To help hospitals improve quality of their services, Delhi chief minister Sheila Dikshit in December 2007 recommended eight state-run hospitals to the Quality Council of India (QCI) for National Accreditation Board for Hospital (NABH) accreditation.

QCI is an autonomous body set up by the government of India and the Indian industry to promote quality through accreditation and NABH ensures this quality for the healthcare providers in the country.

More than two-and-a half years have gone by, leave apart getting a stamp of quality, seven out of eight recommended hospitals have not even applied for accreditation.

Although, all the hospitals have gone through the initial stage of pre-assessment where a team by NABH files a report highlighting the gaps in the processes followed in the hospital and what more needs to be done to get accreditation.

QCI secretary general, Dr Girdhar Gyani, told Governance Now here that he is “disappointed with the lack of commitment” shown by the hospital authorities. “Only Chacha Nehru Bal Chikitsalya, which is a smaller hospital in comparison with the others, worked hard towards attaining the accreditation and is the only public hospital in the country which meets the international standard in delivering healthcare,” said Gyani.

The other seven hospitals in the list are: Institute of Human Behavior and Allied Sciences (IHBAS), Govind Ballabh Pant (GB Pant), Deen Dayal Upadhyaya Hospital (DDU), Maulana Azad Dental Hospital, Lok Nayak Jay Prakash Hospital (LNJP), Dada Den Shishu Evam Matri Chikitsalya and Guru Teg Bahadur Hospital (GTB).

With the commonwealth games approaching, Gyani pointed out that the hospital facilities in the city might be used by the foreign delegates and one of their primary concerns would be hospital accreditation. “Unlike some other countries, accreditation is a new concept in India. In case the delegates do not receive proper treatment at any of the public hospitals, the state government would not have anything in their defence because none of their hospitals have quality assurance,” said Gyani.

In two letters written to the Delhi health minister Kiran Walia, Gyani has suggested that the state sign a deal with the 14 accredited private hospitals in Delhi to allot space for emergency purposes during the games for the foreign delegates. The first letter was written in October 2009 and the second one was written two months ago.

“There is no way the public hospitals can meet NABH standards before the commonwealth games since they have not yet applied for accreditation. To save some embarrassment, the state government should look for alternatives,” he said.

Meanwhile, LNJP hospital’s medical superintendent, Dr Amit Banerjee, said that the delay in applying for accreditation in the hospital is due to several internal problems and that it would take more than a year for the hospital to be ready to meet the NABH standards.

“LNJP’s pre-assessment by NABH was done in April 2009. There are few things in the hospital which unless altered, we will not go for accreditation. Our operation theatre, which is a three-floored building, was commissioned in 1974 and the technology there hasn’t changed yet. This is our major facility for routine operations of all disciplines and we are dependent on this building. We cannot close it for renovation and it will take us at least one-and-a-half-year to completely move to the new OT. We are unlikely to shift there before the commonwealth games end. We will apply to NABH once the commonwealth games are over on a condition if the QCI agrees to assess the hospital minus the OT,” said Banerjee. He added that the hospital has no qualms in seeking QCI’s help but the hospital services are running successfully without NABH accreditation. “This certificate is not mandatory for the commonwealth games. Why should we improve our system only for the games? It is a continuous process. We work toward improving our services with or without the commonwealth games. Asian games were held in 1950 in India with whatever little resources we had. The confidence exuded from the inspectors who come to see the preparation for the games is our quality assurance,” he said.

Dr. Zainab Zaidi, assistant director, QCI, said that states like Gujarat, Kerala, Tamil Nadu, Delhi, Madhya Pradesh and Andhra Pradesh have shown interest in getting NABH accreditation.

By December 2010, Assam, Punjab, Haryana and Jammu and Kashmir state governments may also come forward and sign memorandum of understanding with the QCI.

For accreditation for public hospitals, state governments have to sign MoUs with QCI after which they send a list of hospitals they want under NABH to the QCI. A team from NABH goes to the hospital for pre-assessment. The team assesses the hospital’s processes and submits a gap report. They suggest a corrective action to the hospital and assist them in improving facilities if they ask for it. Once the hospital improves upon the gap areas, they may apply for accreditation for which they will have to give a nominal fee to QCI. If the hospital follows standards set by NABH, they are given the accreditation. This certificate is valid for three years and every 18 months, there is a surveillance visit by the NABH team to ensure that the hospital is upgrading the facilities even after the certificate. Six months before the expiry of the NABH certificate, the hospital may re-apply for accreditation.

NABH has different guidelines for different clinical establishments, depending on the size of the establishment.