Manisha Khurana
Assistant Manager – Quality,
QRG Central Hospital and Research Center

Shifting Focus to Quality Healthcare in India

In developing countries like India, the care that people currently receive is often inadequate and of poor quality, with Tier-II and Tier-III population being the worst hit. A study has estimated that more than 2.4 million people died in India in 2016 due to conditions that could have been treated by healthcare and of this, nearly 1.6 million people (66 percent) died of poor quality of the healthcare services. This poor-quality care can largely be attributed to lack of capacity or knowledge in healthcare settings, lack of accountability among providers, and poorly functioning governance system in the country.

In recent times, there has been a gradual shift toward providing quality healthcare, and quality measures have been adopted by hospitals in metro and Tier-I cities. These quality measures assess care across the entire continuum of healthcare delivery, and they can be grouped into structure, processes, and outcomes. The structural measures assess characteristics of the facility and the human resources available, while the processes measure whether the services provided are consistent and represent various clinical and supportive interactions between the providers and the patients. The outcomes reflect the changes in the healthcare status, i.e., relief from symptoms or cure of a disease because of care received.

Currently in India, there is no mandatory system to gauge the level of adoption of the quality measures for healthcare organizations. Though there are bodies like National Accreditation Board for Hospital and Healthcare organizations (NABH) but the process of accreditation is completely voluntary and lack of certification does not imply that the overall quality of services of the healthcare institution is poor. To get NABH accredited, a 150–200 bedded hospital ends up spending Rs 15–20 lakh per annum in ensuring compliance to quality standards, including a fee of Rs 2 lakh payable to NABH. Some Indian hospitals have also opted for international quality accreditation like Joint Commission International (JCI) to attract medical tourism. Their annual spends on quality generally ranges between Rs 40 and 50 lakh.

Cost of accreditation and lack of knowledge are seen as the biggest deterrents to quality accreditation. The association between cost and quality is highly debatable with one section claiming that improvements in quality will increase the cost of treatment while other section being a firm believer of the fact that healthcare costs can be reduced by reducing complications and hospital readmissions with focus on quality standards. In reality it can be any of the cases, depending on the direction in which the money is spent.

In the recent past, the government has also taken initiatives to ensure quality healthcare, which is evident from the fact that 15 percent extra payouts are done to the NABH-accredited hospitals for treating CGHS, ESI, and Ayushman Bharat patients. With the IRDAI guidelines, making entry level accreditations of NABH, mandatory for the hospitals to process cashless claims, there has been a significant upsurge in the NABH entry-level/complete-accredited hospitals. As on March 31, 2019, approximately 3000 hospitals/SHCOs in the country (less than 5 percent of the total hospitals in the country) have some sort of NABH accreditation (entry-level/complete), and another 38 hospitals being JCI accredited.

Accreditation Status

NABH-Accredited Hospitals


NABH-Accredited Small Healthcare Organizations


NABH-Certified Pre-Accreditation Entry-Level Hospitals


NABH-Certified Pre-Accreditation Entry-Level SHCOs


As India moves toward Universal Health coverage, making healthcare accessible and affordable for all with schemes like Ayushman Bharat, quality should be at the center. A low-quality healthcare system, if scaled, can have serious implications and can set the clock back. In this regard, the government is required to take policy-level decisions, and one-step in this effort can be rolling out of a National Quality Strategy, which should have measures for timely collection and analysis of the data from all the healthcare facilities and should aim to make the healthcare delivery safe, effective, and affordable.

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