Quality

Properly accrediting service delivery institutions (primary health care facilities and hospitals) to deliver the agreed service package is the supplement to ensuring coverage. WHO will support the Government of India in the process of accrediting service delivery institutions (primary health care facilities and hospitals) able to deliver the “covered” package with adequate staff and proper standards.

WHO will support a qualitative leap forward in the quality of licensing, accreditation and certification of public and private health services delivery institutions and existing schemes. This would ensure that chosen hospitals are really able to deliver the required package of services if and when accredited or quality certified to do so, in order to increase demand for the package of services offered, coupled with synergized patient charters with explicit mention of patients’ rights.

Given the current ownership structure in service delivery, it is envisaged that the planned increase in public expenditure will involve a substantial supply-side intervention; it is intended in principle that there will be at least one public hospital able to deliver the required package of services in each defined area. Private hospitals (perhaps initially from the not-for-profit voluntary sector) may be contracted by the government to provide services using public funds wherever necessary.

To that end, improvements in the entire field of contracting arrangements (formulated in the NRHM as “increasing district accountability for the money received by making certain specifications”) also need support; districts and particularly hospitals need to have the necessary measurement, accounting and managerial instruments to make them accountable. Better Programme Implementation Plans and District Action Plans should also be developed, supported by refinements in the Health Management Information System (HMIS), contractual arrangements and other tools.

Access to high-quality, affordable essential pharmaceuticals and other technologies will also be promoted in the context of accreditation; this is something that also connects with India’s duties in addressing health challenges globally through S-SC, BRICS commitments and beyond.

Realistic health workforce plans including, for example, initiatives to encourage migrants willing to return to India at the end of their careers will become important in the efforts to meet the required standards of practice in India (numbers, skills and ethics). WHO would advise in work on the human capital that might entail different modalities, to be determined by the government and the concerned institutions, for example:

  • increasing the production of professionals;
  • providing intensive, specific training to targeted groups;
  • changing the skill mix of the workforce; and
  • providing incentives, either positive (e.g. better job conditions or bonuses) or negative (e.g. tighter discipline and more sanctions).

WHO will also support refinements in the HMIS needed for modern licensing and accreditation. As indicated in the section on Stewardship, better registration and reporting systems will have to be simple but effective. Professionals in the public sector are supposed to already have reporting obligations. For health authorities, better involving private doctors and institutions (clinics and hospitals) in the pursuit of national health objectives is an obligation that cannot be renounced – more so if private institutions aspire to contractual arrangements which would allow them to provide services using public funds. The human resource and technological implications of these improvements in HMIS should be taken into account.