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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)
National Accreditation Board for Hospitals
and Healthcare Providers
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
National Accreditation Board for Hospitals
and Healthcare Providers
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
National Accreditation Board for Hospitals
and Healthcare Providers
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
National Accreditation Board for Hospitals
and Healthcare Providers
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
National Accreditation Board for Hospitals
and Healthcare Providers
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
National Accreditation Board for Hospitals
and Healthcare Providers
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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National Accreditation Board for Hospitals and Healthcare Providers
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
National Accreditation Board for Hospitals and Healthcare Providers
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National Accreditation Board for Hospitals and Healthcare Providers
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
This data should not be
used/presented without written
permission of NABH
VAP
Percentile Value
25 0.00
50 2.63
75 7.30
This data should not be
used/presented without written
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