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National Quality Assuarance Scheme

Quality is doing the right things in a right way…first time and every time. It is the degree of adherence to the predetermined standards. There is need of a comprehensive approach called Quality Assurance in Health care systems as today’s Health care system includes avoidable errors, underutilized services, overuse/ underuse/ misuse of services, variation in services, communication problems, lack of evidence and dissatisfied clients. Perceptions of poor quality of health care may prevent patients from using the available services because health issues are among the most salient of human concerns. There is need to address inequities and focus on Quality for further gains. Ensuring quality of the services will result in improved patient / client level outcomes at the facility level.

Ministry of Health and Family Welfare, Government of India is committed to support and facilitate the Quality Assurance Programme, which meets needs of Public Health System and is sustainable. Main focus of the Quality Assurance Programme is to enhance satisfaction level among users of the Government Health Facilities and reposing trust in the Public Health System.

The Organizational structure under the programme is as follows:-

The State Quality Assurance Committee (SQAC) is a body at state level for the policy decision and directions. This is also responsible for all QA initiative, its success & shortcomings. The primary role of the committees at the state level is to provide overall guidance, mentoring and monitoring of QA efforts in the districts. State Quality Assurance Unit (SQAU) is the operational arm under SQAC that is responsible for undertaking various activities as per the TORs of the unit, and other tasks, as entrusted to them from time to time by the SQAC.

Likewise at district level, there is District Quality Assurance Committee (DQAC) and District Quality Assurance Unit (DQAU) is the working arm under DQAC that is responsible for undertaking various activities as per the TORs and entrusted upon DQAU by the DQAC.

In order to process claims & complaint received from the clients lodged against the service providers / facilities, there should be a District Family Planning Indemnity Subcommittee (DISC) at district level that shall work under the supervision of State Family Planning Indemnity Subcommittee (SISC).

The District Quality Team (DQT) is functioning exclusively at the district hospitals for ensuring adherence to quality standards and interdepartmental coordination.

Quality Measurement System:-

1. Areas of Concerns- These are eight broad areas/ themes for assessing different aspects for quality in a facility. These include Service provision, Patient Rights, Inputs, Support services, Clinical Services, Infection Control, Quality Management and Outcome.
2. Standards- These are statements of requirement of particular aspect of quality such as hand hygiene, intrapartum care etc.
3. Measurable Elements- These are the Specific attributes of a standard which should be looked into for assessing the degree of compliance to a particular standard such as Hand washing facility, Active management of third stage of labour (AMTSL) etc.
4. Checkpoint- Tangible measurable checkpoints are those, which can be objectively observed and scored such as availability of soap, administration of Oxytocin within one minute of birth, availability of screens and curtains etc.
   
   

Assessment Protocols:-

1. Assessment Method- Assessment could be done through Observation (OB), Staff Interview (SI), Record Review (RR), Patient Interview (PI).
2. Compliance and Scoring Rules-

• 2 for full compliance when all requirements in checklist are meeting, all tracers given in Means of verification are available, and intent of Measurable Element is meeting.
• 1 for partial compliance when Some of the requirements in checkpoints are meeting, at least 50-99% of tracers in Means of verification are available, and intent of Measurable Element is partially meeting.
• 0 for non compliance when most of the requirements are not meeting, less than 50% of tracers in Means of verification are available, and intent of Measurable Element is not meeting

Method of doing Assessment:-

Quality Certification of Facilities at State & National Level-

• 3% incentive if at least 20% of District Hospitals certified at state level.
• 2% incentive if at least 10% of CHCs/ PHCs certified at state level.

Incentives on Achievement & Sustenance:-

Financial-

Incentive per Functional bed on National Accreditation.

25% for Individual Incentives and 75% for Staff welfare and Improving Work environment.

Annual Incentives of Same Amount for maintaining the accreditation.

QA Incentivization Norm as per GOI:-

Type of Health Facility	Areas for Assessment for QA Certification	Type of Certification	Incentive
DH/CHC	All departments of health facility	Full certification	Rs.10,000 x number of functional beds.
DH/CHC	All departments of health facility	Certification with functionality	Rs.7,000 x number of functional beds.
DH/CHC	Part of hospital/ services (Labour room, Maternity Ward, Blood Bank etc)	Full certification	Rs.10,000 x number of functional beds x No. of applicable checklists in the standards.
PHC/ U-PHC with beds	All departments	Full Certifiation	Rs. 3.0 lakhs
PHC/ U-PHC with beds	All departments	Certification with conditionality	Rs. 2.0 lakhs
PHC/ U-PHC without beds	All checklists	Full Certification	Rs. 2.0 lakhs
PHC/ U-PHC without beds	All checklists	Certification with conditionality	Rs. 1.50 lakhs

Non Financial-

Facilitation at State Level.

Publication of Achievement in Media.

CMEs, Trainings, Short Courses for Staff.

Weightage during Appraisal.

Organisational framework QA in J&K.

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Awareness workshop QA - Kashmir Division on 3rd Oct, 2017

Internal Assessors Training of 2 batches of Kashmir Division w.e.f 4rd Oct.- 6th Oct. 2017 in Dhobiwan, Baramulla