needs and importance of accreditation rather than depending on a consultant.
  • To Make Visible The Benefits Of Accreditation To Various Stakeholders: Patients, Insurance, Healthcare Providers and Industry Leaders.
  • To Share Best Practices and Learn From Each Other.
  • To Showcase ‘Brand India’s’ Healthcare within and internationally.
  • To Have A Voice In Unison.


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