© 2016, National Health Mission, Ministry of Health & Family Welfare, Government of India

First Edition: 2016

Revised Edition: 2018
Revised Edition: 2020
Reproduction of any excerpts from this document does not require permission from the publisher so
long as it is verbatim, is meant for free distribution and the source is acknowledged

ISBN 978-93-82655-30-5

Ministry of Health & Family Welfare

Government of India
Nirman Bhavan, New Delhi, India
Designed and Printed by: Macro Graphics Pvt. Ltd.
 List of Contributors

List of contributors 2020

1 Ms. Vandana Gurnani Additional Secretary & Mission Director (NHM), MoHFW

2 Mr. Vikas Sheel Joint Secretary (Policy), MoHFW

3 Dr. N. Yuvaraj Director (NHM-I), MoHFW

4 Mr. Sachin Mittal Director (NHM-II), MoHFW

5 Mr. Mandar Randive Consultant, MoHFW

Standard Review Committee- 2020

1 Dr. K. Dayanand Rao General Manager, AAHC Telangana

2 Ms. Madhukala Mishra D.D Nursing, Sikkim

3 Dr. Kartik Shah State Quality Nodal Officer, Gujarat

4 Dr. M. Mariappan Professor, Tata Institute of Social Sciences, Mumbai

5 Maj. Gen. (Dr.) M. Srivastava Senior Consultant, Academy of Hospital Administration, Noida

6 Dr. Nikhil Prakash Gupta Expert, WHO Head Quarter Geneva

7 Dr. J.N. Srivastava Head, Quality Improvement, NHSRC

8 Dr. Deepika Sharma Senior Consultant, QI, NHSRC

9 Dr. Arpita Agrawal Consultant, QI, NHSRC

Standard Review Committee- 2017

Group I – Focus on Maternal Health Components

1 Dr. Dinesh Baswal DC (Maternal Health-I/C), MoHFW

2 Dr. J.N. Srivastav NHSRC

3 Dr. Paul Francis/Dr. Amrita Kansal WHO

4 Dr. Asheber Gaym UNICEF

5 Dr. Neelesh Kapoor IPE Global

6 Dr. Vikas Yadav/Deepti Singh Jhpiego

7 Nikhil Prakash NHSRC

8 Dr. Anil Kandukuri NHSRC

9 Dr. Salima Bhatia, Sr. Consultant MoHFW

10 Dr. Tarun Singh Sodha, Consultant MoHFW

List of Contributors iii

 11 Dr. JyotiBaghel, Jr. Consultant MoHFW

12 Additional Experts (as nominated by MH Division)

Group II – Focus on Child Health Components

1 Dr. Ajay Khera DC (Child Health-I/C), MoHFW

2 Dr. J.N. Srivastav NHSRC

3 Dr. Prabhakar DC (Child Health), MoHFW

4 Dr. Paul Francis/Dr. Amrita Kansal WHO

5 Dr. Gagan Gupta UNICEF

6 Dr. Harish Kumar IPE Global

7 Dr. Renu Srivastav IPE Global

8 Dr. Vikas Yadav/Deepti Singh Jhpiego

9 Nikhil Prakash NHSRC

Standard Review Committee- 2016

1 Dr. J.N. Srivastava Advisor Quality Improvement, NHSRC-Chairperson

2 Prof. Sangeeta Sharma Prof. & Head, Neruropsychopharmacology, IHBAS, New Delhi

3 Prof. M. Mariappan Prof. & Chairperson, Centre for Hospital Management, TISS, Mumbai

4 Prof. Avinash Supe Dean, KEN Medical College Hospitals, Mumbai

5 Prof. Urmila Thatte Prof. & Head, Dept. of Pharmacology, Seth GS Medical College, Mumbai

6 Dr. Munindra Srivastava President, AHA, Noida

7 Dr. Sandip Sanyal Deputy Director of Health Services, Hospital Administration Branch, Kolkata

8 Dr. Parminder Gautam Senior Consultant, Quality Improvement, NHSRC

9 Dr. Nikhil Prakash Senior Consultant, Quality Improvement, NHSRC

10 Dr. Deepika Sharma Consultant, Quality Improvement, NHSRC

Standard Formulation Committee- 2013

1 Ms. Anuradha Gupta AS&MD (NRHM), MoHFW

2 Dr. Rakesh Kumar JS, RCH, MoHFW

3 Mr Manoj Jhalani JS, Policy, MoHFW

4 Dr. Himanshu Bhushan DC (I/c MH), MoHFW

5 Dr. Manisha Malhotra DC (MH), MoHFW

6 Dr. Dinesh Baswal DC (MH), MoHFW

7 Dr. S.K. Sikdar DC (I/c FP), MoHFW

8 Dr. P.K. Prabhakar DC (CH), MoHFW

9 Dr. Poonam Varma Shivkumar Prof. of OBGY, MGIMS, Wardha

iv National Quality Assurance Standards for Public Health Facilities | 2020

10 Dr. R. Rajendran State Nodal Officer, Anaesthesia, Tamil Nadu

11 Dr. Arvind Mathur WHO, SEARO

12 Dr. Dinesh Agarwal UNFPA

13 Dr. Pavitra Mohan UNICEF

14 Dr. Neerja Bhatla Prof of OBGY, AIIMS, New Delhi

15 Dr. Somesh Kumar Jhpiego

16 Dr. Archana Mishra DD (MH), GoMP

17 Dr. Ritu Agrawal UNICEF

18 Dr. Aparajita Gogoi CEDPA, India

19 Dr. Sridhar R.P. State Health Consultant (MCH), Gujarat

20 Dr. Pushkar Kumar Lead Consultant, MH, MoHFW

21 Mr. Nikhil Herur Consultant MH, MoHFW

22 Dr. Rajeev Agarwal Sr. Mgt. Consultant, MH, MoHFW

23 Dr. Ravinder Kaur Senior Consultant, MH, MoHFW

24 Dr. Renu Srivastava SNCU Co-ordinator, CH, MoHFW

25 Dr. Anil Kashyap Consultant NRHM, MoHFW

26 S. Chandrashekhar JD(QA & IEC, KHSDRP, Karnataka

27 Ms. Jyoti Verma DD & Nodal Officer, QA, Govt. of Bihar

28 Ms. Laura Barnitz CEDPA, India

29 Ms. Priyanka Mukherjee CEDPA, India

NHSRC Team

1 Dr. T. Sundararaman ED, NHSRC

2 Dr. J.N. Srivastava Advisor – QI, NHSRC

3 Dr. P. Padmanaban Advisor (PHA Div.), NHSRC

4 Mr. Prasanth K.S. Sr. Consultant (PHA Div.), NHSRC

5 Dr. Nikhil Prakash Consultant NHSRC (QI Div)

6 Dr. Deepika Sharma Consultant NHSRC (QI Div)

Maharashtra Team

1 Shri Vikas Kharage Ex MD, NRHM, Govt. of Maharashtra

2 Dr. Satish Pawar Director, Health Services, Govt. of Maharashtra

3 Dr. M.S. Diggikar Ex Principal, Public Health Institute, Nagpur, Maharashtra

4 Mr. Shridhar Pandit PO, NRHM, Govt. of Maharashtra

List of Contributors v
 Table of Contents

National Quality Assurance Standards 1

National Quality Assurance Standards for District Hospital 9
National Quality Assurance Standards for Community Health Centre (First Referral Unit) 47
National Quality Assurance Standards for Primary Health Centre (24x7) 77
National Quality Assurance Standards for Urban Primary Health Centre 105
National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 129
National Quality Assurance Standard for Aefi Surveillance Program 153
National Quality Assurance Standard for Comprehensive Lactation Management Centres 157
Amendments Made under National Quality Assurance Standards 161
Bibliography 163

Table of Contents vii

National Quality Assurance
Standards
 Introduction to National Quality
Assurance Standards

Often, measuring the quality in health facilities has never been easy, more so, in Public Health Facilities. We have
had quality frame-work and Quality Standards & linked measurement system, globally and as well as in India. The
proposed system has incorporated best practices from the contemporary systems, and contextualized them for
meeting the needs of Public Health System in the country.
The system draws considerably from the guidelines (more than one hundred fifty in number), Standards and Texts
on the Quality in Healthcare and Public health system, which ranges from ISO 9001 based system to healthcare
specific standards such as JCI, IPHS, etc. Operational Guidelines for National Health Programmes and schemes
have also been consulted.
We do realise that there would always be some kind of ‘trade-off’, when measuring the quality. One may have
short and simple tools, but that may not capture all micro details. Alternatively one may devise all-inclusive
detailed tools, encompassing the micro-details, but the system may become highly complex and difficult to apply
across Public Health Facilities in the country.
Another issue needed to be addressed is having some kind of universal applicability of the quality measurement
tools, which are relevant and practical across the states. Therefore, proposed system has flexibility to cater for
differential baselines and priorities of the states.
Following are salient features of the proposed quality system:
1. Comprehensiveness – The proposed system is all inclusive and captures all aspects of quality of care
within the eight areas of concern. The departmental check-lists transposed within Quality Standards, and
commensurate measurable elements provide an exhaustive matrix to capture all aspects of quality of care
at the Public Health Facilities.
2. Contextual – The proposed system has been developed primarily for meeting the requirements of the
Public Health Facilities; since Public Hospitals have their own processes, responsibilities and peculiarities,
which are very different from ‘for-profit’ sector. For instance, there are standards for providing free drugs,
ensuring availability of clean linen, etc. which may not be relevant for other hospitals.
3. Contemporary – Contemporary Quality standards such as NABH, ISO and JCI, and Quality improvement
tools such as Six Sigma, Lean and CQI have been consulted and their relevant practices have been
incorporated.
4. User Friendly – The Public Health System requires a credible Quality system. It has been endeavour
of the team to avoid complex language and jargon. So that the system remains user-friendly to enable
easy understanding and implementation by the service providers. Checklists have been designed to be
user-friendly with guidance for each checkpoint. Scoring system has been made simple with uniform
scoring rules and weightage. Additionally, a formula fitted excel sheet tool has been provided for the
convenience, and also to avoid calculation errors.
5. Evidence based – The Standards have been developed after consulting vast knowledge resource available
on the quality. All respective operational and technical guidelines related to RMNCH+A and National
Health Programmes have been factored in.

National Quality Assurance Standards 3

 6. Objectivity – Ensuring objectivity in measurement of the Quality has always been a challenge. Therefore
in the proposed quality system, each Standard is accompanied with measurable elements & Checkpoints
to measure compliance to the standards. Checklists have been developed for various departments, which
also captures inter-departmental variability for the standards. At the end of assessment, there would be
numeric scores, bringing out the quality of care in a snap-shot, which can be used for monitoring, as well
as for inter-hospital/inter-state(s) comparison.
7. Flexibility – The proposed system has been designed in such a way that states and Health Facilities can
adapt the system according to their priorities and requirements. State or facilities may pick some of the
departments or group of services in the initial phase for Quality improvement. As baseline differs from
state to state, checkpoints may either be made essential or desirable, as per availability of resources.
Desirable checkpoints will be counted in arriving at the score, but this may not withhold its certification,
if compliance is still not there. In this way the proposed system provides flexibility, as well as ‘road-map’.
8. Balanced – All three components of Quality – Structure, process & outcome, have been given due
weightage.
9. Transparency – All efforts have been made to ensure that the measurement system remains transparent,
so that assessee and assessors have similar interpretation of each checkpoint.
10. Enabler – Though standards and checklists are primarily meant for the assessment, it can also be used
as a ‘road-map’ for improvement.

4 National Quality Assurance Standards for Public Health Facilities | 2020

 Components of Quality Measurement
System and their Intent

The main pillars of Quality Measurement Systems are Quality Standards. These standards have been defined for
various level of facilities. The Standards have been grouped within the eight Areas of Concern. Each Standard further
has specific Measurable Elements. These standards and measurable elements are checked in each department of
a health facility through department specific Checkpoints. All Checkpoints for a department are collated, and
together they form assessment tool called ‘Checklist’. Scored/filled-in Checklists would generate scorecards.
Functional relationship between quality standards, measurable elements, check-points and check-list is shown in
Figure 1.
Figure 1: Functional Relationship between Components of Quality Measurement System

Departmental
Checklists

Checkpoint Score
Measurable
Elements card
Checkpoint Departmental
Standard &
Checkpoint Facility
Area of Concern Measurable
Elements
Checkpoint
Standard

Following are the area of concern in a health facility:

1. Service Provision
2. Patient Rights
3. Inputs
4. Support Services
5. Clinical Services
6. Infection Control
7. Quality Management
8. Outcome

National Quality Assurance Standards 5

Currently National Quality Assurance Standards for following level of facilities are available:
1. District Hospital
2. Community Health Centre
3. Primary Health Centre (24x7)
4. Urban Primary Health Centre
5. Health and Wellness Centre (Sub-centre)
Following is the summary of Standard, Measurable Element, Check Point & Departmental Checklist for various
level of Facilities:

MEASUREMENT SYSTEM FOR VARIOUS LEVELS OF FACILITIES

Component DH CHC PHC UPHC HWC(SC)
Area of Concern 8 8 8 8 8
Standards 74 65 50 35 50
Measurable Elements 369 297 250 200 129
Checklists 19 12 6 12 1

Facility Levelwise Assessment Tools

District Hospital
Volume I
1 Accident & Emergency Department
2 Out Patient Department
3 Labour Room (LaQshya)
4 Maternity Ward
5 Pediatric Ward
6 Sick Newborn Care Unit (SNCU)
7 Nutritional Rehabilitation Center (NRC)
8 Operation Theatre
9 Maternity Operation Theatre (LaQshya)
10 Post Partum Unit
Volume II
11 Intensive Care Unit (ICU)
12 Indoor Patient Department
13 Blood Bank
14 Laboratory Services
15 Radiology
16 Pharmacy
17 Auxiliary Services
18 Mortuary
19 General Administration

6 National Quality Assurance Standards for Public Health Facilities | 2020

Community Health Centre
1 Accident and Emergency Department
2 Out Patients Department (OPD)
3 Labour Room
4 In patient Department
5 New Born Stabilization Unit
6 Operation Theatre
7 Laboratory
8 Radiology
9 Pharmacy and Stores
10 Blood Storage Unit
11 Auxiliary Services
12 General Administration

Primary Health Centre

1 Outdoor Department
2 Labour Room
3 Indoor Department
4 Laboratory Services
5 National Health Program
6 General Administration

Urban Primary Health Centre

1 General Clinic
2 Maternal Health
3 Newborn and Child Health
4 Immunisation
5 Family Planning
6 Communicable Diseases
7 Non-Communicable Diseases
8 Dressing and Emergency
9 Pharmacy
10 Laboratory
11 Outreach
12 General Administration

National Quality Assurance Standards 7

Health and Wellness Centre (Sub-centre)

1 Care in pregnancy and childbirth

2 Neonatal and infant health care services
3 Childhood and adolescent health care services
4 Family planning, Contraceptive services and other Reproductive Health care services
5 Management of Communicable diseases including National Health Programmes
6 Management of Common Communicable Diseases and Outpatient care for acute simple illnesses and minor
ailments
7 Screening, Prevention, Control and Management of Non-Communicable diseases
8 Care for Common Opthalmic and ENT problems
9 Basic Oral health care
10 Elderly and Palliative health care services
11 Emergency Medical Services
12 Screening and basic Management of Mental health ailments

8 National Quality Assurance Standards for Public Health Facilities | 2020

National Quality Assurance
Standards for District Hospital
 National Quality Assurance Standards for
District Hospital

Area of Concern - A: Service Provision

Standard A1 The facility provides curative services

Standard A2 The facility provides RMNCHA services

Standard A3 The facility provides diagnostic services

Standard A4 The facility provides services as mandated in National Health Programmes/State Scheme.

Standard A5 The facility provides support services

Standard A6 Health services provided at the facility are appropriate to community needs.

Area of Concern - B: Patient Rights

Standard B1 The facility provides information to care seekers, attendants & community about the available services
and their modalities.

Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are
no barriers on account of physical economic, cultural or social reasons.

Standard B3 The facility maintains privacy, confidentiality & dignity of patient, and has a system for guarding patient
related information.

Standard B4 The facility has defined and established procedures for informing patients about the medical condition,
and involving them in treatment planning, and facilitates informed decision making.

Standard B5 The facility ensures that there are no financial barriers to access, and that there is financial protection
given from the cost of hospital services.

Standard B6 The facility has defined framework for ethical management including dilemmas confronted during
delivery of services at public health facilities.

Area of Concern - C: Inputs

Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the
prevalent norms.

Standard C2 The facility ensures the physical safety of the infrastructure.

Standard C3 The facility has established Programme for fire safety and other disaster.

Standard C4 The facility has adequate qualified and trained staff, required for providing the assured services to the
current case load.

Standard C5 The facility provides drugs and consumables required for assured list of services.

Standard C6 The facility has equipment & instruments required for assured list of services.

Standard C7 The facility has a defined and established procedure for effective utilization, evaluation and augmentation
of competence and performance of staff

National Quality Assurance Standards for District Hospital 11

 Area of Concern - D: Support Services

Standard D1 The facility has established Programme for inspection, testing and maintenance and calibration of
Equipment.

Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs in
pharmacy and patient care areas.

Standard D3 The facility provides safe, secure and comfortable environment to staff, patients and visitors.

Standard D4 The facility has established Programme for maintenance and upkeep of the facility.

Standard D5 The facility ensures 24 X 7 water and power backup as per requirement of service delivery, and support
services norms.

Standard D6 Dietary services are available as per service provision and nutritional requirement of the patients.

Standard D7 The facility ensures clean linen to the patients.

Standard D8 The facility has defined and established procedures for promoting public participation in management
of hospital transparency and accountability.

Standard D9 Hospital has defined and established procedures for Financial Management.

Standard D10 The facility is compliant with all statutory and regulatory requirement imposed by local, state or central
government.

Standard D11 Roles & Responsibilities of administrative and clinical staff are determined as per govt. regulations and
standards operating procedures.

Standard D12 The facility has established procedure for monitoring the quality of outsourced services and adheres to
contractual obligations.

Area of Concern - E: Clinical Services

Standard E1 The facility has defined procedures for registration, consultation and admission of patients.

Standard E2 The facility has defined and established procedure for clinical assessment and preparation of the
treatment plan

Standard E3 The facility has defined and established procedures for continuity of care of patient and referral.

Standard E4 The facility has defined and established procedures for nursing care.

Standard E5 The facility has a procedure to identify high risk and vulnerable patients.

Standard E6 Facility ensures rationale prescribing and use of medicines

Standard E7 The facility has defined procedures for safe drug administration.

Standard E8 The facility has defined and established procedures for maintaining, updating of patients’ clinical records
and their storage.

Standard E9 The facility has defined and established procedures for discharge of patient.

Standard E10 The facility has defined and established procedures for intensive care.

Standard E11 The facility has defined and established procedures for Emergency Services and Disaster
Management.

Standard E12 The facility has defined and established procedures of diagnostic services.

Standard E13 The facility has defined and established procedures for Blood Bank/Storage Management and
Transfusion.

12 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E14 The facility has established procedures for Anaesthetic Services.

Standard E15 The facility has defined and established procedures of Operation theatre services.

Standard E16 The facility has defined and established procedures for end of life care and death.

Maternal & Child Health Services

Standard E17 The facility has established procedures for Antenatal care as per guidelines.

Standard E18 The facility has established procedures for Intranatal care as per guidelines.

Standard E19 The facility has established procedures for postnatal care as per guidelines.

Standard E20 The facility has established procedures for care of new born, infant and child as per guidelines.

Standard E21 The facility has established procedures for abortion and family planning as per government guidelines
and law.

Standard E22 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines.

National Health Programmes

Standard E23 The facility provides National health Programme as per operational/Clinical Guidelines.

Area of Concern - F: Infection Control

Standard F1 The facility has infection control Programme and procedures in place for prevention and measurement
of hospital associated infection.

Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and
antisepsis.

Standard F3 The facility ensures standard practices and materials for Personal protection.

Standard F4 The facility has standard procedures for processing of equipment and instruments.

Standard F5 Physical layout and environmental control of the patient care areas ensures infection prevention.

Standard F6 The facility has defined and established procedures for segregation, collection, treatment and disposal
of Bio Medical and hazardous Waste.

Area of Concern - G: Quality Management

Standard G1 The facility has established organizational framework for quality improvement.

Standard G2 The facility has established system for patient and employee satisfaction.

Standard G3 The facility have established internal and external quality assurance programs.

Standard G4 The facility has established, documented implemented and maintained Standard Operating Procedures
for all key processes and support services.

Standard G5 The facility maps its key processes and seeks to make them more efficient by reducing non-value adding
activities and wastages.

Standard G6 The facility has defined mission, values, Quality policy & objectives & prepared a strategic plan to
achieve them.

Standard G7 The facility seeks continually improvement by practicing Quality method and tools.

Standard G8 The facility has defined, approved and communicated Risk Management framework for existing and
potential risks.

National Quality Assurance Standards for District Hospital 13

 Standards G9 The facility has established procedures for assessing, reporting, evaluating and managing risk as per
Risk Management Plan

Standard G10 The facility has established clinical Governance framework to improve the quality and safety of clinical
care processes

Area of Concern - H: Outcome Indicator

Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National benchmarks.

Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark.

Standard H3 The facility measures Clinical Care & Safety Indicators and tries to reach State/National benchmark.

Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National benchmark.

14 National Quality Assurance Standards for Public Health Facilities | 2020

 INTENT OF STANDARDS AND MEASURABLE ELEMENTS
FOR DISTRICT HOSPITAL

Area of Concern - A: Service Provision

Overview
Apart from the curative services that district hospitals provides, Public hospitals are also mandated to provide
preventive and promotive services. Reproductive and Child Health services are now grouped as RMNCH+A,
which are major chunk of the services. These services are also priority for the government, so as to have direct
impact on the key indicators such as MMR and IMR.
This area of concern measures availability of services. “Availability” of functional services means service is available
to end-users because mere availability of infrastructure or human resources does not always ensure into availability
of the services. For example, a facility may have functional OT, Blood Bank, and availability of Obstetrician and
Anaesthetist, but it may not be providing CEmOC services on 24x7 basis. The facility may have functional Dental
Clinic, but if there are hardly any procedures undertaken at the clinic, it may be assumed that the services are either
not available or non-accessible to users. Compliance to these standards and measurable elements should be checked,
preferably by observing delivery of the services, review of records and checking utilisation of the service.
Compliance to following standards ensures that the health facility is addressing this area of concern:

Standard A1 The standard would include availability of OPD consultation, Indoor services
The facility provides Curative and Surgical procedures, Intensive care and Emergency Care under different
Services specialities e. g. Medicine, Surgery, Orthopaedics, Paediatrics etc. Each measurable
element under this standard measures one speciality across the departments.
For Example, ME A1.2 measures availability of emergency surgical procedures in
Accident & Emergency department, availability of General surgery clinic at OPD,
Availability of surgical procedures in Operation theatre and availability of indoors
services for surgery patients in wards.
Standard A2 This standard measures availability of Reproductive, Maternal, Newborn, Child
The facility provides RMNCHA and Adolescent services in different departments of the hospital. Each aspect of
Services RMNCH+A services is covered by one measurable element of this standard.
Standard A3 It covers availability of Laboratory, Radiology and other diagnostics services in
The facility Provides the respective departments.
diagnostic Services
Standard A4 This standard measures availability of the services at health facility under different
The facility provides services National Health Programmes such as RNTCP, NVBDCP, etc. One Measurable
as mandated in national element has been assigned to each National Health Programme.
Health Programmes/state
scheme
Standard A5 The standard measures availability of support services like dietary, laundry
The facility provides support and housekeeping services at the facility.
services
Standard A6 The standard mandates availability of the services according to specific
Health services provided at local health needs. Different geographical area may have certain health
the facility are appropriate to problems, which are prevalent locally.
community needs

National Quality Assurance Standards for District Hospital 15

Measurable Elements
Area of Concern - A: Measurable Elements Service Provision
Standard A1 The facility provides Curative Services
ME A1.1 The facility provides General Medicine services
ME A1.2 The facility provides General Surgery services
ME A1.3 The facility provides Obstetrics & Gynaecology Services
ME A1.4 The facility provides Paediatric Services
ME A1.5 The facility provides Ophthalmology Services
ME A1.6 The facility provides ENT Services
ME A1.7 The facility provides Orthopaedics Services
ME A1.8 The facility provides Skin & VD Services
ME A1.9 The facility provides Psychiatry Services
ME A1.10 The facility provides Dental Treatment Services
ME A1.11 The facility provides AYUSH Services
ME A1.12 The facility provides Physiotherapy Services
ME A1.13 The facility provides services for OPD procedures
ME A1.14 Services are available for the time period as mandated
ME A1.15 The facility provides services for Super specialties, as mandated
ME A1.16 The facility provides Accident & Emergency Services
ME A1.17 The facility provides Intensive care Services
ME A1.18 The facility provides Blood bank & transfusion services
Standard A2 The facility provides RMNCHA Services
ME A2.1 The facility provides Reproductive health Services
ME A2.2 The facility provides Maternal health Services
ME A2.3 The facility provides Newborn health Services
ME A2.4 The facility provides Child health Services
ME A2.5 The facility provides Adolescent health Services
Standard A3 The facility provides diagnostic Services
ME A3.1 The facility provides Radiology Services
ME A3.2 The facility provides Laboratory Services
ME A3.3 The facility provides other diagnostic services, as mandated
Standard A4 The facility provides services as mandated in National Health Programmes/State Scheme
ME A4.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines
ME A4.2 The facility provides services under National TB elimination Programme as per guidelines
ME A4.3 The facility provides services under National Leprosy Eradication Programme as per guidelines
ME A4.4 The facility provides services under National AIDS Control Programme as per guidelines

16 National Quality Assurance Standards for Public Health Facilities | 2020

ME A4.5 The facility provides services under National Programme for control of Blindness as per guidelines
ME A4.6 The facility provides services under Mental Health Programme as per guidelines
ME A4.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines
ME A4.8 The facility provides services under National Programme for Prevention and control of Cancer,
Diabetes, Cardiovascular diseases & Stroke (NPCDCS) as per guidelines
ME A4.9 The facility provides services under Integrated Disease Surveillance Programme as per Guidelines
ME A4.10 The facility provides services under National health Programme for deafness
ME A4.11 The facility provides services as per State specific health programmes
ME A4.12 The facility provides services as per Rashtriya Bal Swasthya Karykram
Standard A5 The facility provides support services
ME A5.1 The facility provides dietary services
ME A5.2 The facility provides laundry services
ME A5.3 The facility provides security services
ME A5.4 The facility provides housekeeping services
ME A5.5 The facility ensures maintenance services
ME A5.6 The facility provides pharmacy services
ME A5.7 The facility has services of medical record department
ME A5.8 The facility provides mortuary services
Standard A6 Health services provided at the facility are appropriate to community needs
ME A6.1 The facility provides curatives & preventive services for the health problems and diseases, prevalent
locally.
ME A6.2 There is a process for consulting community/or their representatives when planning or revising
scope of services of the facility.

National Quality Assurance Standards for District Hospital 17

 Area of Concern - B: Patient Rights

Overview
Mere availability of services does not serve the purpose until the services are accessible to the users, and
are provided with dignity and confidentiality. Access includes Physical access as well as financial access. The
Government has launched many schemes, such as JSSK, RBSK and RBSY, for ensuring that the service packages
are available cashless to different targeted groups. There are evidences to suggest that patients’ experience and
outcome improves, when they are involved in the care. So availability of information is critical for access as well
as enhancing patients’ satisfaction. Patients’ rights also include that health services give due consideration to
patients’ cultural and religious preferences.
Brief description of the standards under this area of concern are given below:

Standard B1 Standard B1 measures availability of the information about services and their
The facility provides the modalities to patients and visitors. Measurable elements under this standard
information to care seekers, check for availability of user-friendly signages, display of services available
attendants & community about and user charges, citizen charter, enquiry desk and access to his/her clinical
the available services and their records.
modalities
Standard B2 Standard B2 This standard ensure that the services are sensitive to gender,
Services are delivered in a cultural and religious needs. This standard also measures the physical access,
manner that is sensitive to and disa ble-friendliness of the services, such as availability of ramps and
gender, religious and cultural disable friendly toilets. Last measurable element of this standard mandates
needs, and there are no barriers for provision for affirmative action for vulnerable and marginalized patients
on account of physical economic, like orphans, destitute, terminally ill patients, victims of rape and domestic
cultural or social reasons. violence so they can avail health care service with dignity and confidence at
public hospitals.
Standard B3 Standard B3 This standard measures the patient friendliness of the services
The facility maintains privacy, in terms of ensuring privacy, confidentiality and dignity. Measurable elements
confidentiality & dignity of under this standard check for provisions of screens and curtains, confidentiality
patient, and has a system for of patients’ clinical information, behaviour of service providers, and also
guarding patient related ensuring specific precautions to be taken, while providing care to patients
information with HIV infection, abortion, teenage pregnancy, etc.
Standard B4 Standard B4 This standard mandates that health facility has procedures
The facility has defined and of informing patients about their rights, and actively involves them in the
established procedures for decision-making about their treatment. Measurable elements in this standards
informing patients about the look for practices such informed consent, dissemination of patient rights and
medical condition, and involving how patients are communicated about their clinical conditions and options
them in treatment planning, and available. This standard also measures for procedure for grievance redressal.
facilitates informed decision Compliance to these standards can be checked through review of records
making for consent, interviewing staff about their awareness of patients’ rights,
interviewing patients whether they had been informed of the treatment plan
and available options.
Standard B5 Standard B5 This standard majorly checks that there are no financial barriers
The facility ensures that there to the services. Measurable elements under this standard check for availability
is no financial barrier to access, of drugs, diagnostics and transport free of cost under different schemes,
and that there is financial and timely payment of the entitlements under JSY and Family planning
protection given from the cost of incentives.
hospital services

18 National Quality Assurance Standards for Public Health Facilities | 2020

Standard B6 Public Health faculties have been instituted for providing health care services for the
Facility has defined larger good and welfare of community. Apart from providing health care services,
framework for ethical the public health facilities have a statutory obligation to conduct medico-legal
management including examinations, post-mortems, facilitate dispensation justice as required by the law,
dilemmas confronted issuing medical certificates and implement government health policies. It is of utmost
during delivery of services importance that public health facilities portray highest standards for ethical practices
at public health facilities in clinical care and governance.
This standard requires the facility to adhere to Ethical norms, and a pre-defined code of
conduct is followed by its staff. Preferably code of conducts should be communicated
to the staff in form of written instructions. This may include do’s and don’t while
performing their duties. These norms should broadly encompass provider’s duty
to sick, doing ‘no-harm’, keeping privacy, confidentiality and autonomy of patients,
non-discrimination and equity. Ethical norms should be in consonance with Code of
Medial Ethics and Code of Nursing ethics released by the Indian Medical Council and
Indian Nursing Council respectively.
While providing the services, the providers may confront ethical dilemmas. These
may arise from patient’s refusal to receive treatment, withdrawal of life support,
prescribing drugs that doctor found more effective but are not part of essential
drug list, entertaining representatives of pharmaceuticals companies at workplace,
sharing data with research purposes where consent has not been taken from
patients, etc. to address these ethical dilemmas effectively and within the legal
parameters, the health facility should develop and implement a framework to
address ethical dilemmas.
Initially the facility should identify the situations, where ethical dilemma usually arise
or have potential to arise. Second facility should appoint a person or group that
will address such issues of ethical dilemma, and will endeavour to timely resolve
it. The mechanism of referral of such issues to appointed person on group should
be defined and effectively communicated to concerned staff. These standards are
targeted for secondary and primary care public hospital; those are not usually not
involved research activities. However, if any health care facility is involved in clinical
or public health research activity, it should take formal approval for research ethics
committee.

National Quality Assurance Standards for District Hospital 19

 Area of Concern - B: Measurable Elements Patient Rights
Standard B1 The facility provides the information to care seekers, attendants & community about the
available services and their modalities.
ME B1.1 The facility has uniform and user-friendly signage system.
ME B1.2 The facility displays the services and entitlements available in its departments.
ME B1.3 The facility has established citizen charter, which is followed at all levels.
ME B1.4 User charges are displayed and communicated to patients effectively.
ME B1.5 Patients & visitors are sensitised and educated through appropriate IEC/BCC approaches.
ME B1.6 Information is available in local language and easy to understand.
ME B1.7 The facility provides information to patients and visitor through an exclusive
set-up.
ME B1.8 The facility ensures access to clinical records of patients to entitled personnel.
Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs,
and there are no barriers on account of physical economic, cultural or social reasons.
ME B2.1 Services are provided in manner that are sensitive to gender.
ME B2.2 Religious and cultural preferences of patients and attendants are taken into consideration while
delivering services.
ME B2.3 Access to facility is provided without any physical barrier & friendly to people with disability.
ME B2.4 There is no discrimination on basis of social & economic status of patients.
ME B2.5 There is affirmative action to ensure that vulnerable sections can access services.
Standard B3 The facility maintains privacy, confidentiality & dignity of patient, and has a system for
guarding patient related information.
ME B3.1 Adequate visual privacy is provided at every point of care.
ME B3.2 Confidentiality of patients records and clinical information is maintained.
ME B3.3 The facility ensures the behaviours of staff is dignified and respectful, while delivering the services.
ME B3.4 The facility ensures privacy and confidentiality to every patient, especially of those conditions having
social stigma, and also safeguards vulnerable groups.
Standard B4 The facility has defined and established procedures for informing patients about the medical
condition, and involving them in treatment planning, and facilitates informed decision
making.
ME B4.1 There is established procedures for taking informed consent before treatment and procedures.
ME B4.2 Patient is informed about his/her rights and responsibilities.
ME B4.3 Staff are aware of Patients rights responsibilities.
ME B4.4 Information about the treatment is shared with patients or attendants, regularly.
ME B4.5 The facility has defined and established grievance redressal system in place.
Standard B5 The facility ensures that there is no financial barrier to access, and that there is financial
protection given from the cost of hospital services.
ME B5.1 The facility provides cashless services to pregnant women, mothers and neonates as per prevalent
government schemes.
ME B5.2 The facility ensures that drugs prescribed are available at Pharmacy and wards.

20 National Quality Assurance Standards for Public Health Facilities | 2020

ME B5.3 It is ensured that facilities for the prescribed investigations are available at the facility.
ME B5.4 The facility provide free of cost treatment to Below poverty line patients without administrative
hassles.
ME B5.5 The facility ensures timely reimbursement of financial entitlements and reimbursement to the
patients.
ME B5.6 The facility ensure implementation of health insurance schemes as per National/state scheme.
Standard B6 The facility has defined framework for ethical management including dilemmas confronted
during delivery of services at public health facilities.
ME B6.1 Ethical norms and code of conduct for medical and paramedical staff have been established.
ME B6.2 The facility staff is aware of code of conduct established.
ME B6.3 The facility has an established procedure for entertaining representatives of drug companies and
suppliers.
ME B6.4 The facility has an established procedure for medical examination and treatment of individual under
judicial or police detention as per prevalent law and government directions.
ME B6.5 There is an established procedure for sharing of hospital/patient data with individuals and external
agencies including non governmental organization.
ME B6.6 There is an established procedure for ‘end-of-life’ care.
ME B6.7 There is an established procedure for patients who wish to leave hospital against medical advice or
refuse to receive specific treatment.
ME B6.8 There is an established procedure for obtaining informed consent from the patients in case facility is
participating in any clinical or public health research.
ME B6.9 There is an established procedure to issue of medical certificates and other certificates.
ME B6.10 There is an established procedure to ensure medical services during strikes or any other mass protest
leading to dysfunctional medical services.
ME B6.11 An updated copy of code of ethics under Indian Medical council act is available with the facility.
ME B6.12 Facility has established a framework for identifying, receiving, and resolving ethical dilemmas’ in a
time-bound manner through ethical committee

National Quality Assurance Standards for District Hospital 21

 Area of concern - C: Input

Overview
This area of concern predominantly covers the structural part of the facility. Indian Public Health Standards
(IPHS) defines infrastructure, human resources, drugs and equipment requirements for different level of health
facilities. Quality standards given in this area of concern take into cognizance of the IPHS requirement. However,
focus of the standards has been in ensuring compliance to minimum level of inputs, which are required for
ensuring delivery of committed level of the services. The words like ‘adequate’ and ‘as per load‘ has been given
in the requirements for many standards & measurable elements, as it would be hard to set structural norms for
every level of the facility that commensurate with patient load. For example, a 100-bedded hospital having 40%
bed occupancy may not have same requirements as the similar hospital having 100% occupancy. So structural
requirement should be based more on the utilization, than fixing the criteria like beds available. Assessor should
use his/her discretion to arrive at a decision, whether available structural component is adequate for committed
service delivery or not.
Following are the standards under this area of concern:

Standard C1 Standard C1 measures adequacy of infrastructure in terms of space, patient amenities,

The facility has layout, circulation area, communication facilities, service counters, etc. It also looks
infrastructure for into the functional aspect of the structure, whether it commensurate with the process
delivery of assured flow of the facility or not.
services, and available
infrastructure meets the Minimum requirement for space, layout and patient amenities are given in some of
prevalent norms departments, but assessors should use his discretion to see whether space available
is adequate for the given work load. Compliance to most of the measurable elements
can be assessed by direct observation except for checking functional adequacy, where
discussion with staff and hospital administration may be required to know the process
flow between the departments, and also within a department.
Standard C2 Standard C2 deals with Physical safety of the infrastructure. It includes seismic safety,
The facility ensures the safety of lifts, electrical safety, and general condition of hospital infrastructure.
physical safety of the
infrastructure.
Standard C3 Standard C3 is concerned with fire safety of the facility. Measurable elements in this
The facility has established standard look for implementation of fire prevention, availability of adequate number
Programme for fire safety of fire fighting equipment and preparedness of the facility for fire disaster in terms of
and other disaster mock drill and staff training.
Standard C4 Standard C4 measures the numerical adequacy and skill sets of the staff. It includes
The facility has adequate availability of doctors, nurses, paramedics and support staff. It also ensures that the
qualified and trained staff, staff have been trained as per their job description and responsibilities. There are
required for providing the two components while assessing the staff adequacy - first is the numeric adequacy,
assured services to the which can be checked by interaction with hospital administration and review of
current case load records. Second is to access human resources in term of their availability within
the department. For instance, a hospital may have 20 security guards, but if none
of them is posted at the labour room, then the intent of standard is not being
complied with.
Skill set may be assessed by reviewing training records and staff interview
and demonstration to check whether staff have requisite skills to perform the
procedures.
Standard C5 Standard C5 measures availability of drugs and consumables in user departments.
The facility provides drugs Assessor may check availability of drugs under the broad group such as antibiotics,
and consumables required IV fluids, dressing material, and make an assessment that majority of normal patients
for assured services and critically ill patients are getting treated at the health facility.

22 National Quality Assurance Standards for Public Health Facilities | 2020

Standard C6 Standard C6 is also concerned with availability of instruments in various departments
The facility has equipment and service delivery points. Equipment and instruments have been categorized into
& instruments required for sub groups as per their use, and measurable elements have been assigned to each
assured list of services sub group, such as examination and monitoring, clinical procedures, diagnostic
equipment, resuscitation equipment, storage equipment and equipment used for non
clinical support services. Some representative equipment could be used as tracers
and checked in each category.
Standard C7 Human resources are the most critical asset of a healthcare organization. Public health
Facility has a defined facilities serve volumes of patients and sometime feel constrained by limited human
and established resources. For being a facility providing quality and safe healthcare services, it is
procedure for effective indispensable to ensure that the staff engaged in patient care and auxiliary activities
utilization, evaluation have requisite knowledge and skills to accomplish their task in the expected manner.
and augmentation It is also very important to ensure that workforce is working at optimal level and their
of competence and performance is evaluated periodically.
performance of staff
This standard and related measurable elements require that public health facility
should have defined staff’s competency and have a system for assessing it periodically
at pre-defined interval, and takes actions for maintaining it. These criteria should
be based on job description as defined in Standard D-10. These defined criteria
can be converted into simple checklist that can work as tools for the competency
assessment e. g. Checklist for competency assessment of Labour room nurse, Lab
technician, Security guard, Hospital manager, etc. The Ministry of Health & Family
Welfare, Government of India also has prepared checklist for competence assessment.
In addition there are explicit requirement spelled by the professional bodies such
as Medical Council of India, Nursing Council of India, Dental Council of India, etc.
These can also be used after local customization. This standard also requires that
performance evaluation criteria should also be defined for each cadre of staff. These
criteria may have some indicators measuring productivity and efficiency of the staff
as well. Based on these defined criteria the competence and performance of staff
should be evaluated at least once in a year though it may be more frequent ongoing
activity. Competence assessment program and performance evaluation program
should include contractual staff, staff working in hospital premises through outsources
agencies, empanelled doctors providing services for specific duration. Based on these
assessment and evaluation, the training needs of each staff are identified and training
plan is prepared. Staff should be trained according to the training plan. Facility should
also ensure that skills gained through training are retained and utilized and feedback
is given to individual staff on their competence and performance.

National Quality Assurance Standards for District Hospital 23

 Area of Concern - C: Measurable Elements Inputs
Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure
meets the prevalent norms.
ME C1.1 Departments have adequate space as per patient or work load.
ME C1.2 Patient amenities are provide as per patient load.
ME C1.3 Departments have layout and demarcated areas as per functions.
ME C1.4 The facility has adequate circulation area and open spaces according to need and local law.
ME C1.5 The facility has infrastructure for intramural and extramural communication.
ME C1.6 Service counters are available as per patient load.
ME C1.7 The facility and departments are planned to ensure structure follows the function/processes
(Structure commensurate with the function of the hospital).
Standard C2 The facility ensures the physical safety of the infrastructure.
ME C2.1 The facility ensures the seismic safety of the infrastructure.
ME C2.2 The facility ensures safety of lifts and lifts have required certificate from the designated bodies/
board.
ME C2.3 The facility ensures safety of electrical establishment.
ME C2.4 Physical condition of buildings are safe for providing patient care.
Standard C3 The facility has established Programme for fire safety and other disaster.
ME C3.1 The facility has plan for prevention of fire.
ME C3.2 The facility has adequate fire fighting Equipment.
ME C3.3 The facility has a system of periodic training of staff and conducts mock drills regularly for fire and
other disaster situation.
Standard C4 The facility has adequate qualified and trained staff, required for providing the assured
services to the current case load.
ME C4.1 The facility has adequate specialist doctors as per service provision.
ME C4.2 The facility has adequate general duty doctors as per service provision and work load.
ME C4.3 The facility has adequate nursing staff as per service provision and work load.
ME C4.4 The facility has adequate technicians/paramedics as per requirement.
ME C4.5 The facility has adequate support/general staff.
Standard C5 The facility provides drugs and consumables required for assured services.
ME C5.1 The departments have availability of adequate drugs at point of use.
ME C5.2 The departments have adequate consumables at point of use.
ME C5.3 Emergency drug trays are maintained at every point of care, where ever it may be needed.
Standard C6 The facility has equipment & instruments required for assured list of services.
ME C6.1 Availability of equipment & instruments for examination & monitoring of patients.
ME C6.2 Availability of equipment & instruments for treatment procedures, being undertaken in the facility.
ME C6.3 Availability of equipment & instruments for diagnostic procedures being undertaken in the facility.
ME C6.4 Availability of equipment and instruments for resuscitation of patients and for providing intensive
and critical care to patients.

24 National Quality Assurance Standards for Public Health Facilities | 2020

ME C6.5 Availability of Equipment for Storage.
ME C6.6 Availability of functional equipment and instruments for support services.
ME C6.7 Departments have patient furniture and fixtures as per load and service provision.
Standard C7 The facility has a defined and established procedure for effective utilization, evaluation and
augmentation of competence and performance of staff
ME C7.1 Criteria for Competence assessment are defined for clinical and Para clinical staff.
ME C7.2 Competence assessment of Clinical and Para clinical staff is done on predefined criteria at least once
in a year.
ME C7.3 Criteria for performance evaluation clinical and para clinical staff are defined.
ME C7.4 Performance evaluation of clinical and para clinical staff is done on predefined criteria at least once
in a year
ME C7.5 Criteria for performance evaluation of support and administrative staff are defined.
ME C7.6 Performance evaluation of support and administration staff is done on predefined criteria at least
once in a year.
ME C7.7 Competence assessment and performance assessment includes contractual, empanelled, and
outsourced staff.
ME C7.8 Training needs are identified based on competence assessment and performance evaluation and
facility prepares the training plan.
ME C7.9 The Staff is provided training as per defined core competencies and training plan.
ME C7.10 There is established procedure for utilization of skills gained thought trainings by on-job supportive
supervision.
ME C7.11 Feedback is provided to the staff on their competence assessment and performance evaluation.

National Quality Assurance Standards for District Hospital 25

 Area of Concern - D: Support services

Overview
Support services are backbone of every health care facility. The expected clinical outcome cannot be envisaged
in absence of sturdy support services. This area of concern includes equipment maintenance, calibration, drug
storage and inventory management, security, facility management, water supply, power backup, dietary services
and laundry. Administrative processes like RKS, Financial management, legal compliances, staff deputation and
contract management have also been included in this area of concern.
Brief description of the standards under this area of concern are given below:

Standard D1 Standard D1 is concerned with equipment maintenance processes, such as AMC,

The facility has established daily and breakdown maintenance processes, calibration and availability of operating
Programme for inspection, instructions. Equipment records should be reviewed to ensure that valid AMC is
testing and maintenance available for critical equipment and preventive/corrective maintenance is done timely.
and calibration of Calibration records and label on the measuring equipment should be reviewed to
Equipment confirm that the calibration has been done. Operating instructions should be displayed
or should readily available with the user.
Standard D2 Standard D2 is concerned with safe storage of drugs and scientific management of
The facility has defined the inventory, so drugs and consumables are available in adequate quantity in patient
procedures for storage, care area. Measurable elements of this standard look into processes of indenting,
inventory management procurement, storage, expired drugs management, inventory management, stock
and dispensing of drugs in management at patient care areas, including storage at optimum temperature.
pharmacy and patient care While assessing drug management system, these practices should be looked into
areas each clinical department, especially at the nursing stations and its complementary
process at drug stores/Pharmacy.
Standard D3 Standard D3 This standard is concerned with providing safe, secure and
The facility provides safe, comfortable environment to patients as well service providers. The measurable
secure and comfortable elements under this standard have two aspects, - firstly, provision of comfortable
environment to staff, work environment in terms of illumination and temperature control in patient
patients and visitors care areas and work stations, and secondly, arrangement for security of patients
and staff. Availability of environment control arrangements should be looked
into. Security arrangements at patient area should be observed for restriction of
visitors and crowd management.
Standard D4 Standard D4 This standard is concerned with adequacy of facility management
The facility has established processes. This includes appearance of facility, cleaning processes, infrastructure
Programme for maintenance, removal of junk and condemned items and control of stray animals and
maintenance and upkeep of pest control at the facility.
the facility
Standard D5 Standard D5 covers processes to ensure water supply (quantity & quality), power
The facility ensures 24X7 back-up and medical gas supply. All departments should be assessed for availability
water and power backup as of water and power back-up. Some critical area like OT and ICU may require two-tire
per requirement of service power backup in terms of UPS. Availability of central oxygen and vacuum supply
delivery, and support should especially be assessed in critical area like OT and ICU.
services norms
Standard D6 Standard D6 is concerned with processes ensuring timely and hygienic dietary
Dietary services are services. This includes nutritional assessment of patients, availability of different types
available as per service of diets and standard procedures for preparation and distribution of food, including
provision and nutritional hygiene & sanitation in the kitchen. Patients/staff may be interacted for knowing their
requirement of the perception about quality and quantity of the food.
patients

26 National Quality Assurance Standards for Public Health Facilities | 2020

Standard D7 Standard D7 is concerned with the laundry processes. It includes availability of
The facility ensures clean adequate quantity of clean & usable linen, process of providing and changing bed
linen to the patients sheets in patient care area and process of collection, washing and distributing the
linen. Besides direct observation, staff interaction may help in knowing availability
of adequate linen and work practices. An assessment of segregation and disinfection
of soiled laundry should be undertaken. Observation should be recorded if laundry is
being washed at some public water body like pond or river.
Standard D8 Standard D8 measures processes related to functioning of Rogi Kalyan Samiti
The facility has defined (RKS; equivalent to Hospital Management Society) and community participation
and established in Hospital Management. RKS records should be reviewed to assess frequency of
procedures for promoting the meetings, and issues discussed there. Participation of non-official members like
public participation in community/NGO representatives in such meetings should be checked.
management of hospital
transparency and
accountability
Standard D9 Standard D9 is concerned with the financial management of the funds/grants,
Hospital has defined and received from different sources including NHM. Assessment of financial management
established procedures for processes by no means should be equated with financial or accounts audit. Hospital
Financial Management administration and accounts department can be interacted to know process of
utilization of funds, timely payment of salaries, entitlements and incentives to different
stakeholders and process of receiving funds and submitting utilization certificates. An
assessment of resource utilisation and prioritisation should be undertaken.
Standard D10 Standard D10 is concerned with compliances to statuary and regulatory requirements.
The facility is compliant It includes availability of requisite licenses, updated copies of acts and rules, and
with all statutory and adherence to the legal requirements as applicable to Public Health Facilities.
regulatory requirement
imposed by local, state or
central government
Standard D11 Standard D11 is concerned with processes regarding staff management and
Roles & Responsibilities of their deployment in the departments of a facility. This includes availability of Job
administrative and clinical descriptions for different cadre, processes regarding preparation of duty rosters and
staff are determined as staff discipline. The staff can be interviewed to assess about their awareness of their
per govt. regulations own job description. It should be assessed by observation and review of the records.
and standards operating Adherence to dress-code should be observed during the assessment.
procedures
Standard D12 Standard D12 This standard measures the processes related to outsourcing and
The facility has established contract management. This includes monitoring of outsourced services, adequacy of
procedure for monitoring contact documents and tendering system, timely payment for the availed services and
the quality of outsourced provision for action in case for inadequate/poor quality of services. Assessor should
services and adheres to review the contract records related to outsourced services, and interview hospital
contractual obligations administration about the management of outsource services.

National Quality Assurance Standards for District Hospital 27

 Area of Concern - D: Measurable Elements Support Services
Standard D1 The facility has established Programme for inspection, testing and maintenance and
calibration of Equipment.
ME D1.1 The facility has established system for maintenance of critical Equipment.
ME D1.2 The facility has established procedure for internal and external calibration of measuring Equipment.
ME D1.3 Operating and maintenance instructions are available with the users of equipment.
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of
drugs in pharmacy and patient care areas.
ME D2.1 There is established procedure for forecasting and indenting drugs and consumables.
ME D2.2 The facility has established procedure for procurement of drugs.
ME D2.3 The facility ensures proper storage of drugs and consumables.
ME D2.4 The facility ensures management of expiry and near expiry drugs.
ME D2.5 The facility has established procedure for inventory management techniques.
ME D2.6 There is a procedure for periodically replenishing the drugs in patient care areas.
ME D2.7 There is a process for storage of vaccines and other drugs, requiring controlled temperature.
ME D2.8 There is a procedure for secure storage of narcotic and psychotropic drugs.
Standard D3 The facility provides safe, secure and comfortable environment to staff, patients and
visitors.
ME D3.1 The facility provides adequate illumination at patient care areas.
ME D3.2 The facility has provision of restriction of visitors in patient areas.
ME D3.3 The facility ensures safe and comfortable environment for patients and service providers.
ME D3.4 The facility has security system in place in patient care areas.
ME D3.5 The facility has established measure for safety and security of female staff.
Standard D4 The facility has established Programme for maintenance and upkeep of the facility.
ME D4.1 Exterior and interior of the facility building is maintained appropriately
ME D4.2 Patient care areas are clean and hygienic.
ME D4.3 Hospital infrastructure is adequately maintained.
ME D4.4 Hospital maintains open areas and landscaped of them.
ME D4.5 The facility has policy of removal of condemned junk material.
ME D4.6 The facility has established procedures for pest, rodent and animal control.
Standard D5 The facility ensures 24 × 7 water and power backup as per requirement of service delivery,
and support services norms.
ME D5.1 The facility has adequate arrangement storage and supply for potable water in all functional areas.
ME D5.2 The facility ensures adequate power backup in all patient care areas as per load.
ME D5.3 Critical areas of the facility ensures availability of oxygen, medical gases and vacuum supply.
Standard D6 Dietary services are available as per service provision and nutritional requirement of the
patients.
ME D6.1 The facility has provision of nutritional assessment of the patients.
ME D6.2 The facility provides diets according to nutritional requirements of the patients.

28 National Quality Assurance Standards for Public Health Facilities | 2020

ME D6.3 Hospital has standard procedures for preparation, handling, storage and distribution of diets, as per
requirement of patients.
Standard D7 The facility ensures clean linen to the patients.
ME D7.1 The facility has adequate availability of linen for meeting its need.
ME D7.2 The facility has established procedures for changing of linen in patient care areas
ME D7.3 The facility has standard procedures for handling, collection, transportation and washing of linen.
Standard D8 The facility has defined and established procedures for promoting public participation in
management of hospital transparency and accountability.
ME D8.1 The facility has established a procedure for management of activities of Rogi Kalyan Samiti.
ME D8.2 The facility has established procedures for community based monitoring of its services.
Standard D9 Hospital has defined and established procedures for Financial Management.
ME D9.1 The facility ensures proper utilization of the fund provided to it.
ME D9.2 The facility ensures proper planning and requisition of resources based on its need.
Standard D10 The facility is compliant with all statutory and regulatory requirement imposed by local,
state or central government.
ME D10.1 The facility has requisite licences and certificates for operation of hospital and its different activities.
ME D10.2 Updated copies of relevant laws, regulations and government orders are available at the facility.
ME D10.3 The facility ensures relevant processes are in compliance with the statutory requirements.
Standard D11 Roles & Responsibilities of administrative and clinical staff are determined as per govt.
regulations and standards operating procedures.
ME D11.1 The facility has established job description as per govt guidelines.
ME D11.2 The facility has a established procedure for duty roster and deputation to different departments.
ME D11.3 The facility ensures adherence to dress code as mandated by the administration.
Standard D12 The facility has established procedure for monitoring the quality of outsourced services and
adheres to contractual obligations.
ME D12.1 There is established system of contract management for the out sourced services.
ME D12.2 There is a system of periodic review of quality of out-sourced services.

National Quality Assurance Standards for District Hospital 29

 Area of Concern - E: Clinical Care

Overview
The ultimate purpose of existence of a hospital is to provide clinical care. Therefore, clinical processes are the
most critical and important in the hospitals. These are the processes that define directly the outcome of services
and quality of care. The Standards under this area of concern could be grouped into three categories. First,
nine standards are concerned with those clinical processes that ensure adequate care to the patients. It includes
processes such as registration, admission, consultation, clinical assessment, continuity of care, nursing care,
identification of high risk and vulnerable patients, prescription practices, safe drug administration, maintenance
of clinical records and discharge from the hospital.
Second set of next seven standards are concerned with specific clinical and therapeutic processes including intensive
care, emergency care, diagnostic services, transfusion services, anaesthesia, surgical services and end of life care.
The third set of seven standards are concerned with specific clinical processes for Maternal, Newborn, Child,
Adolescent & Family Planning services and National Health Programmes. These standards are based on the
technical guidelines published by the Government of India on respective programmes and processes.
It may be difficult to assess clinical processes, as direct observation of clinical procedure may not always be possible
at time of assessment. Therefore, assessment of these standards would largely depend upon review of the clinical
records as well. Interaction with the staff to know their skill level and how they practice clinical care (Competence
testing) would also be helpful. Assessment of theses standard would require thorough domain knowledge.
Following is the brief description of standards under this area of concern:

Standard E1 Standard E1 This standard is concerned with the registration and admission
The facility has defined processes in hospitals. It also covers OPD consultation processes. The Assessor
procedures for registration, should review the records to verify that details of patients have been recorded, and
consultation and admission patients have been given unique identification number. OPD consultation may be
of patients directly observed, followed by review of OPD tickets to ensure that patient history,
examination details, etc. have been recorded on the OPD ticket. Staff should be
interviewed to know, whether there is any fixed admission criteria especially in
critical care department.
Standard E2 Standard E2 This standard pertains to clinical assessment of the patients. It includes
The facility has defined initial assessment as well as reassessment of admitted patients.
and established procedure
Care planning is done for individual case as per assessment and investigation
for clinical assessment
findings (Wherever applicable). It also ensures that care or treatment is provided
and preparation of the
as per standard treatment guidelines/available clinical evidences
treatment plan
Standard E3 Standard E3 is concerned with continuity of care for the patient’s ailment. It includes
The facility has defined and process of inter-departmental transfer, referral to another facility, deputation of staff
established procedures for for the care, and linkages with higher institutions. Staff should be interviewed to
continuity of care of patient know the referral linkages, how they inform the referral hospital about the referred
and referral patients and arrangement for the vehicles and follow-up car. Records should be
reviewed for confirming that referral slips have been provided to the patients.
Standard E4 Standard E4 measures adequacy and quality of nursing care for the patients. It
The facility has defined and includes processes for identification of patients, timely and accurate implementation
established procedures for of treatment plan, nurses’ handover processes, maintenance of nursing records and
nursing care monitoring of the patients. Staff should be interviewed and patients’ records should
be reviewed for assessing how drugs distribution/administration endorsement and
other procedures like sample collection and dressing have been done on time as per
treatment plan. Handing-over of patients is a critical process and should be assessed
adequately. Review BHT for patient monitoring & nursing notes should be done.
Standard E5 Standard E5 is concerned with identification of vulnerable and High-risk patients.
The facility has a procedure Review of records and staff interaction would be helpful in assessing how High-risk
to identify high risk and patients are given due attention and treatment.
vulnerable patients

30 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E6 Standard E6 is concerned with assessing that patients are prescribed drugs
Facility ensures rationale according standard treatment guidelines and protocols. Patient records are assessed
prescribing and use of to ascertain that prescriptions are written in generic name only.
medicines
Standard E7 Standard E7 concerns with the safety of drug administration. It includes
The facility has defined administration of high alert drugs, legibility of medical orders, process for checking
procedures for safe drug drugs before administration and processes related to self-drug administration.
administration Patient’s records should be reviewed for legibility of the writing and recording
of date and time of orders. Safe injection practices like use of separate needle for
multi-dose vial should be observed.
Standard E8 Standard E8 is concerned with the processes of maintaining clinical records
The facility has defined and systematically and adequately. Compliance to this standard can be assessed by
established procedures for comprehensive review of the patients’ record.
maintaining, updating of
patients’ clinical records and
their storage
Standard E9 Standard E9 measures adequacy of the discharge process. It includes pre-discharge
The facility has defined and assessment, adequacy of discharge summary, pre-discharge counselling and
established procedures for adherence to standard procedures, if a patient is leaving against medical advice
discharge of patient. (LAMA) or is found absconding. Patients’ record should also be reviewed for
adequacy of the discharge summary.
Standard E10 Standard E10 is concerned with processes related to intensive care treatment of
The facility has defined and patients, availability and adherence to protocols related to pain management,
established procedures for sedation, intubation, etc.
intensive care.
Standard E11 Standard E11 is concerned with emergency clinical processes and procedures. It
The facility has defined and includes triage, adherence to emergency clinical protocols, disaster management,
established procedures for processes related to ambulance services, handling of medico-legal cases, etc.
Emergency Services and Availability of the buffer stock for medicines and other supplies for disaster and mass
Disaster Management casualty needs to be found out. Interaction with staff and hospital administration
should be done to asses overall disaster preparedness of the health facility.
Standard E12 Standard E12 deals with the procedures related to diagnostic services. The standard is
The facility has defined and majorly applicable for laboratory and radiology services. It includes pre-testing, testing
established procedures of and post-testing procedures. It needs to be observed that samples in the laboratory are
diagnostic services properly labelled, and instructions for handling sample are available. The process for
storage and transportation of samples needs to be ensured. Availability of critical values
and biological references should also be checked.
Standard E13 Standard E13 is concerned with functioning of blood bank and transfusion services.
The facility has defined and The measurable elements under this standard are processes for donor selection,
established procedures collection of blood, testing procedures, preparation of blood components,
for Blood Bank/Storage labelling and storage of blood bags, compatibility testing, issuing, transfusion and
Management and Transfusion monitoring of transfusion reaction. The assessor should observe the functioning,
and interact with the staff to know regarding adherence to standard procedures
for blood collection and testing, including preparation of blood components,
storage practices, as per standard protocols. Record of temperature maintained
in different storage units should be checked. The staff should also be interacted
to know how they mange if certain blood is not available at the blood bank.
Records should be reviewed for assessing processes of monitoring transfusion
reactions.
Standard E14 Standard E14 is concerned with the processes related with safe anaesthesia
The facility has established practices. It includes pre-anaesthesia, monitoring and post-anaesthesia processes.
procedures for Anaesthetic Records should be reviewed to assess how Pre-anaesthesia check-up is done and
Services records are maintained. Interact with Anaesthetists and OT technician/Nurse for
adherence to protocols in respect of anaesthesia safety, monitoring, recording &
reporting of adverse events, maintenance of anaesthesia notes, etc.

National Quality Assurance Standards for District Hospital 31

 Standard E15 Standard E15 is concerned with processes related with Operation Theatre. It includes
The facility has defined and processes for OT scheduling, pre-operative, Post-operative practices of surgical safety.
established procedures of Interaction with the surgeon(s) and OT staff should be done to assess processes -
Operation theatre services preoperative medication, part preparation and evaluation of patient before surgery,
identification of surgical site, etc. Review of records for usage of surgical safety checklist
& protocol for instrument count, suture material, etc may be undertaken.
Standard E16 Standard E 16 concerned with end of life care and management of death. Records
The facility has defined and should be reviewed for knowing adequacy of the notes. Interact with the facility
established procedures for staff to know how news of death is communicated to relatives, and kind of support
end of life care and death available to family members.
Standard E17 Standard E17 is concerned with processes ensuring that adequate and quality
The facility has established antenatal care is provided at the facility. It includes measurable elements for ANC
procedures for Antenatal registration, processes during check-up, identification of High Risk pregnancy,
care as per guidelines management of serve anaemia and counselling services. Staff at ANC clinic should
be interviewed and records should be reviewed for maintenance of MCP cards and
registration of pregnant women. For assessing quality and adequacy of ANC check-
up, direct observation may be undertaken after obtaining requisite permission.
ANC records can be reviewed to see findings of examination and diagnostic
tests are recorded. Review the line listing of anaemia cases and how they are
followed. Client and staff can be interacted for counselling on the nutrition, birth
preparedness, family planning, etc.
Standard E18 Standard E18 measures the quality of intra-natal care. It includes clinical process
The facility has established for normal delivery as well management of complications and C-Section surgeries.
procedures for Intranatal Staff can be interviewed to know their skill and practices regarding management of
care as per guidelines different stages of labour, especially Active Management of Third stage of labour.
Staff may be interacted for demonstration of resuscitation and essential newborn
care. Competency of the staff for managing obstetric emergencies, interpretation
of partograph, APGAR score should also be assessed.
Standard E19 Standard E19 is concerned with adherence to post-natal care of mother and
The facility has established newborn within the hospital. Observe that postnatal protocols of prevention of
procedures for postnatal Hypothermia and breastfeeding are adhered to. Mother may be interviewed to
care as per guidelines know that proper counselling has been provided.
Standard E20 Standards E20 is concerned with adherence to clinical protocols for newborn and
The facility has established child health. It covers immunization, emergency triage, management of newborn
procedures for care of new and childhood illnesses like neonatal asphyxia, low birth weight, neo-natal jaundice,
born, infant and child as per sepsis, malnutrition and diarrhoea. Immunization services are majorly assessed
guidelines at immunization clinic. Staff interview and observation should be done to assess
availability of diluents, adherence to protocols of reconstitution of vaccine, storage
of VVM labels and shake test. Adherence to clinical protocols for management of
different illnesses in newborn and child should be done through interaction with
the doctors and nursing staff.
Standard E21 Standard 21 is concerned with providing safe and quality family planning and
The facility has established abortion services. This includes standard practices and procedures for Family
procedures for abortion palling counselling, spacing methods, family planning surgeries and counselling
and family planning as per and procedures for abortion. Quality and adequacy of counselling services can be
government guidelines and assessed by exit interview with the clients. Staff at family planning clinic may be
law interacted to assess adherence to the protocols for IUD insertion, precaution &
contraindication for oral pills, family planning surgery, etc.
Standard E22 Standard E22 is concerned with services related to adolescent Reproductive and
The facility provides Sexual health (ARSH) guidelines. It includes promotive, preventive, curative and
Adolescent Reproductive and referral services under the ARSH. Staff should be interviewed, and records should
Sexual Health services as per be reviewed.
guideline
Standard E23 Standard E23 pertains to adherence for clinical guidelines under the National
The facility provides National Health Programmes. For each national health programme, availability of clinical
health Programme as services as per respective guidelines should be assessed
per operational/Clinical
Guidelines

32 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - E: Measurable Elements Clinical Services
Standard E1 The facility has defined procedures for registration, consultation and admission of
patients.
ME E1.1 The facility has established procedure for registration of patients.
ME E1.2 The facility has a established procedure for OPD consultation.
ME E1.3 There is established procedure for admission of patients.
ME E1.4 There is established procedure for managing patients, in case beds are not available at
the facility.
Standard E2 The facility has defined and established procedure for clinical assessment and preparation
of the treatment plan.
ME E2.1 There is established procedure for initial assessment of patients.
ME E2.2 There is established procedure for follow-up/reassessment of Patients.
ME E2.3 There is an established procedure to document treatment or care plan involving individual patient
to achieve the best possible results
Standard E3 The facility has defined and established procedures for continuity of care of patient and
referral.
ME E3.1 The facility has established procedure for continuity of care during interdepartmental transfer.
ME E3.2 The facility provides appropriate referral linkages to the patients/Services for transfer to other/
higher facilities to assure the continuity of care.
ME E3.3 A person is identified for care during all steps of care.
ME E3.4 The facility is connected to medical colleges through telemedicine services.
Standard E4 The facility has defined and established procedures for nursing care.
ME E4.1 Procedure for identification of patients is established at the facility.
ME E4.2 Procedure for ensuring timely and accurate nursing care as per treatment plan is established at the
facility.
ME E4.3 There is established procedure of patient hand over, whenever staff duty change happens.
ME E4.4 Nursing records are maintained.
ME E4.5 There is procedure for periodic monitoring of patients.
Standard E5 The facility has a procedure to identify high risk and vulnerable patients.
ME E5.1 The facility identifies vulnerable patients and ensure their safe care.
ME E5.2 The facility identifies high risk patients and ensure their care, as per their need.
Standard E6 Facility ensures rationale prescribing and use of medicines
ME E6.1 The facility ensured that drugs are prescribed in generic name only.
ME E6.2 There is procedure of rational use of drugs.
ME E6.3 There are procedures defined for medication review and optimization
Standard E7 The facility has defined procedures for safe drug administration.
ME E7.1 There is process for identifying and cautious administration of high alert drugs (to check).
ME E7.2 Medication orders are written legibly and adequately.
ME E7.3 There is a procedure to check drug before administration/dispensing.

National Quality Assurance Standards for District Hospital 33

 ME E7.4 There is a system to ensure right medicine is given to right patient.
ME E7.5 Patient is counselled for self drug administration.
Standard E8 The facility has defined and established procedures for maintaining, updating of patients’
clinical records and their storage.
ME E8.1 All the assessments, re-assessment and investigations are recorded and updated.
ME E8.2 All treatment plan prescription/orders are recorded in the patient records.
ME E8.3 Care provided to each patient is recorded in the patient records.
ME E8.4 Procedures performed are written on patients records.
ME E8.5 Adequate form and formats are available at point of use.
ME E8.6 Register/records are maintained as per guidelines.
ME E8.7 The facility ensures safe and adequate storage and retrieval of medical records.
Standard E9 The facility has defined and established procedures for discharge of patient.
ME E9.1 Discharge is done after assessing patient readiness.
ME E9.2 Case summary and follow-up instructions are provided at the discharge.
ME E9.3 Counselling services are provided as during discharges wherever required.
Standard E10 The facility has defined and established procedures for intensive care.
ME E10.1 The facility has established procedure for shifting the patient to step-down/ward based on explicit
assessment criteria.
ME E10.2 The facility has defined and established procedure for intensive care.
ME E10.3 The facility has explicit clinical criteria for providing intubation & extubation, and care of patients
on ventilation and subsequently on its removal.
Standard E11 The facility has defined and established procedures for Emergency Services and Disaster
Management.
ME E11.1 There is procedure for Receiving and triage of patients.
ME E11.2 Emergency protocols are defined and implemented.
ME E11.3 The facility has disaster management plan in place.
ME E11.4 The facility ensures adequate and timely availability of ambulances services and mobilisation of
resources, as per requirement.
ME E11.5 There is procedure for handling medico legal cases.
Standard E12 The facility has defined and established procedures of diagnostic services.
ME E12.1 There are established procedures for Pre-testing Activities.
ME E12.2 There are established procedures for testing Activities.
ME E12.3 There are established procedures for Post-testing Activities.
Standard E13 The facility has defined and established procedures for Blood Bank/Storage Management
and Transfusion.
ME E13.1 Blood bank has defined and implemented donor selection criteria.
ME E13.2 There is established procedure for the collection of blood.
ME E13.3 There is established procedure for the testing of blood.
ME E13.4 There is established procedure for preparation of blood component.

34 National Quality Assurance Standards for Public Health Facilities | 2020

ME E13.5 There is establish procedure for labelling and identification of blood and its product.
ME E13.6 There is established procedure for storage of blood.
ME E13.7 There is established the compatibility testing.
ME E13.8 There is established procedure for issuing blood.
ME E13.9 There is established procedure for transfusion of blood.
ME E13.10 There is a established procedure for monitoring and reporting Transfusion complication.
Standard E14 The facility has established procedures for Anaesthetic Services.
ME E14.1 The facility has established procedures for Pre-anaesthetic Check up and maintenance of records.
ME E14.2 The facility has established procedures for monitoring during anaesthesia and maintenance of
records.
ME E14.3 The facility has established procedures for Post-anaesthesia care.
Standard E15 The facility has defined and established procedures of Operation theatre services.
ME E15.1 The facility has established procedures OT Scheduling.
ME E15.2 The facility has established procedures for Preoperative care.
ME E15.3 The facility has established procedures for Surgical Safety.
ME E15.4 The facility has established procedures for Post operative care.
Standard E16 The facility has defined and established procedures for end of life care and death.
ME E16.1 Death of admitted patient is adequately recorded and communicated.
ME E16.2 The facility has standard procedures for handling the death in the hospital.
ME E16.3 The facility has standard procedures for conducting post-mortem, its recording and meeting its
obligation under the law.
Maternal & Child Health Services
Standard E17 The facility has established procedures for Antenatal care as per guidelines.
ME E17.1 There is an established procedure for Registration and follow up of pregnant women.
ME E17.2 There is an established procedure for History taking, Physical examination, and counselling of each
antenatal woman, visiting the facility.
ME E17.3 The facility ensures availability of diagnostic and drugs during antenatal care of pregnant women.
ME E17.4 There is an established procedure for identification of High risk pregnancy and appropriate
treatment/referral as per scope of services.
ME E17.5 There is an established procedure for identification and management of moderate and severe
anaemia.
ME E17.6 Counselling of pregnant women is done as per standard protocol and gestational age.
Standard E18 The facility has established procedures for Intranatal care as per guidelines.
ME E18.1 The facility staff adheres to standard procedures for management of second stage of labor.
ME E18.2 The facility staff adheres to standard procedure for active management of third stage of labor
ME E18.3 The facility staff adheres to standard procedures for routine care of newborn immediately after birth.
ME E18.4 There is an established procedure for assisted and C-section deliveries per scope of services.
ME E18.5 The facility staff adheres to standard protocols for identification and management of Pre
Eclampsia/Ecalmpsia

National Quality Assurance Standards for District Hospital 35

 ME E18.6 The facility staff adheres to standard protocols for identification and management of PPH.
ME E18.7 The facility staff adheres to standard protocols for Management of HIV in Pregnant Woman & Newborn
ME E18.8 The facility staff adheres to standard protocol for identification and management of preterm delivery.
ME E18.9 Staff identifies and manages infection in pregnant woman
ME E18.10 There is Established protocol for newborn resuscitation is followed at the facility.
ME E18.11 The facility ensures Physical and emotional support to the pregnant women means of birth
companion of her choice
Standard E19 The facility has established procedures for postnatal care as per guidelines
ME E19.1 The facility staff adheres to protocol for assessments of condition of mother and baby and
providing adequate postpartum care
ME E19.2 The facility staff adheres to protocol for counseling on danger signs, post-partum family planning
and exclusive breast feeding
ME E19.3 The facility staff adheres to protocol for ensuring care of newborns with small size at birth
ME E19.4 The facility has established procedures for stabilization/treatment/referral of post natal
complications
ME E19.5 The facility ensures adequate stay of mother and newborn in a safe environment as per standard
Protocols
ME E19.6 There is established procedure for discharge and follow up of mother and newborn
Standard E20 The facility has established procedures for care of new born, infant and child as per
guidelines
ME E20.1 The facility provides immunization services as per guidelines
ME E20.2 Triage, Assessment & Management of newborns, infant & children having emergency signs are
done as per guidelines
ME E20.3 Management of Low birth weight newborns is done as per guidelines
ME E20.4 Management of neonatal asphyxia is done as per guidelines
ME E20.5 Management of neonatal sepsis is done as per guidelines
ME E20.6 Management of children with Jaundice is done as per guidelines.
ME E20.7 Management of children presenting with fever, cough/breathlessness is done as per guidelines
ME E20.8 Management of children with severe acute Malnutrition is done as per guidelines
ME E20.9 Management of children presenting diarrhoea is done per guidelines
ME E20.10 The facility ensures optimal breast feeding practices for new born & infants as per guidelines
Standard E21 The facility has established procedures for abortion and family planning as per government
guidelines and law.
ME E21.1 Family planning counselling services provided as per guidelines.
ME E21.2 The facility provides spacing method of family planning as per guideline.
ME E21.3 The facility provides limiting method of family planning as per guideline.
ME E21.4 The facility provide counselling services for abortion as per guideline.
ME E21.5 The facility provide abortion services for 1st trimester as per guideline.
ME E21.6 The facility provide abortion services for 2nd trimester as per guideline.

36 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E22 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines.
ME E22.1 The facility provides Promotive ARSH Services.
ME E22.2 The facility provides Preventive ARSH Services.
ME E22.3 The facility provides Curative ARSH Services.
ME E22.4 The facility provides Referral Services for ARSH.
National Health Programmes
Standard E23 The facility provides National health Programme as per operational/Clinical Guidelines.
ME E23.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines.
ME E23.2 The facility provides services under National TB elimination Programme as per guidelines.
ME E23.3 The facility provides services under National Leprosy Eradication Programme as per guidelines.
ME E23.4 The facility provides services under National AIDS Control Programme as per guidelines.
ME E23.5 The facility provides services under National Programme for control of Blindness as per guidelines.
ME E23.6 The facility provides services under Mental Health Programme as per guidelines.
ME E23.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines.
ME E23.8 The facility provides service under National Programme for Prevention and Control of cancer,
diabetes, cardiovascular diseases & stroke (NPCDCS) as per guidelines.
ME E23.9 The facility provide service for Integrated disease surveillance Programme.
ME E23.10 The facility provide services under National Programme for prevention and control of deafness.

National Quality Assurance Standards for District Hospital 37

 Area of concern - F: Infection Control

Overview
The first principle of health care is “to do no harm”. As Public Hospitals usually have high occupancy, the Infection
control practices become more critical to avoid cross-infection and its spread. This area of concern covers Infection
control practices, hand-hygiene, antisepsis, Personal Protection, processing of equipment, environment control,
and Biomedical Waste Management.
Following is the brief description of the Standards within this area of concern:

Standard F1 Standard F1 is concerned with the implementation of Infection control

The facility has infection programme at the facility. It is includes existence of functional infection control
control Programme and committee, microbiological surveillance, measurement of hospital acquired
procedures in place for infection rates, periodic medical check-up and immunization of staff and
prevention and measurement monitoring of Infection control Practices. Hospital administration should be
of hospital associated interacted to assess the functioning of infection control committee. Records
infection should be reviewed for confirming the culture surveillance practices, monitoring
of Hospital acquired infection, status of staff immunization, etc. Implementation
of antibiotic policy can be assessed though staff interview, perusal of patient
record and usage pattern of antibiotic.
Standard F2 Standard F2 is concerned with practices of hand-washing and antisepsis. Availability
The facility has defined and of Hand washing facilities with soap and running water should be observed at
Implemented procedures the point of use. Technique of hand-washing for assessing the practices, and
for ensuring hand hygiene effectiveness of training may be observed.
practices and antisepsis
Standard F3 Standard F3 is concerned with usage of Personal Protection Equipment (PPE)
The facility ensures standard such as gloves, mask, apron, etc. Interaction with staff may reveal the adequacy of
practices and materials for supply of PPE.
Personal protection
Standard F4 Standard F4 is concerned with standard procedures, related to processing of
The facility has standard equipment and instruments. It includes adequate decontamination, cleaning,
procedures for processing of disinfection and sterilization of equipment and instruments. These practices should
equipment and instruments be observed and staff should be interviewed for compliance to certain standard
procedures.
Standard F5 Standard F5 pertains to environment cleaning. It assesses whether lay out
Physical layout and and arrangement of processes are conducive for the infection control or not.
environmental control Environment cleaning processes like mopping, especially in critical areas like OT
of the patient care areas and ICU should be observed for the adequacy and technique.
ensures infection prevention
Standard F6 Standard F6 is concerned with Management of Biomedical waste management
The facility has defined and including its segregation, transportation, disposal and management of sharps.
established procedures for Availability of equipment and practices of segregation can be directly observed.
segregation, collection, Staff should be interviewed about the procedure for management of the needle
treatment and disposal of stick injuries. Storage and transportation of waste should be observed and records
Bio Medical and hazardous are verified.
Waste

38 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - F: Measurable Elements Infection Control
Standard F1 The facility has infection control Programme and procedures in place for prevention and
measurement of hospital associated infection.
ME F1.1 The facility has functional infection control committee.
ME F1.2 The facility has provision for Passive and active culture surveillance of critical & high risk areas.
ME F1.3 The facility measures hospital associated infection rates.
ME F1.4 There is Provision of Periodic Medical Check-up and immunization of staff.
ME F1.5 The facility has established procedures for regular monitoring of infection control practices.
ME F1.6 The facility has defined and established antibiotic policy.
Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices
and antisepsis.
ME F2.1 Hand washing facilities are provided at point of use.
ME F2.2 The facility staff is trained in hand washing practices and they adhere to standard hand washing
practices.
ME F2.3 The facility ensures standard practices and materials for antisepsis.
Standard F3 The facility ensures standard practices and materials for Personal protection.
ME F3.1 The facility ensures adequate personal protection Equipment as per requirements.
ME F3.2 The facility staff adheres to standard personal protection practices.
Standard F4 The facility has standard procedures for processing of equipment and instruments.
ME F4.1 The facility ensures standard practices and materials for decontamination and cleaning of instruments
and procedures areas.
ME F4.2 The facility ensures standard practices and materials for disinfection and sterilization of instruments
and equipment.
Standard F5 Physical layout and environmental control of the patient care areas ensures infection
prevention.
ME F5.1 Functional area of the department are arranged to ensure infection control practices
ME F5.2 The facility ensures availability of standard materials for cleaning and disinfection of patient care
areas.
ME F5.3 The facility ensures standard practices are followed for the cleaning and disinfection of patient care
areas.
ME F5.4 The facility ensures segregation infectious patients.
ME F5.5 The facility ensures air quality of high risk area.
Standard F6 The facility has defined and established procedures for segregation, collection, treatment
and disposal of Bio Medical and hazardous Waste.
ME F6.1 The facility Ensures segregation of Bio Medical Waste as per guidelines and 'on-site' management of
waste is carried out as per guidelines.
ME F6.2 The facility ensures management of sharps as per guidelines.
ME F6.3 The facility ensures transportation and disposal of waste as per guidelines.

National Quality Assurance Standards for District Hospital 39

 Area of concern - G: Quality Management

Overview
Quality management requires a set of interrelated activities that assure quality of services according to set
standards and strive to improve upon it through a systematic planning, implementation, checking and acting
upon the compliances. The standards in this area concern are the opportunities for improvement to enhance
quality of services and patient satisfaction. These standards are in synchronization with facility based quality
assurance programme given in ‘Operational Guidelines’.
Following are the Standards under this area of Concern:

Standard G1 Standard G1 is concerned with creating a Quality Team at the facility and making
The facility has established it functional. Assessor may review the document and interact with Quality Team
organizational framework members to know how frequently they meet and responsibilities have been
for quality improvement delegated to them. Quality team meeting records may be reviewed.
Standard G2 Standard G2 is concerned with having a system of measurement of patient and
The facility has established employee satisfaction. This includes periodic patients’ satisfaction survey, analysis of
system for patient and the feedback and preparing action plan. Assessors should review the records pertaining
employee satisfaction to patient satisfaction and employee satisfaction survey to ascertain that Patient
feedback is taken at prescribed intervals and adequate sample size is adequate.
Standard G3 Standard G3 is concerned with implementation of internal and external
Facility have established assessments, quality assurance programmes within departments such as EQAS of
internal and external quality diagnostic services, daily round and use of departmental checklists etc. Interview
assurance programs with hospital staff, Matron, Hospital Mangers etc may give information about
how they conduct internal assessments, daily round of departments, usage of
checklists etc at a defined periodicity. Review of Internal assessment records may
reveal their adequacy and periodicity.
Standard G4 Standard G4 is concerned with availability and adequacy of Standard operating
The facility has established, procedures and work instructions with the respective process owners. Display
documented implemented and of work instructions and clinical protocols should be observed during the
maintained Standard Operating assessment.
Procedures for all key
processes and support services.
Standard G5 Standard G5 concerns the efforts’ made for the mapping and improving
The facility maps its key processes. Records should be checked to ensure that the critical processes have
processes and seeks to been mapped, wastes have been identified and efforts are made to remove them
make them more efficient by to make processes more efficient.
reducing non value adding
activities and wastages
Standard G6 Every organization has a purpose for its existence and what it wants to be achieve
The facility has defined in future. Public health facilities have been created not only to provide curative
mission, values, Quality policy services, but also support health promotion in their target community and disease
& objectives & prepared a prevention. Therefore public hospitals not only cater needs of sick and those in
strategic plan to achieve them need of medical care, but also provide holistic care, which includes preventive &
promotive care.
With this positioning it is very important that health facilities should clearly
articulate their mission statement in consultation with internal and external
stakeholders and disseminate it effectively amongst staff, visitors& community.
The Mission statement may incorporate ‘what is the purpose of existence’,‘ who
are our users’ and ‘what do we intend to do by operating this facility’. Mission
statement should be pragmatic and simple so it can be easily understood by
target audiences and they can relate it with their work. As the public health facility
is part of larger public health system governed by State Health Department, it

40 National Quality Assurance Standards for Public Health Facilities | 2020

 is recommended the facility’s mission statement should be in congruence with
mission of the State’s Health department. Mission statement should be approved
and endorsed by administration of facility and effectively communicated in local
language through display. Caution should also be taken to keep the language
simple and easily understandable.
This standard also requires health facilities to define core value that should be
part of all policies & procedures, and are always considered while realizing the
services to the patients and community. Being public hospital, facility should
have core values of Honesty, transparency, Non–discrimination, ethical practices,
Competence, empathy and goodwill towards community. It is also of utmost
importance that how hospital administration plan and promote that these values
amongst its staff so it becomes part of their attitude and work culture.
Quality policy is overall intension and direction of an organization related to
quality as formally expressed by hospital administration. Hospital should define
what they intend to achieve in terms of quality, safety and patient satisfaction.
Quality Policy is should be aligned with the mission statement to achieve overall
aim of the facility. To achieve the mission and quality policy, the facility should
define commensurate objectives. Objectives are more tangible and short-term
goals, with each objective targeting one specific issue or aspiration of organization.
Objectives should be Specific, Measurable, Attainable, Relevant/realistic and
Time-bound (SMART). Though Mission and Quality Policy are framed at the
organizational level, objectives can be at departmental or activity level. Quality
Policy and objectives should also be disseminated effectively to staff and other
relevant stakeholders. It is equally important that hospital administration prepares
a time bound plan to achieve these objectives and provide adequate resources to
achieve them.
Assessment of this standard and related measurable elements can be done by
reviewing the records pertaining to mission, quality policy and objectives.
Assessors may also interview some of the staff about their awareness of Mission,
Values, Quality Policy and objectives.
Standard G7 Standard G8 is concerned with the practice of using Quality tools and methods
THE Facility seeks continually like control charts, 5-‘S’, etc. The Assessor should look for any specific methods
improvement by practicing and tools practiced for quality improvement.
Quality method and tools.
Standard G8 Healthcare facilities of all level are exposed to risks from Internal and External
THE Facility has defined, sources, which may put attainment of Quality objective at a risk. In Public hospitals
approved and communicated these risks may be patients’ safety issues, shortage of supplies, fall in allocation of
Risk Management framework resources, man-made or natural disaster, failure to comply with statuary & legal
for existing and potential risks. requirements, Violence towards service providers or even risk of getting outdated
or becoming obsolete. Hospitals are complex organizations and just reacting on
occurred threats may not alone be helpful.
This standard requires healthcare facilities to develop, implement and
continuously improve a risk management framework considering both internal
and external threats. Risk Management framework should not be isolated
exercise. It should be integrated with facilitie’s objectives and intended Quality
Management System (QMS).
In this direction, the initial step is to define scope of rick management and
objectives of the framework keeping in mind the context and environment.
The hospital administration should prepare a comprehensive list of current and
perceived risks. It is also important to define the responsibility and process of
reporting and managing risks. Facility should also have provision for training of
staff on risk management framework.

National Quality Assurance Standards for District Hospital 41

 Assessors may verify documents that defines facilities risk management system.
Assessors should verify that potential risks has been identified in framework keeping
in accordance to context of. Assessors can also interview hospital administration and
staff for their knowledge and practice of risk management framework.
Standards G9 To implement risk management framework facility should prepare a risk management
THE Facility has established plan. The Plan will delineate responsibilities and timelines for risk management
procedures for assessing, activities such as assessment and risk treatment. All staff and external stakeholders
reporting, evaluating and should be made aware of the plan in general and their roles &responsibilities in
managing risk as per Risk particular. Facility should define the criteria for identifying the risk and finalise its
Management Plan assessment tools. These tools may be a simple checklist, reporting format or work
instruction for identifying risks. It may be checklist for fire safety preparedness,
infection control audit, electrical safety audit or even an open ended questionnaire
for staff on what potential threats they feel on their security at workplace. Once risks
are identified, they should be analysed and evaluated for their impact. Based on their
impact the risk should be graded - severe, moderate and low. Accordingly actions are
taken to mitigate prevent or eliminate the risks. Actions may need to be prioritized in
term of potential impact a rick may have. Facility should also establish a risk register.
This register will record the identified or reported risk, their severity and actions to
be taken.
Assessors should review relevant records for verify availability of a valid plan for risk
management and whether risk management activities have been conducted as per
plan. Assessors should also review risk register to see how facility has graded their
risks and prioritized them for action.
Standard G10 Clinical Governance has broad 7 elements viz. Education & training, clinical audits,
The facility has established clinical effectiveness, research and development, openness, information management
clinical Governance and risk management. Under NQAS structure, most of the elements are covered in
framework to improve their respective area of concerns.
the quality and safety of
clinical care processes This Standard requires healthcare facilities to develop, implement and improve
clinical Governance framework. Framework should cover policy formulation,
constitution of Apex Committee for clinical governance, defined roles and
responsibilities of its members and ensuring regular discussions & monitoring on
clinical cases.
In this direction, the first step should be reviewing the functioning of existing clinical
committee viz. Drug and therapeutic committee, Medical, death and prescription
audit committee etc by the Apex committee.
Committee should ensure the use of evidence-based practices and Standard
treatment guideline for all the clinical treatment provided to the patient.
Assessor will verify the clinical governance policy, ensuring apex committee is meeting
at regular intervals, data or information is analysed and presented during the meeting
&steps are taken to improve the processes further using PDCA approach. Assessor
may verify the transparency in the processes while respecting the confidentiality of
patient and service providers.

42 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - G: Measurable Elements Quality Management
Standard G1 The facility has established organizational framework for quality improvement.
ME G1.1 The facility has a quality team in place.
ME G1.2 The facility reviews quality of its services at periodic intervals.
Standard G2 The facility has established system for patient and employee satisfaction.
ME G2.1 Patient satisfaction surveys are conducted at periodic intervals.
ME G2.2 The facility analyses the patient feedback, and root-cause analysis.
ME G2.3 The facility prepares the action plans for the areas, contributing to low satisfaction of patients.
Standard G3 Facility have established internal and external quality assurance programs.
ME G3.1 The facility has established internal quality assurance programme in key departments.
ME G3.2 The facility has established external assurance programmes at relevant departments.
ME G3.3 The facility has established system for use of check lists in different departments and services.
ME G3.4 Actions are planned to address gaps observed during quality assurance process
ME G3.5 Planned actions are implemented through Quality improvement cycles (PDCA)
Standard G4 The facility has established, documented implemented and maintained Standard Operating
Procedures for all key processes and support services.
ME G4.1 Departmental standard operating procedures are available.
ME G4.2 Standard Operating Procedures adequately describes process and procedures.
ME G4.3 Staff is trained and aware of the procedures written in SOPs.
ME G4.4 The facility ensures documented policies and procedures are appropriately approved and controlled.
Standard G 5 The facility maps its key processes and seeks to make them more efficient by reducing non
value adding activities and wastages.
ME G5.1 The facility maps its critical processes.
ME G5.2 The facility identifies non value adding activities/waste/redundant activities.
ME G5.3 The facility takes corrective action to improve the processes.
Standard G6 The facility has defined Mission, Values, Quality policy and Objectives, and prepares a
strategic plan to achieve them.
ME G6.1 The facility has defined mission statement.
ME G6.2 The facility has defined core values of the organization.
ME G6.3 The facility has defined Quality policy, which is in congruency with the mission of facility.
ME G6.4 The facility has defined quality objectives to achieve mission and quality policy.
ME G6.5 Mission, Values, Quality policy and objectives are effectively communicated to staff and users of
services.
ME G6.6 The facility prepares strategic plan to achieve mission, quality policy and objectives.
ME G6.7 The facility periodically reviews the progress of strategic plan towards mission, policy and
objectives.
Standard G7 The facility seeks continually improvement by practicing Quality method and tools.
ME G7.1 The facility uses method for quality improvement in services.
ME G7.2 The facility uses tools for quality improvement in services.
Standard G8 The facility has defined, approved and communicated Risk Management framework for
existing and potential risks.

National Quality Assurance Standards for District Hospital 43

 ME G8.1 Risk Management framework has been defined including context, scope, objectives and criteria.
ME G8.2 Risk Management framework defines the responsibilities for identifying and managing risk at each
level of functions.
ME G8.3 Risk Management Framework includes process of reporting incidents and potential risk to all
stakeholders
ME G8.4 A compressive list of current and potential risk including potential strategic, regulatory, operational,
financial, environmental risks has been prepared.
ME G8.5 Modality for staff training on risk management is defined
ME G8.6 Risk Management Framework is reviewed periodically
Standard G9 The facility has established procedures for assessing, reporting, evaluating and managing
risk as per Risk Management Plan
ME G9.1 Risk management plan has been prepared and approved by the designated authority and there is a
system of its updation at least once in a year.
ME G9.2 Risk Management Plan has been effectively communicated to all the staff, and as well as relevant
external stakeholders.
ME G9.3 Risk assessment criteria and checklist for assessment have been defined and communicated to
relevant stakeholders
ME G9.4 Periodic assessment for Physical and Electrical risks is done as per defined criteria
ME G9.5 Periodic assessment for potential disasters including fire is done as per defined criteria
ME G9.6 Periodic assessment for Medication and Patient care safety risks is done as per defined criteria.
ME G9.7 Periodic assessment for potential risk regarding safety and security of staff including violence against
service providers is done as per defined criteria
ME G9.8 Risks identified are analyzed evaluated and rated for severity.
ME G9.9 Identified risks are treated based on severity and resources available.
ME G9.10 A risk register is maintained and updated regularly to risk records identified risks, there severity and
action to be taken.
Standard G10 The facility has established clinical Governance framework to improve the quality and safety
of clinical care processes
ME G10.1 The facility has defined clinical governance framework.
ME G10.2 Clinical Governance framework has been effectively communicated to all staff
ME G10.3 Clinical care effectiveness criteria have been defined and communicated
ME G10.4 Facility conducts the periodic clinical audits including prescription, medical and death audits
ME G10.5 Clinical care audits data is analysed, and actions are taken to close the gaps identified during the
audit process
ME G10.6 Governing body of healthcare facilities ensures accountability for clinical care provided
ME G10.7 Facility ensures easy access and use of standard treatment guidelines & implementation tools at
point of care

44 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - H: Outcome

Overview
Measurement of the quality is critical to improvement of processes and outcomes. This area of concern has four
standard measures for quality - Productivity, Efficiency, Clinical Care and Service quality in terms of measurable
indicators. Every standard under this area has two aspects – Firstly, there is a system of measurement of indicators
at the health facility; and secondly, how the hospital meets the benchmark. It is realised that at the beginning
many indictors given in these standards may not be getting measured across all facilities, and therefore it would
be difficult to set benchmark beforehand. However, with the passage of time, the state can set their benchmarks,
and evaluate performance of health facilities against the set benchmarks.
Following is the brief description of the Standards in this area of concern:

Standard H1 Standard H1 is concerned with the measurement of Productivity indicators and

The facility measures meeting the benchmarks. This includes utilization indicators like bed occupancy
Productivity Indicators and rate and C-Section rate. Assessor should review these records to ensure that theses
ensures compliance with indictors are getting measured at the health facility.
State/National benchmarks
Standard H2 Standard H2 pertains to measurement of efficiency indicators and meeting
The facility measures benchmark. This standard contains indicators that measure efficiency of processes,
Efficiency Indicators and such as turnaround time, and efficiency of human resource like surgery per
ensure to reach State/ surgeon. Review of records should be done to assess that these indicators have
National Benchmark been measured correctly.
Standard H3 Standard H3 is concerned with the indicators of clinical quality, such as average
The facility measures Clinical length of stay and death rates. Record review should be done to see the
Care & Safety Indicators and measurement of these indicators.
tries to reach State/National
benchmark
Standard H4 Standard H4 is concerned with indicators measuring service quality and patient
The facility measures Service satisfaction like Patient satisfaction score and waiting time and LAMA rate.
Quality Indicators and
endeavours to reach State/
National benchmark

National Quality Assurance Standards for District Hospital 45

 Area of Concern - H: Measurable Elements Outcomes
Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National
Benchmarks.
ME H1.1 The facility measures productivity Indicators on monthly basis
ME H1.2 The facility endavours to improve its productivity indicators to meet benchmarks
Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark.
ME H2.1 The facility measures efficiency Indicators on monthly basis
ME H2.2 The facility endavours to improve its efficiency indicators to meet benchmarks
Standard H3 The facility measures Clinical Care & Safety Indicators and tries to reach State/National
benchmark
ME H3.1 The facility measures Clinical Care & Safety Indicators on monthly basis
ME H3.2 The facility endavours to improve its clincal & safety indicators to meet benchmarks
Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National
benchmark
ME H4.1 The facility measures Service Quality Indicators on monthly basis
ME H4.2 The facility endavours to improve its service Quality indicators to meet benchmarks

46 National Quality Assurance Standards for Public Health Facilities | 2020

National Quality Assurance
Standards for Community Health
Centre (First Referral Unit)
 NATIONAL QUALITY ASSURANCE Standards for
COMMUNITY HEALTH CENTRE (FIRST REFERRAL UNIT)

Area of Concern - A: Service Provision

Standard A1 The facility provides Curative Services

Standard A2 The facility provides RMNCHA Services

Standard A3 The facility provides diagnostic Services

Standard A4 The facility provides services as mandated in national Health Programmes/State Scheme.

Standard A5 The facility provides support and administrative services

Standard A6 Health services provided at the facility are appropriate to community needs.

Area of Concern - B: Patient Rights

Standard B1 The facility provides the information to care seekers, attendants & community about the available
services and their modalities.

Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are
no barriers on account of physical economic, cultural or social reasons.

Standard B3 The facility maintains privacy, confidentiality & dignity of patient, and has a system for guarding patient
related information.

Standard B4 The facility has defined and established procedures for informing patients about the medical condition,
and involving them in treatment planning, and facilitates informed decision making.

Standard B5 The facility ensures that there are no financial barriers to access, and that there is financial protection
given from the cost of hospital services.

Area of Concern - C: Inputs

Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the
prevalent norms.

Standard C2 The facility ensures the physical safety including Fire safety of the infrastructure.

Standard C3 The facility has adequate qualified and trained staff, required for providing the assured services to the
current case load.

Standard C4 The facility provides drugs and consumables required for assured services.

Standard C5 The facility has equipment & instruments required for assured list of services

Area of Concern - D: Support Services

Standard D1 The facility has established Programme for inspection, testing and maintenance and calibration of
Equipment.

Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs in
pharmacy and patient care areas.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 49
 Standard D3 The facility has established program for maintenance and upkeep of the facility to provide safe, secure
and comfortable environment to staff, patients and visitors.

Standard D4 The facility ensures 24x7 water and power back up as per requirement of Service delivery and Support
Services norms

Standard D5 The facility ensures availability of Diet as per Nutritional requirement of the patients and clean linen to
all admitted patients

Standard D6 The facility has defined and established procedures for promoting public participation in management
of hospital transparency and accountability.

Standard D7 The facility has defined and established procedures for promoting public participation in management
of hospital with transparency and accountability.

Standard D8 The facility is complaint with all statutory and regulatory requirement imposed by local. state or Central
Government

Standard D9 Roles & Responsibilities of administrative and clinical staff are determined as per govt. regulations and
standards operating procedures.

Standard D10 The facility has established procedure for monitoring the quality of outsourced services and adheres to
contractual obligations.

Area of Concern - E: Clinical Services

Standard E1 The facility has defined procedures for registration, consultation and admission of patients.

Standard E2 The facility has defined and established procedures for clinical assessment and reassessment of the
patients.

Standard E3 The facility has defined and established procedures for continuity of care of patient and referral.

Standard E4 The facility has defined and established procedures for nursing care.

Standard E5 The facility has a procedure to identify high risk and vulnerable patients.

Standard E6 The facility follows standard treatment guidelines defined by state/Central government for prescribing
the generic drugs & their rational use.

Standard E7 The facility has defined procedures for safe drug administration.

Standard E8 The facility has defined and established procedures for maintaining, updating of patients’ clinical
records and their storage.

Standard E9 The facility has defined and established procedures for discharge of patient.

Standard E10 The facility has defined and established procedures for Emergency Services and Disaster
Management.

Standard E11 The facility has defined and established procedures for Diagnostic services.

Standard E12 The facility has defined and established procedures of Blood Bank/Storage Management and
Transfusion.

Standard E13 The facility has defined and established procedures for Anaesthetic Services.

Standard E14 The facility has established procedures for Operation theatre and Surgical services.

Standard E15 The facility has defined and established procedures for and of life care and death.

Maternal & Child Health Services

Standard E16 The facility has defined and established procedures for Antenatal Care as per guidelines.

Standard E17 The facility has established procedures for Intranatal care as per guidelines.

50 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E18 The facility has established procedures for postnatal care as per guidelines.

Standard E19 The facility has established procedures for Care of New born, Infant and Children.

Standard E20 The facility has established procedures for Medical Termination of Pregnancy and Family planning as
per government guidelines and law.

Standard E21 The facility provides Adolescent Reproductive and Sexual Health services as per guideline

National Health Programmes

Standard E22 The facility provides National health Programme as per operational/Clinical Guidelines.

Area of Concern - F: Infection Control

Standard F1 The facility has infection control Programme and procedures in place for prevention and measurement
of hospital associated infection.

Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and
antisepsis.

Standard F3 The facility ensures standard practices and materials for Personal protection.

Standard F4 The facility has standard procedures for processing of equipment and instruments.

Standard F5 Physical layout and environmental control of the patient care areas ensures infection prevention.

Standard F6 The facility has defined and established procedures for segregation, collection, treatment and disposal
of Bio Medical and hazardous Waste.

Area of Concern - G: Quality Management

Standard G1 The facility has established organizational framework for quality improvement.

Standard G2 The facility has established system for patient and employee satisfaction.

Standard G3 The facility has established internal and external quality assurance Programmes wherever it is critical
to quality.

Standard G4 The facility has established, documented implemented and maintained Standard Operating Procedures
for all key processes and support services.

Standard G5 The facility has established system of periodic review as internal assessment, medical & death audit and
prescription audit.

Standard G6 The facility has defined Quality policy and Objectives.

Standard G7 The facility seeks continual improvement by practicing Quality Toll and Method.

Area of Concern - H: Outcome Indicator

Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National benchmarks.

Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark.

Standard H3 The facility measures Clinical Care & Safety Indicators and tries to reach State/National benchmark.

Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National benchmark.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 51
 Intent of standards AND Measurable elements
FOR COMMUNITY HEALTH CENTRE (FIRST REFERRAL UNIT)

AREA OF CONCERN – A: SERVICES PROvISION

Overview
Community Health Centres constitute the First referral Units (FRUs) and are designed to provide referral health
care for cases from the Primary Health Centres level and for cases in need of specialist care approaching the centre
directly. Indian Public Health Standards (IPHS) defines minimum assured services, which should to be available at
a Community Health Centre. Recently launched RMNCH+A initiative has also defined service availability norms
for Reproductive, Maternal, Neonatal, and Child and Adolescent health services at a CHC.
Community Health Centre is an important link between PHC and District Hospital. CHC is a 30-bedded Hospital
providing specialist care in Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Dental and AYUSH.
This area of concern measures availability of services. “Availability” of functional services means service is available
to end-users because mere presence of infrastructure and human resources does not always ensure availability
of the services. For example an Operation Theatre, Surgeon and Anaesthetist may be available, but no LSCS
are being conducted due to varied reasons. Compliance to these standards and measurable elements should
be checked, preferably by observing delivery of the services, review of records for utilization of services and
interviewing the users to know, whether the services were provided to them or not.
There are six standards in this area of concern. Compliance to following standards ensures that the health facility
is addressing this area of concern:

Standard A1 This standard includes availability of OPD consultation, Indoor services and
The Facility Provides Curative Surgical procedures and Emergency Care under different specialities e.g. Medicine,
Services Surgery, Paediatrics, etc. Each measurable element under this standard measures
one speciality across the departments. For Example, ME A1.2 measures availability
of emergency surgical procedures in Accident and Emergency department,
availability of General surgery clinic at OPD, and Availability of surgical procedures
in Operation theatre.
Standard A2 This standard measures availability of Reproductive, Maternal, Newborn, Child
The Facility provides RMNCH+A and Adolescent services in different departments of the hospital. Each aspect of
Services RMNCH+A services is covered by one measurable element of this standard.
Standard A3 It covers availability of Laboratory, Radiology and other diagnostics services in the
The facility provides respective departments.
Diagnostics Services
Standards A4 This standard measures availability of the services under different National Health
The facility provides services as Programmes such as RNTCP, NVBDCP, etc. One Measurable element has been
mandated in national Health assigned to each National Health Programme.
Programmes/State Scheme
Standard A5 The standard measures availability of support services like dietary, laundry and
The facility provides Support housekeeping services at the facility.
services and Administrative
Services
Standard A6 The standard mandates availability of the services according to specific local health
Health services provided at needs. Different geographical area may have certain health problems, which are
the facility are appropriate to prevalent locally, e. g. Kala-azar, Dengue, Arsenic Poisoning, AES, etc.
community needs

52 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - A: Service Provision

Standard A1 The facility provides Curative Services

ME A1.1 The facility provides General Medicine services

ME A1.2 The facility provides General Surgery services

ME A1.3 The facility provides Obstetrics & Gynaecology Services

ME A1.4 The facility provides Paediatric Services

ME A1.5 The facility provides Ophthalmology Services

ME A1.6 The facility provides Dental Treatment Services

ME A1.7 The facility provides AYUSH Services

ME A1.8 The facility provides services for OPD procedures

ME A1.9 Services are available for the time period as mandated

ME A1.10 The facility provides Accident & Emergency Services

ME A1.11 The facility provides Blood Storage & transfusion services

Standard A2 The facility provides RMNCHA Services

ME A2.1 The facility provides Reproductive health Services

ME A2.2 The facility provides Maternal health Services

ME A2.3 The facility provides Newborn health Services

ME A2.4 The facility provides Child health Services

ME A2.5 The facility provides Adolescent health Services

Standard A3 The facility provides diagnostic Services

ME A3.1 The facility provides Radiology Services

ME A3.2 The facility provides Laboratory Services

ME A3.3 The facility provides other diagnostic services, as mandated

Standard A4 The facility provides services as mandated in National Health Programmes/State Scheme

ME A4.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines

ME A4.2 The facility provides services under Revised National TB Control Programme as per guidelines

ME A4.3 The facility provides services under National Leprosy Eradication Programme as per guidelines

ME A4.4 The facility provides services under National AIDS Control Programme as per guidelines

ME A4.5 The facility provides services under National Programme for control of Blindness as per guidelines

ME A4.6 The facility provides services under Mental Health Programme as per guidelines

ME A4.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines

ME A4.8 The facility provides services under National Programme for Prevention and control of Cancer,
Diabetes, Cardiovascular diseases & Stroke (NPCDCS) as per guidelines

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 53
 ME A4.9 The facility provides services under Integrated Disease Surveillance Programme as per Guidelines

ME A4.10 The facility provide services under National health Programme for deafness

ME A4.11 The facility provides services under Universal Immunization Programme (UIP) as per guidelines

ME A4.12 The facility provides services under National Tobacco Control Programme as per guidelines

ME A4.13 The facility provides services under National Iodine Deficiency Disorder Control Programme as per
guidelines

ME A4.14 The facility provides services as per State specific health programmes

Standard A5 The facility provides support services and Administrative services

ME A5. 1 The facility provides dietary services

ME A5.2 The facility provides laundry services

ME A5.3 The facility provides security services

ME A5.4 The facility provides Housekeeping services

ME A5.5 The facility ensures maintenance services

ME A5.6 The facility provides pharmacy and store services

ME A5.7 The facility has services for Medical Records

ME A5.8 The facility provides administrative services for the Block

Standard A6 Health services provided at the facility are appropriate to community needs

ME A6.1 The facility provides curatives & preventive services for the health problems and diseases, prevalent
locally

ME A6.2 There is process for consulting community/or their representatives when planning or revising scope
of services of the facility

54 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - B: Patients ’ Rights

Overview
Mere availability of services does not serve the purpose until the services are accessible to the users, and
are provided with dignity and confidentiality. Access includes Physical access as well as financial access. The
Government has launched many schemes, such as JSSK, RBSK and RSBY, for ensuring that the service packages
are available cashless to different targeted groups. There are evidences to suggest that patients’ experience and
outcome improves, when they are involved in the care. So availability of information is critical for access as well
as enhancing patients’ satisfaction. Patients’ rights also include that health services give due consideration to
patients’ cultural and religious preferences.
Brief description of the standards under this area of concern are given below:

Standard B1 This standard measures availability of the information about the services and their
the facility provides modalities of availing them. Measurable elements under this standard check for
the information to care availability of user-friendly signages, display of available services and user charges,
seekers, attendants & citizen charter, enquiry desk and access to his/her clinical records.
community about the
available services and their
modalities
Standard B2 This standard ensures that the services are sensitive to gender, cultural and religious
Services are delivered in a needs. This standard also measures the physical access and disable-friendliness of the
manner that is sensitive to services, such as availability of ramps and disable friendly toilets. Last measurable
gender, religious, gender element of this standard mandates for provision for affirmative action for vulnerable
and cultural needs, and and marginalized patients like orphans, destitute, terminally ill patients, victims of
there are no barrier on rape and domestic violence so they can avail health care service with dignity and
account of physical access, confidence at public hospitals.
social, economic, cultural
or social status
Standard B3 This standard measures the patient friendliness of the services in terms of ensuring
The facility maintains privacy, confidentiality and dignity. Measurable elements under this standard
privacy, confidentiality and check for provisions of screens and curtains, confidentiality of patients’ clinical
dignity of patient, and has a information, behaviour of service providers, and also ensuring specific precautions
system for guarding patient to be taken, while providing care to patients with HIV infection, abortion, teenage
related information pregnancy, etc.
Standard B4 This standard mandates that health facility has procedures for informing patients
The facility has defined and about their rights, and actively involves them in the decision-making about their
established procedures for treatment. Measurable elements in this standard look for practices such informed
informing patients about consent, dissemination of patient rights and how patients are communicated about
the medical condition, their clinical conditions and options available. This standard also measures for
and involving them in procedure for grievance redressal. Compliance to these standards can be checked
treatment planning, through review of records for consent, interviewing staff about their awareness
and facilitates informed of patients’ rights, interviewing patients whether they had been informed of the
decision making treatment plan and available options.
Standard B5 This standard majorly checks that there are no financial barriers for the community,
The facility ensures that more so those belong to BPL category, vulnerable in available the services. Measurable
there are no financial elements under this standard check for availability of drugs, diagnostics and transport
barriers to access, and free of cost under different schemes, and timely payment of the entitlements under
that there is financial JSY and Family planning incentives.
protection given from the
cost of hospital services

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 55
 Area of Concern - B: Patient Rights
Standard B1 The facility provides the information to care seekers, attendants & community about the
available services and their modalities
ME B1.1 The facility has uniform and user-friendly signage system
ME B1.2 The facility displays the services and entitlements available in its departments
ME B1.3 The facility has established citizen charter, which is followed at all levels
ME B1.4 User charges are displayed and communicated to patients effectively
ME B1.5 Patients & visitors are sensitised and educated through appropriate IEC/BCC approaches
ME B1.6 Information is available in local language and easy to understand
ME B1.7 The facility provides information to patients and visitor through an exclusive set-up.
ME B1.8 The facility ensures access to clinical records of patients to entitled personnel
Standard B2 Services are delivered in a manner that is sensitive to gender, religious, gender and cultural
needs, and there are no barrier on account of physical access, social, economic, cultural or
social status
ME B2.1 Services are provided in manner that are sensitive to gender
ME B2.2 Religious and cultural preferences of patients and attendants are taken into consideration while
delivering services
ME B2.3 Access to facility is provided without any physical barrier & friendly to people with disability.
ME B2.4 There is no discrimination on basis of social and economic status of the patients
ME B2.5 There is affirmative action to ensure that vulnerable sections can access services
Standard B3 The facility maintains privacy, confidentiality & dignity of patient, and has a system for
guarding patient related information
ME B3.1 Adequate visual privacy is provided at every point of care
ME B3.2 Confidentiality of patients records and clinical information is maintained
ME B3.3 The facility ensures the behaviours of staff is dignified and respectful, while delivering the
services
ME B3.4 The facility ensures privacy and confidentiality to every patient, especially of those conditions
having social stigma, and also safeguards vulnerable groups
Standard B4 The facility has defined and established procedures for informing patients about the medical
condition, and involving them in treatment planning, and facilitates informed decision making
ME B4.1 There is established procedures for taking informed consent before treatment and procedures
ME B4.2 Patient is informed about his/her rights and responsibilities
ME B4.3 Staff are aware of Patients rights responsibilities
ME B4.4 Information about the treatment is shared with patients or attendants, regularly
ME B4.5 The facility has defined and established grievance redressal system in place
Standard B5 The facility ensures that there are no financial barrier to access, and that there is financial
protection given from the cost of hospital services
ME B5.1 The facility provides cashless services to pregnant women, mothers and neonates as per prevalent
government schemes
ME B5.2 The facility ensures that drugs prescribed are available at Pharmacy and wards
ME B5.3 It is ensured that facilities for the prescribed investigations are available at the facility
ME B5.4 The facility provide free of cost treatment to Below poverty line patients without administrative
hassles
ME B5.5 The facility ensures timely reimbursement of financial entitlements and reimbursement to the patients
ME B5.6 The facility ensure implementation of health insurance schemes as per National/state scheme

56 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of concern - C: Inputs

Overview
This area of concern predominantly covers the structural part of the facility. Indian Public Health Standards (IPHS)
defines infrastructure, human resources, drugs and equipment requirements for different level of health facilities.
Quality standards given in this area of concern take into cognizance of the IPHS requirement. However, focus
of the standards has been in ensuring compliance to minimum level of inputs, which are required for ensuring
delivery of committed level of the services. The words like ‘adequate’ and ‘as per load‘ has been given in the
requirements for many standards and measurable elements, as it would be hard to set structural norms for
every level of the facility that commensurate with patient load. For example, a 30-bedded CHC having 40% bed
occupancy may not have same requirements as another CHC having 100% occupancy. So structural requirement
should be based more on the utilization, than fixing the criteria like beds available. Assessor should use his/her
discretion in arriving at a just decision for compliance.

Standard C1 The standard measures adequacy of infrastructure in terms of space, patient

The facility has amenities, layout, circulation area, communication facilities, service counters, etc.
infrastructure for delivery It also looks into the functional aspect of the structure, whether it commensurate
of assured services, and with the process flow of the facility or not.
available infrastructure
meets the prevalent norms Minimum requirement for space, layout and patient amenities are given for some of
the departments, but assessors would be expected to use his discretion to conclude
whether available space is adequate for the given work load. Compliance to most of
the measurable elements can be assessed by direct observation except for checking
functional adequacy, where discussion with staff and hospital administration may
be required to know the process flow between the departments, and also within
a department.
Standard C2 The standard deals with Physical safety of the infrastructure. It includes seismic
The facility ensures the safety, electrical safety, and general condition of hospital infrastructure. It also
physical safety including Fire covers fire safety of the facility. Measurable elements in this standard look for
safety of the infrastructure implementation of fire prevention, availability of adequate number of firefighting
equipment and preparedness of the facility for fire disaster in terms of mock drill
and staff training.
Standard C3 The standard measures the numerical adequacy and skill sets of the staff. It includes
The facility has adequate availability of doctors, nurses, paramedics and support staff. It also ensures that
qualified and trained staff, the staffs have been trained as per their job description and responsibilities. There
required for providing the are two components while assessing the staff adequacy - first is the numeric
assured services to the adequacy, which can be checked by interaction with in charge of the CHC and
current caseload review of records. Second is to access human resources in term of their availability
within the department. For instance, a CHC may have four SBA trained nurses, but
if none of them is available in the night to conduct deliveries, then the intent of
standard is not being complied with.
Standard C4 This standard measures availability of drugs and consumables in the user
The facility provides drugs departments. Assessor may check availability of drugs under the broad group such
and consumables required as antibiotics, IV fluids, dressing material, and make an assessment that drugs for
for assured services treatment majority of normal patients and critically ill patients are getting treated
at the health facility.
Standard C5 This standard is concerned with availability of instruments in various departments
The facility has equipment and service delivery points. Equipment and instruments have been categorized into
and instruments required for sub-groups as per their use, and measurable elements have been assigned to each
assured list of services sub-group, such as examination and monitoring, clinical procedures, diagnostic
equipment, resuscitation equipment, storage equipment and equipment used for
non-clinical support services. Some representative equipment could be used as
tracers and checked in each category.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 57
 Area of Concern - C: Inputs
Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the
prevalent norms
ME C1.1 Departments have adequate space as per patient or work load
ME C1.2 Patient amenities are provide as per patient load
ME C1.3 Departments have layout and demarcated areas as per functions
ME C1.4 The facility has adequate circulation area and open spaces according to need and local law
ME C1.5 The facility has infrastructure for intramural and extramural communication
ME C1.6 Service counters are available as per patient load
ME C1.7 The facility and departments are planned to ensure structure follows the function/processes
(Structure commensurate with the function of the hospital)
Standard C2 The facility ensures the physical safety including Fire safety of the infrastructure.
ME C2.1 The facility ensures the seismic safety of the infrastructure
ME C2.2 The facility ensures safety of electrical establishment
ME C2.3 Physical condition of buildings are safe for providing patient care
ME C2.4 The facility has plan for prevention of fire
ME C2.5 The facility has adequate fire fighting Equipment
ME C2.6 The facility has a system of periodic training of staff and conducts mock drills regularly for fire
and other disaster situation
Standard C3 The facility has adequate qualified and trained staff, required for providing the assured services to
the current case load
ME C3.1 The facility has adequate specialist doctors as per service provision.
ME C3.2 The facility has adequate general duty doctors as per service provision and work load
ME C3.3 The facility has adequate nursing staff as per service provision and work load
ME C3.4 The facility has adequate technicians/paramedics as per requirement
ME C3.5 The facility has adequate support/general staff
ME C3.6 The staff has been provided required training/skill sets
ME C3.7 The Staff is skilled as per job description
Standard C4 The facility provides drugs and consumables required for assured services
ME C4.1 The departments have availability of adequate drugs at point of use
ME C4.2 The departments have adequate consumables at point of use
ME C4.3 Emergency drug trays are maintained at every point of care, where ever it may be needed
Standard C5 The facility has equipment & instruments required for assured list of services
ME C5.1 Availability of equipment & instruments for examination & monitoring of patients
ME C5.2 Availability of equipment & instruments for treatment procedures, being undertaken in the
facility
ME C5.3 Availability of equipment & instruments for diagnostic procedures being undertaken in the
facility
ME C5.4 Availability of equipment and instruments for resuscitation of patients and for providing
intensive and critical care to patients
ME C5.5 Availability of Equipment for Storage
ME C5.6 Availability of functional equipment and instruments for support services
ME C5.7 Departments have patient furniture and fixtures as per load and service provision

58 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - D: Support services

Overview
Support services are backbone of health care facilities. The expected clinical outcome cannot be envisaged in
absence of sturdy support services. This area of concern includes equipment maintenance, calibration, drug
storage and inventory management, security, facility management, water supply, power backup, dietary services
and laundry. Administrative processes like RKS, Financial management, legal compliances, staff deputation and
contract management have also been included in this area of concern.

Standard D1 The standard is concerned with equipment maintenance processes, such as AMC,
The facility has established daily and breakdown maintenance processes, calibration and availability of operating
Programme for inspection, instructions. Equipment records should be reviewed to ensure that valid AMC is
testing and maintenance available for critical equipment and preventive/corrective maintenance is being
and calibration of done timely. Calibration records and label on the measuring equipment should
Equipment be reviewed to confirm that the calibration has been done. Operating instructions
should be displayed or should readily available with the user.
Standard D2 This standard is concerned with safe storage of drugs and scientific management
The facility has defined of the inventory, so drugs and consumables are available in adequate quantity in
procedures for storage, patient care area. Measurable elements of this standard look into at patient care
inventory management areas, including storage at optimum temperature. While assessing drug management
and dispensing of drugs in system, these practices should be looked into each clinical department, especially at
pharmacy and patient care the nursing stations and its complementary process at drug stores/Pharmacy.
areas
Standard D3 This standard is concerned with adequacy of facility management processes. This
The facility has established includes appearance of facility, cleaning processes, infrastructure maintenance, removal
Programme for of junk and condemned items and control of stray animals and pest control at the
maintenance and upkeep of facility. This standard is also concerned with providing safe, secure and comfortable
the facility to provide safe, environment to patients as well to service providers. The measurable elements under
secure and comfortable this standard have two aspects, - firstly, provision of comfortable work environment
environment to staff, in terms of adequate illumination and temperature control in patient care areas and
patients and visitors work stations. It would be preferable that assessment of adequacy of illumination is
undertaken by Lux-meter (not a very expensive devise) and compared against BIS
Standards of illumination in Hospital. Second part pertains to arrangement for security
of patients and staff. Availability of environment control arrangements should be
looked into. Security arrangements at patient area should be observed for restriction
of visitors and crowd management.
Standard D4 The standard covers processes to ensure water supply (quantity and quality), power
The facility ensures 24x7 back up and medical gas supply. All departments should be assessed for availability
water and power backup as of water and power back up. Some critical area like OT and LR may require two-
per requirement of service tire power backup in terms of UPS and Invertors. Availability of oxygen and vacuum
delivery, and support
supply should especially be assessed in critical area like OT and LR.
services norms
Standard D5 The standard is concerned with processes ensuring availability of nutritious food, as
The facility ensures per requirement of different category of patients. The food is served in an appealing
availability of Diet as per and hygienic manner. This includes nutritional assessment of patients, availability of
nutritional requirement of different types of diets and standard procedures for preparation and distribution of
the patients and clean Linen food, including hygiene and sanitation in the kitchen. Patients/staff may be interacted
to all admitted patients for knowing their perception about quality and quantity of the food.
This standard also covers laundry processes. It includes availability of adequate
quantity of clean and usable linen, process of providing and changing bed sheets
in-patient care area and process of collection, washing and distributing the linen.
Besides direct observation, staff interaction may help in knowing availability
of adequate sets of linen and work practices. An assessment of segregation and
disinfection of soiled laundry should be undertaken. Observation should be recorded
if laundry is being washed at some public water body like pond or river.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 59
 Standard D6 The standards measures processes related to functioning of Rogi Kalyan Samiti
The facility has defined and (RKS), equivalent to Hospital Development Society (HDS) and community
established procedures participation in facility management. RKS records should be reviewed to assess
for promoting public frequency of the meetings, and issues discussed there. Participation of non-
participation in management official members like community/NGO representatives in such meetings should
of hospital transparency be checked.
and accountability
Standard D7 The standard is concerned with the financial management of the funds/grants,
Hospital has defined and received from different sources including NHM. Assessment of financial management
established procedures for processes by no means should be equated with financial or accounts audit. Hospital
Financial Management administration and accounts department can be interacted to know process of
utilization of funds, timely payment of salaries, entitlements and incentives to
different stakeholders and process of receiving funds and submitting utilization
certificates. An assessment of resource utilisation and prioritisation should be
undertaken.
Standard D8 This standard is concerned with compliances to statuary and regulatory
The facility is compliant requirements. It includes availability of requisite licenses, updated copies of acts
with all statutory and and rules, and adherence to the legal requirements as applicable to Public Health
regulatory requirement Facilities.
imposed by local, state or
central government
Standard D9 This standard is concerned with processes regarding staff management and
Roles and Responsibilities of their deployment in the departments of a facility. This includes availability of
administrative and clinical Job descriptions for different cadre, processes regarding preparation of duty
staffs are determined rosters and staff discipline. The facility staff can be interviewed to assess about
as per govt. regulations their awareness of job description. It should be assessed by observation and
and standards operating review of the records. Adherence to dress code should be observed during the
procedures assessment.
Standard D10 This standard measures the processes related to outsourcing and contract
The facility has established management. This includes monitoring of outsourced services, adequacy of contact
procedure for monitoring documents and tendering system, timely payment for the availed services and
the quality of outsourced provision for action in case for inadequate/poor quality of services. Assessor should
services and adheres to review the contract records related to outsourced services, and interview hospital
contractual obligations administration about the management of outsources services.

60 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - D: Support Services
Standard D1 The facility has established Programme for inspection, testing and maintenance and calibration
of Equipment
ME D1.1 The facility has established system for maintenance of critical Equipment
ME D1.2 The facility has established procedure for internal and external calibration of measuring Equipment
ME D1.3 Operating and maintenance instructions are available with the users of equipment
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs
in pharmacy and patient care areas
ME D2.1 There is established procedure for forecasting and indenting drugs and consumables
ME D2.2 The facility has establish procedure for procurement of drugs
ME D2.3 The facility ensures proper storage of drugs and consumables
ME D2.4 The facility ensures management of expiry and near expiry drugs
ME D2.5 The facility has established procedure for inventory management techniques
ME D2.6 There is a procedure for periodically replenishing the drugs in patient care areas
ME D2.7 There is process for storage of vaccines and other drugs, requiring controlled temperature
ME D2.8 There is a procedure for secure storage of narcotic and psychotropic drugs
Standard D3 The facility has established Program for maintenance and upkeep to of the facility to provide
safe, secure and comfortable environment to staff, patients and visitors
ME D3.1 Exterior of the facility building is maintained with landscaping in open area.
ME D3.2 Hospital infrastructure is adequately maintained.
ME D3.3 Patient care areas are clean and hygienic.
ME D3.4 The facility has policy of removal of condemned junk material
ME D3.5 The facility has established procedures for pest, rodent and animal control
ME D3.6 The facility provides adequate illumination level at patient care areas
ME D3.7 The facility has provision of restriction of visitors in patient areas
ME D3.8 The facility ensures safe and comfortable environment for patients and service providers
ME D3.9 The facility has security system in place at patient care areas
ME D3.10 The facility has established measure for safety and security of female staff
Standard D4 The facility ensures 24x7 water and power backup as per requirement of service delivery, and
support services norms
ME D4.1 The facility has adequate arrangement storage and supply for portable water in all functional areas
ME D4.2 The facility ensures adequate power backup in all patient care areas as per load
ME D4.3 Critical areas of the facility ensures availability of oxygen, medical gases and vacuum supply
Standard D5 The facility ensures availability of Diet as per nutritional requirement of the patients and clean
Linen to all admitted patients
ME D5.1 The facility has provision of nutritional assessment of the patients
ME D5.2 The facility provides diets according to nutritional requirements of the patients
ME D5.3 Hospital has standard procedures for preparation, handling, storage and distribution of diets, as per
requirement of patients
ME D5.4 The facility has adequate sets of linen
ME D5.5 The facility has established procedures for changing of linen in patient care areas

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 61
 ME D5.6 The facility has standard procedures for handling, collection, transportation and washing of linen
Standard D6 The facility has defined and established procedures for promoting public participation in
management of hospital transparency and accountability
ME D6.1 The facility has established process for management of activities of Rogi Kalyan Samitis
ME D6.2 The facility has established procedures for community based monitoring of its services
Standard D7 Hospital has defined and established procedures for Financial Management
ME D7.1 The facility ensures the proper utilization of fund provided to it
ME D7.2 The facility ensures proper planning and requisition of resources based on its need
Standard D8 The facility is compliant with all statutory and regulatory requirement imposed by local, state
or central government
ME D8.1 The facility has requisite licences and certificates for operation of hospital and different activities
ME D8.2 Updated copies of relevant laws, regulations and government orders are available at the facility
ME D8.3 The facility ensure relevant processes are in compliance with statutory requirement
Standard D9 Roles & Responsibilities of administrative and clinical staff are determined as per government
regulations and standards operating procedures
ME D9.1 The facility has established job description as per govt guidelines
ME D9.2 The facility has a established procedure for duty roster and deputation to different departments
ME D9.3 The facility ensures the adherence to dress code as mandated by its administration/the health
department
Standard D10 The facility has established procedure for monitoring the quality of outsourced services and
adheres to contractual obligations
ME D10.1 There is established system for contract management for out sourced services
ME D10.2 There is a system of periodic review of quality of out sourced services

62 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - E: Clinical Care

Overview
The ultimate purpose of existence of a hospital is to provide clinical care. Therefore, clinical processes are the
most critical and important in the hospitals. These are the processes that define directly the outcome of services
and quality of care. The Standards under this area of concern could be grouped into three categories. First,
nine standards are concerned with those clinical processes that ensure adequate care to the patients. It includes
processes such as registration, admission, consultation, clinical assessment, continuity of care, nursing care,
identification of high risk and vulnerable patients, prescription practices, safe drug administration, maintenance
of clinical records and discharge from the hospital.
Second set of next six standards are concerned with specific clinical and therapeutic processes including emergency
care, diagnostic services, Blood storage and transfusion services, anaesthesia, surgical services and end of life care.
Last set of seven standards under this area of concern is concerned with specific clinical processes for Maternal,
Newborn, Child, Adolescent and Family Planning services and National Health Programmes. These standards are
based on the technical guidelines published by the Government of India.
It may be difficult to assess clinical processes, as direct observation of clinical procedure may not always be
possible at time of assessment. Therefore, assessment of these standards would largely depend upon review of
the clinical records as well.
Interaction with the staff to know their skill level and how they practice clinical care (Competence testing) would
also be helpful. Assessment of theses standard would require thorough domain knowledge.
Following is the brief description of standards under this area of concern:

Standard E1 This standard is concerned with the registration and admission processes in
The facility has defined hospitals. It also covers OPD consultation processes. The Assessor should review
procedures for registration, the records to verify that details of patients have been recorded, and patients
consultation and admission have been given unique identification number. OPD consultation may be directly
of patients observed, followed by review of OPD tickets to ensure that patient history,
examination details, etc. have been recorded on the OPD ticket. The facility staff
should be interviewed to know, whether there is any fixed admission criteria
especially in critical care department.
Standard E2 This standard pertains to clinical assessment of the patients. It includes initial
The facility has defined and assessment as well as reassessment of admitted patients.
established procedures for
clinical assessment and
reassessment of the patients.
Standard E3 The standard is concerned with continuity of care for the patient’s ailment. It includes
The facility has defined and process of inter-departmental transfer, referral to another facility, deputation of staff
established procedures for for the care, and linkages with higher institutions. The staff should be interviewed to
continuity of care of patient know the referral linkages, how they inform the referral hospital about the referred
and referral patients and arrangement for the vehicles and follow-up care. Records should be
reviewed for confirming that referral slips have been provided to the patients.
Standard E4 This standard measures adequacy and quality of nursing care for the patients. It
The facility has defined and includes processes for identification of patients, timely and accurate implementation
established procedures for of treatment plan, nurses’ handover processes, maintenance of nursing records
nursing care and monitoring of the patients. The staff should be interviewed and patients’
records should be reviewed for assessing how drugs distribution/administration
endorsement and other procedures like sample collection and dressing have
been done on time as per treatment plan. Handing-over of patients is a critical
process and should be assessed adequately. Review BHT for patient monitoring
and nursing notes should be done.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 63
 Standard E5 This standard is concerned with identification of vulnerable and High-risk patients.
The facility has a procedure Review of records and staff interaction would be helpful in assessing how High-risk
to identify high risk and patients are given due attention and treatment.
vulnerable patients
Standard E6 The standard is concerned with assessing that patients are prescribed drugs
The facility follows standard according standard treatment guidelines and protocols. Patient records are
treatment guidelines defined assessed to ascertain that prescriptions are written in generic name only.
by state/Central government
for prescribing the generic
drugs and their rational use
Standard E7 The standard is concerned with the safety of drug administration. It includes
The facility has defined administration of high alert drugs, legibility of medical orders, process for checking
procedures for safe drug drugs before administration and processes related to self-drug administration.
administration Patient’s records should be reviewed for legibility of the writing and recording
of date and time of orders. Safe injection practices like use of separate needle for
multi-dose vial should be observed.
Standard E8 This standard is concerned with the processes of maintaining clinical records
The facility has defined and systematically and adequately. Compliance to this standard can be assessed
established procedures for by comprehensive review of the patients’ record. standard can be assessed by
maintaining, updating of comprehensive review of the patients’ record.
patients’ clinical records and
their storage
Standard E9 This standard measures adequacy of the discharge process. It includes pre-
the facility has defined and discharge assessment, adequacy of discharge summary, pre-discharge counselling
stablished procedures for and adherence to standard procedures, if a patient is leaving against medical
discharge of patient advice (LAMA) or is found absconding. Patients’ records should also be reviewed
for adequacy of the discharge summary.
Standard E10 This standard is concerned with emergency clinical processes and procedures. It
The facility has defined and includes triage, adherence to emergency clinical protocols, disaster management,
established procedures for processes related to ambulance services, handling of medico-legal cases, etc.
Emergency Services and Availability of the buffer stock for medicines and other supplies for disaster and
Disaster Management mass casualty needs to be found out. Interaction with the staff and hospital
administration should be done to asses overall disaster preparedness of the
health facility.
Standard E11 This standard deals with the procedures related to diagnostic services. The
The facility has defined and standard is majorly applicable for laboratory and radiology services. It includes
established procedures of pre-testing, testing and post-testing procedures. It needs to be observed that
diagnostic services samples in the laboratory are properly labelled, and instructions for handling
samples are available. The process for storage and transportation of samples
needs to be ensured. Availability of critical values and biological references should
also be checked.
Standard E12 This standard is concerned with functioning of blood storage and transfusion
The facility has defined and services. The measurable elements under this standard are processes for transport
established procedures for of blood from parent blood bank, storage procedures, cross matching, issuing,
Blood Storage Management transfusion and monitoring of transfusion reaction. The assessor should observe the
and Transfusion functioning, and interact with the staff to know adherence to standard procedures
for blood transport storage and issue of blood as per standard protocols. Records
of temperature maintained in different storage units should be checked. Records
should be reviewed for assessing processes of monitoring transfusion reactions.
Standard E13 This standard is concerned with the processes related to safe anaesthesia practices.
The facility has established It includes pre-anaesthesia, monitoring and post-anaesthesia processes. Records
procedures for Anaesthetic should be reviewed to assess, how Pre-anaesthetic check-up is done and records
Services are maintained. Interact with Anaesthetist and OT technician/Nurse for adherence
to protocols in respect of anaesthesia safety, monitoring, recording and reporting
of adverse events, maintenance of anaesthesia notes, etc.

64 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E14 This standard is concerned with processes related with Operation Theatre. It
The facility has defined and includes processes for OT scheduling, pre-operative, Post-operative practices
established procedures of surgical safety. Interaction with the surgeon(s) and OT staff should be done
of Operation theatre and to assess processes - preoperative medication, part preparation and evaluation
surgical services of patient before surgery, identification of surgical site, etc. Review of records
for usage of surgical safety checklist and protocol for instrument count, suture
material, etc. may be undertaken.
Standard E 15 This is concerned with end of life care and management of death. Records should
The facility has defined and be reviewed for knowing adequacy of the notes. Interact with the facility staff
established procedures for to know how news of death is communicated to relatives, and kind of support
end of life care and death available to family members.
Standard E16 The standard includes processes that ensure adequacy and quality of antenatal care
The facility has established provided at the facility. It includes measurable elements for ANC registration, processes
procedures for Antenatal during check-up, identification of High Risk pregnancy, management of serve anaemia
care as per guidelines and counselling services. Staff at ANC clinic should be interviewed and records should
be reviewed for maintenance of MCP cards and registration of pregnant women. For
assessing quality and adequacy of ANC check-up, direct observation may be undertaken
after obtaining requisite permission. ANC records can be reviewed to see findings of
examination and diagnostic tests are recorded. Review the line listing of anaemia cases
and how they are followed. Client and staff can be interacted for counselling on the
nutrition, birth preparedness, family planning, etc.
Standard E17 This standard measures the quality of intra-natal care. It includes clinical process
The facility has established for normal delivery as well management of complications and C-Section surgeries.
procedures for intranatal The concerned staff can be interviewed to know their skill and practices regarding
care as per guidelines management of different stages of labour, especially Active Management of Third
stage of labour. Demonstration of resuscitation and essential newborn care may be
asked. Competency of the staff for managing obstetric emergencies, interpretation
of partograph, APGAR score should also be assessed.
Standard E18 The standard is concerned with adherence to post-natal care of mother and
The facility has established newborn within the hospital. Observe if postnatal protocols for prevention of
procedures for postnatal Hypothermia and breast feeding are adhered to. Mother may be interviewed to
care as per guidelines know that proper counselling has been provided.
Standards E19 This standard is concerned with adherence to clinical protocols for newborn and child
The facility has established health. It covers immunization, management of new-born and childhood illnesses like
procedures for care of new neonatal asphyxia, low birth weight, neo-natal jaundice, malnutrition and diarrhoea.
born, infant and child as per Immunization services are majorly assessed at immunization clinic. Staff interview and
guidelines observation should be done to assess availability of diluents, adherence to protocols of
reconstitution of vaccine, storage of VVM labels and shake test. Adherence to clinical
protocols for management of different illnesses in newborn and child should be done
through interaction with the doctors and nursing staff.
Standard E 20 The standard is concerned with providing safe and quality family planning and
The facility has established abortion services. This includes standard practices and procedures for Family
procedures for abortion planning, counselling, spacing methods, family planning surgeries and counselling
and family planning as per and procedures for abortion. Quality and adequacy of counselling services can be
government guidelines and assessed by exit interview with the clients. Staff at family planning clinic may be
law interacted to assess adherence to the protocols for IUD insertion, precaution and
contra-indication for oral pills, family planning surgery, etc.
Standard E21 This standard is concerned with services related to Adolescent, Reproductive and
The facility provides Adolescent Sexual Health (ARSH) guidelines. It includes promotive, preventive, curative and
Reproductive and Sexual Health referral services under the ARSH. Staff should be interviewed, and records should
services as per guidelines. be reviewed.
Standard E22 The standard is concerned with adherence to clinical guidelines under the National
The facility provides services Health Programmes. For each national health programme, availability of clinical
as per National Health services as per respective guidelines should be assessed.
Programmes’ Operational/
Clinical Guidelines

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 65
 Area of Concern - E: Clinical Services
Standard E1 The facility has defined procedures for registration, consultation and admission of patients
ME E1.1 The facility has established procedure for registration of patients
ME E1.2 The facility has a established procedure for OPD consultation
ME E1.3 There is established procedure for admission of patients
ME E1.4 There is established procedure for managing patients, in case beds are not available at the facility
Standard E2 The facility has defined and established procedures for clinical assessment and reassessment
of the patients
ME E2.1 There is established procedure for initial assessment of patients
ME E2.2 There is established procedure for follow up/reassessment of Patients
Standard E3 The facility has defined and established procedures for continuity of care of patient and
referral
ME E3.1 The facility has established procedure for continuity of care during interdepartmental transfer
ME E3.2 The facility provides appropriate referral linkages to the patients/Services for transfer to other/
higher facilities to assure the continuity of care.
ME E3.3 A person is identified for care during all steps of care
Standard E4 The facility has defined and established procedures for nursing care
ME E4.1 Procedure for identification of patients is established at the facility
ME E4.2 Procedure for ensuring timely and accurate nursing care as per treatment plan is established at the
facility
ME E4.3 There is established procedure of patient hand over, whenever staff duty change happens
ME E4.4 Nursing records are maintained
ME E4.5 There is procedure for periodic monitoring of patients
Standard E5 The facility has a procedure to identify high risk and vulnerable patients
ME E5.1 The facility identifies vulnerable patients and ensure their safe care
ME E5.2 The facility identifies high risk patients and ensure their care, as per their need
Standard E6 The facility follows standard treatment guidelines defined by state/Central government for
prescribing the generic drugs & their rational use
ME E6.1 The facility ensured that drugs are prescribed in generic name only
ME E6.2 There is procedure of rational use of drugs
Standard E7 The facility has defined procedures for safe drug administration
ME E7.1 There is process for identifying and cautious administration of high alert drugs
ME E7.2 Medication orders are written legibly and adequately
ME E7.3 There is a procedure to check drug before administration/dispensing
ME E7.4 There is a system to ensure right medicine is given to right patient
ME E7.5 Patient is counselled for self drug administration
Standard E8 The facility has defined and established procedures for maintaining, updating of patients’
clinical records and their storage
ME E8.1 All the assessments, re-assessment and investigations are recorded and updated
ME E8.2 All treatment plan prescription/orders are recorded in the patient records.
ME E8.3 Care provided to each patient is recorded in the patient records

66 National Quality Assurance Standards for Public Health Facilities | 2020

ME E8.4 Procedures performed are written on patients records
ME E8.5 Adequate form and formats are available at point of use
ME E8.6 Register/records are maintained as per guidelines
ME E8.7 The facility ensures safe and adequate storage and retrieval of medical records
Standard E9 The facility has defined and established procedures for discharge of patient
ME E9.1 Discharge is done after assessing patient readiness
ME E9.2 Case summary and follow-up instructions are provided at the discharge
ME E9.3 Counselling services are provided as during discharges wherever required
ME E9.4 The facility has established procedure for patients leaving the facility against medical advice,
absconding, etc
Standard E10 The facility has defined and established procedures for Emergency Services and Disaster
Management
ME E10.1 There is procedure for Receiving and triage of patients
ME E10.2 Emergency protocols are defined and implemented
ME E10.3 The facility has disaster management plan in place
ME E10.4 The facility ensures adequate and timely availability of ambulances services and mobilisation of
resources, as per requirement
ME E10.5 There is procedure for handling medico legal cases
Standard E11 The facility has defined and established procedures of diagnostic services
ME E11.1 There are established procedures for Pre-testing Activities
ME E11.2 There are established procedures for testing Activities
ME E11.3 There are established procedures for Post-testing Activities
Standard E12 The facility has defined and established procedures for Blood Storage Management and
Transfusion
ME E12.1 There is established procedure for Transport of blood from parent blood bank.
ME E12.2 There is established procedure for storage of blood
ME E12.3 There is established procedure for Cross matching of blood
ME E12.4 There is established procedure for issuing blood
ME E12.5 There is established procedure for transfusion of blood
ME E12.6 There is a established procedure for monitoring and reporting Transfusion complication
Standard E13 The facility has established procedures for Anaesthetic Services
ME E13.1 The facility has established procedures for Pre-anaesthetic Check up and maintenance of records
ME E13.2 The facility has established procedures for monitoring during Anaesthesia and maintenance of
records
ME E13.3 The facility has established procedures for Post-anaesthesia care
Standard E14 The facility has defined and established procedures of Operation theatre and surgical
services
ME E14.1 The facility has established procedures for OT Scheduling
ME E14.2 The facility has established procedures for Pre-operative care
ME E14.3 The facility has established procedures for Surgical Safety
ME E14.4 The facility has established procedures for Post operative care

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 67
 Standard E15 The facility has defined and established procedures for end of life care and death
ME E15.1 Death of admitted patient is adequately recorded and communicated
ME E15.2 The facility has standard procedures for handling the death in the hospital
ME E15.3 The facility has standard operating procedure for end of life support
ME E15.4 The facility has standard procedures for conducting/referring for post-mortem, its recording and
meeting its obligation under the law
Maternal & Child Health Services
Standard E16 The facility has established procedures for Antenatal care as per guidelines
ME E16.1 There is an established procedure for Registration and follow up of pregnant women.
ME E16.2 There is an established procedure for History taking, Physical examination, and counselling of each
antenatal woman, visiting the facility.
ME E16.3 The facility ensures availability of diagnostic and drugs during antenatal care of pregnant women
ME E16.4 There is an established procedure for identification of High risk pregnancy and appropriate treatment/
referral as per scope of services.
ME E16.5 There is an established procedure for identification and management of moderate and severe
anaemia
ME E16.6 Counselling of pregnant women is done as per standard protocol and gestational age
Standard E17 The facility has established procedures for Intranatal care as per guidelines
ME E17.1 Established procedures and standard protocols for management of different stages of labour
including AMTSL (Active Management of Third Stage of Labour) are followed at the facility
ME E17.2 There is an established procedure for assisted and C-section deliveries per scope of services.
ME E17.3 There is established procedure for management/Referral of Obstetrics Emergencies as per scope of
services.
ME E17.4 There is an established procedure for new born resuscitation and newborn care.
Standard E18 The facility has established procedures for postnatal care as per guidelines
ME E18.1 Post Partum Care is provided to the mothers
ME E18.2 The facility ensures adequate stay of mother and newborn in a safe environment as per standard
Protocols.
ME E18.3 There is an established procedure for Post Partum counselling of mother
ME E18.4 The facility has established procedures for stabilization/treatment/referral of post natal
complications
ME E18.5 There is established procedure for discharge and follow up of mother and newborn.
Standard E19 The facility has established procedures for care of new born, infant and child as per
guidelines
ME E19.1 The facility provides immunization services as per guidelines
ME E19.2 Triage, Assessment & Management of newborns having emergency signs are done as per
guidelines
ME E19.3 Management/referral of Low birth weight newborns is done as per guidelines
ME E19.4 Management of neonatal asphyxia, jaundice and sepsis is done as per guidelines
ME E19.5 Management of children presenting with fever, cough/breathlessness is done as per guidelines
ME E19.6 Management/referral of children with severe Acute Malnutrition is done as per guidelines
ME E19.7 Management of children presenting diarrhoea is done per guidelines

68 National Quality Assurance Standards for Public Health Facilities | 2020

Standard E20 The facility has established procedures for abortion and family planning as per government
guidelines and law
ME E20.1 Family planning counselling services provided as per guidelines
ME E20.2 The facility provides spacing method of family planning as per guideline
ME E20.3 The facility provides limiting method of family planning as per guideline
ME E20.4 The facility provide counselling services for abortion as per guideline
ME E20.5 The facility provide abortion services for 1st trimester as per guideline
ME E20.6 The facility provide abortion services for 2nd trimester as per guideline
Standard E21 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines
ME E21.1 The facility provides Promotive ARSH services.
ME E21.2 The facility provides Preventive ARSH services.
Me E21.3 The facility provides curative ARSH services
Me E21.4 The facility provides Referral services for ARSH.
National Health Programmes
Standard E22 The facility provides National health Programme as per operational/Clinical Guidelines
ME E22.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines
ME E22.2 The facility provides services under Revised National TB Control Programme as per guidelines
ME E22.3 The facility provides services under National Leprosy Eradication Programme as per guidelines
ME E22.4 The facility provides services under National AIDS Control Programme as per guidelines
ME E22.5 The facility provides services under National Programme for Control of Blindness as per guidelines
ME E22.6 The facility provides services under Mental Health Programme as per guidelines
ME E22.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines
ME E22.8 The facility provides service under National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular diseases & Stroke (NPCDCS) as per guidelines
ME E22.9 The facility provide service for Integrated disease surveillance Programme
ME E22.10 The facility provide services under National Programme for prevention and control of Deafness

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 69
 Area of concern - F: Infection Control

Overview
The first principle of health care is “to do no harm”. As Public Hospitals usually have high occupancy, the Infection
control practices become more critical to avoid cross-infection and its spread. This area of concern covers Infection
control practices, hand-hygiene, antisepsis, Personal Protection, processing of equipment, environment control,
and Biomedical Waste Management.
Following is the brief description of the Standards within this area of concern:

Standard F1 This standard is concerned with the implementation of Infection control

The facility has Infection programme at the facility. It includes existence of functional infection control
Control Programme, and committee, microbiological surveillance, measurement of hospital acquired
there are procedures in infection rates, periodic medical check-up and immunization of staff and
place for prevention and monitoring of Infection control Practices. Hospital administration should be
measurement of Hospital interacted to assess the functioning of infection control committee. Records
Associated Infections should be reviewed for confirming the culture surveillance practices, monitoring
of Hospital acquired infection, status of staff immunization, etc. Implementation
of antibiotic policy can be assessed though staff interviews, perusal of patient
record and usage pattern of antibiotic.
Standard F2 This standard is concerned with practices of hand washing and antisepsis.
The facility has defined and Availability of Hand washing facilities with soap and running water should
Implemented procedures be observed at the point of use. Technique of hand washing for assessing the
for ensuring hand hygiene practices, and effectiveness of training may be observed.
practices and antisepsis
Standard F3 This standard is concerned with usage of Personal Protection Equipment (PPE)
The facility ensures such as gloves, mask, apron, etc. Interaction with staff may reveal the adequacy
availability of material of supply of PPE.
for personal protection,
and facility staff follows
standard precaution for
personal protection
Standard F4 This standard is concerned with standard procedures, related to processing of
The facility has standard equipment and instruments. It includes adequate decontamination, cleaning,
procedures for processing of disinfection and sterilization of equipment and instruments. These practices should
equipment and instruments be observed and staff should be interviewed for compliance to certain standard
procedures.
Standard F5 The standard pertains to environment cleaning. It assesses whether the layout
Physical layout and and arrangements of processes are conducive for the infection control or not.
environmental control of Environment cleaning processes like mopping, especially in critical areas like OT
the patient care areas ensures and LR should be observed for the adequacy and technique.
infection prevention
Standard F6 This standard is concerned with Management of Biomedical waste management
The facility has defined and including its segregation, transportation, disposal and management of sharps.
established procedures for Availability of equipment and practices of segregation can be directly observed.
segregation, collection, Staff should be interviewed about the procedure for management of the needle
treatment and disposal of stick injuries. Storage and transportation of waste should be observed and records
Bio-medical and hazardous are verified.
Waste
Sharp pits and deep burial pits must be inspected if available.

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 Area of Concern - F: Infection Control
Standard F1 The facility has infection control Programme and procedures in place for prevention and
measurement of hospital associated infection
ME F1.1 The facility has functional infection control committee
ME F1.2 The facility has provision for Passive and active culture surveillance of critical & high risk areas
ME F1.3 The facility measures hospital associated infection rates
ME F1.4 There is Provision of Periodic Medical Check-up and immunization of staff
ME F1.5 The facility has established procedures for regular monitoring of infection control practices
ME F1.6 The facility has defined and established antibiotic policy
Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices
and antisepsis
ME F2.1 Hand washing facilities are provided at point of use
ME F2.2 The facility staff is trained in hand washing practices and they adhere to standard hand washing
practices
ME F2.3 The facility ensures standard practices and materials for antisepsis
Standard F3 The facility ensures standard practices and materials for Personal protection
ME F3.1 The facility ensures adequate personal protection Equipment as per requirements
ME F3.2 The facility staff adheres to standard personal protection practices
Standard F4 The facility has standard procedures for processing of equipment and instruments
ME F4.1 The facility ensures standard practices and materials for decontamination and cleaning of
instruments and procedures areas
ME F4.2 The facility ensures standard practices and materials for disinfection and sterilization of
instruments and equipment
Standard F5 Physical layout and environmental control of the patient care areas ensures infection
prevention
ME F5.1 Layout of the department is conducive for the infection control practices
ME F5.2 The facility ensures availability of standard materials for cleaning and disinfection of patient care
areas
ME F5.3 The facility ensures standard practices are followed for the cleaning and disinfection of patient
care areas
ME F5.4 The facility ensures segregation infectious patients
ME F5.5 The facility ensures air quality of high risk area
Standard F6 The facility has defined and established procedures for segregation, collection, treatment
and disposal of Bio Medical and hazardous Waste
ME F6.1 The facility Ensures segregation of Bio Medical Waste as per guidelines and ‘on-site’ management
of waste is carried out as per guidelines
ME F6.2 The facility ensures management of sharps as per guidelines
ME F6.3 The facility ensures transportation and disposal of waste as per guidelines

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 71
 Area of concern - G: Quality Management

Overview
Quality management requires a set of interrelated activities that assure quality of services according to set
standards and strive to improve upon it through a systematic planning, implementation, checking and acting
upon the compliances. The standards in this area concern are the opportunities for improvement to enhance
quality of services and patient satisfaction. These standards are in synchronization with facility based quality
assurance programme given in ‘Operational Guidelines’.
Following are the Standards under this area of Concern:

Standard G1 This standard is concerned with creating a Quality Team at the facility and making
The facility has established it functional. Assessor may review the document and interact with Quality Team
organizational framework members to know how frequently they meet and responsibilities have been
for quality improvement delegated to them. Quality team meeting records may be reviewed.
Standard G2 The standard is concerned with having a system of measurement of patient and
The facility has established employees’ satisfaction. This includes periodic patients’ satisfaction survey, analysis
system for patient and of the feedback and preparing action plan. Assessors should review the records
employee satisfaction pertaining to patient satisfaction and employee satisfaction survey to ascertain that
feedback of the patients, from a scientifically drawn sample, is taken at prescribed
intervals.
Standard G3 The standard is concerned with implementation of internal quality assurance
The facility have established programmes within departments such as EQAS of diagnostic services, daily round
internal and external quality and use of departmental checklists, External Quality Assurance Service (EQAS)
assurance Programmes records at laboratory, etc. Interview with Matron, Hospital Mangers, Nurse in-
wherever it is critical to charges, OT technician, etc. may give information about how they conduct daily
quality round of departments and usage of checklists.
Standard G4 This standard is concerned with availability and adequacy of Standard operating
The facility has established procedures and work instructions with the respective process owners. Display
documented implemented of work instructions and clinical protocols should be observed during the
and maintained Standard assessment.
Operating Procedures for all
key processes
Standard G5 This standard pertains to the processes of internal assessment, medical and death
The facility has established audit at a defined periodicity. Review of Internal assessment and clinical audit
system of periodic review records may reveal their adequacy and periodicity.
as internal assessment,
medical and death audit and
prescription audit
Standard G6 This standard is concerned with establishment and dissemination of quality policy
The facility has defined and and objectives in the hospital. The staff may be interviewed regarding their
established Quality Policy and awareness of Quality policy and Objectives. Review of records should be done for
Quality Objectives assessing that Quality objectives meet SMART criteria, and have been reviewed
periodically.
Standard G7 This standard is regarding using Quality tools and methods like Process mapping,
The facility seeks continual control charts, 5-‘S’, etc. The Assessor should look for any specific methods and
improvement by practicing tools practiced for quality improvement.
Quality tool and method

72 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - G: Quality Management
Standard G1 The facility has established organizational framework for quality improvement
ME G1.1 The facility has a quality team in place
ME G1.2 The facility reviews quality of its services at periodic intervals
Standard G2 The facility has established system for patient and employee satisfaction
ME G2.1 Patient satisfaction surveys are conducted at periodic intervals
ME G2.2 The facility analyses the patient feed back, and root-cause analysis
ME G2.3 The facility prepares the action plans for the areas, contributing to low satisfaction of patients
Standard G3 The facility have established internal and external quality assurance Programmes wherever
it is critical to quality
ME G3.1 The facility has established internal quality assurance programme in key departments
ME G3.2 The facility has established external assurance programmes at relevant departments
ME G3.3 The facility has established system for use of check lists in different departments and services
Standard G4 The facility has established, documented implemented and maintained Standard Operating
Procedures for all key processes
ME G4.1 Departmental Standard Operating Procedures are available
ME G4.2 Standard Operating Procedures adequately describes process and procedures
ME G4.3 Staff is trained and aware of the procedures written in SOPs
ME G4.4 Work instructions are displayed at Point of use
Standard G5 The facility has established system of periodic review as internal assessment, medical &
death audit and prescription audit
ME G5.1 The facility conducts periodic internal assessment
ME G5.2 The facility conducts the periodic prescription/medical/death audits
ME G5.3 The facility ensures non compliances are enumerated and recorded adequately
ME G5.4 Action plan is made on the gaps found in the assessment/audit process
ME G5.5 Corrective and preventive actions are taken to address issues, observed in the assessment & audit
Standard G6 The facility has defined and established Quality Policy & Quality Objectives
ME G6.1 The facility defines its quality policy
ME G6.2 The facility periodically defines its quality objectives and key departments have their own
objectives
ME G6.3 Quality policy and objectives are disseminated and staff is aware of that
ME G6.4 Progress towards quality objectives is monitored periodically
Standard G7 The facility seeks continual improvement by practicing Quality tool and method
ME G7.1 The facility uses methods for quality improvement in services
ME G7.2 The facility uses tool for quality improvement.

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 73
 Area of Concern - H: Outcome

Overview
Measurement of the quality is critical to improvement of processes and outcomes. This area of concern has
four standard measures for quality - Productivity, Efficiency, and Clinical Care and Service quality in terms of
measurable indicators. Every standard under this area has two aspects – Firstly, there is a system of measurement
of indicators at the health facility; and secondly, how the hospital meets the benchmark. It is realised that at the
beginning many indictors given in these standards may not be getting measured across all facilities, and therefore
it would be difficult to set benchmark beforehand. However, with the passage of time, the state can set their
benchmarks, and evaluate performance of health facilities against the set benchmarks.
Following is the brief description of the Standards in this area of concern:

Standard H1 This standard is concerned with the measurement of Productivity indicators and
The facility measures meeting the benchmarks. This includes utilization indicators like bed occupancy
Productivity Indicators and rate and C-Section rate. Assessor should review these records to ensure that theses
ensures compliance with indictors are getting measured at the health facility.
State/National benchmarks
Standard H2 This standard pertains to measurement of efficiency indicators and meeting
The facility measures benchmark. This standard contains indicators that measure efficiency of processes,
Efficiency Indicators and such as turnaround time, and efficiency of human resource like surgery per
ensures compliance with surgeon. Review of records should be done to assess that these indicators have
State/National benchmarks been measured correctly.
Standard H3 This standard is concerned with the indicators of clinical quality, such as average
The facility measures Clinical length of stay and death rates. Record review should be done to see the
Care and Safety Indicators measurement of these indicators.
and tries to reach State/
National benchmarks
Standard H4 This standard is concerned with indicators measuring service quality and patient
The facility measures Service satisfaction like Patient satisfaction score and waiting time and LAMA rate.
Quality Indicators and
endeavours to reach State/
National benchmarks

74 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - H: Outcomes
Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National
benchmarks
ME H1.1 The facility measures productivity Indicators on monthly basis
ME H1.2 The facility measures equity indicators periodically
ME H1.3 The facility ensures compliance of key productivity indicators with National/State benchmarks
Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark
ME H2.1 The facility measures efficiency Indicators on monthly basis
ME H2.2 The facility ensures compliance of key efficiency indicators with National/State benchmarks
Standard H3 The facility measures Clinical Care & Safety Indicators and tries to reach State/National
benchmark
ME H3.1 The facility measures Clinical Care & Safety Indicators on monthly basis
ME H3.2 The facility ensures compliance of key Clinical Care & Safety with National/State benchmarks
Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National
benchmark
ME H4.1 The facility measures Service Quality Indicators on monthly basis
ME H4.2 The facility ensures compliance of key Service Quality with National/State benchmarks

National Quality Assurance Standards for Community Health Centre (First Referral Unit) 75
National Quality Assurance
Standards for Primary Health
Centre (24x7)
 national QUALITY ASSURANCE STANDARDS
FOR pRIMARY hEALTH CENTRe (24x7)

Area of Concern - A: Service Provision

Standard A1 The facility provides primary level curative services

Standard A2 The facility provides RMNCHA Services

Standard A3 The facility provides Diagnostic Services, Para-clinical and support services

Standard A4 The facility provides services as mandated in the National Health Programmes/State scheme(s)

Area of Concern - B: Patients’ Rights

Standard B1 The facility provides information to care-seekers, attendants and community about the available services
and their modalities

Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs,
and there are no barrier on account of physical, economic, cultural or social status

Standard B3 The facility maintains privacy, confidentiality and dignity of patient, and has a system for guarding
patient related information

Standard B4 The facility ensures that there are no financial barriers to access, and that there is financial protection
given from the cost of hospital services

Area of Concern - C: Inputs

Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the
prevalent norms

Standard C2 The facility ensures the physical safety including fire safety of the infrastructure

Standard C3 The facility has adequate qualified and trained staff, required for providing the assured services to the
current case load

Standard C4 The facility provides drugs and consumables required for assured services

Standard C5 The facility has equipment and instruments required for assured list of services

Area of Concern - D: Support Services

Standard D1 The facility has a established Facility Management Programme for Maintenance and Upkeep of
Equipment and Infrastructure to provide safe and Secure environment to staff and Users

Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs in
pharmacy and patient care areas

Standard D3 The facility ensures availability of diet, linen, water and power backup as per requirement of service
delivery and support services norms

Standard D4 The facility has defined and established procedures for promoting public participation in management
of hospital with transparency and accountability

National Quality Assurance Standards for Primary Health Centre (24x7) 79

 Standard D5 Hospital has defined and established procedures for Financial Management and monitoring of quality
of outsourced services

Standard D6 The facility is compliant with all statutory and regulatory requirement imposed by local, state or central
government

Standard D7 Roles and Responsibilities of administrative and clinical staff are determined as per govt. regulations and
standards operating procedures

Standard D8 Hospital has defined and established procedure for monitoring and reporting of National Health Program
as per state specifications

Area of Concern - E: Clinical Services

Standard E1 The facility has defined procedures for registration, consultation and admission of patients

Standard E2 The facility has procedures for continuity of care of patient

Standard E3 The facility has defined and established procedures for nursing care

Standard E4 The facility has defined and follow correct procedure for drug administration and follows standard
treatment guidelines defined by state/Central government

Standard E5 The facility has defined and established procedures for maintaining, updating of patients’ clinical records
and their storage

Standard E6 The facility has defined and established procedures for discharge of patient

Standard E7 The facility has defined and established procedures for Emergency Services and Disaster Management

Standard E8 The facility has defined and established procedures for diagnostic services

Maternal and Child Health Services

Standard E9 The facility has established procedures for Antenatal care as per guidelines

Standard E10 The facility has established procedures for Intranatal care as per guidelines

Standard E11 The facility has established procedures for postnatal care as per guidelines

Standard E12 The facility has established procedures for care of new born, infant and child as per guidelines

Standard E13 The facility has established procedures for abortion and family planning as per government guidelines
and low

Standard E14 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines

National Health Programmes

Standard E15 The facility provides National health Programme as per operational/Clinical Guidelines of the
Government

Area of Concern - F: Infection Control

Standard F1 The facility has infection control Programme and procedures in place for prevention, control, and
measurement of hospital associated infection

Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and
antisepsis

Standard F3 The facility ensures availability of material for personal protection, and facility staff follow standard
precaution for personal protection

Standard F4 The facility has standard procedures for processing for Disinfection and sterilization of equipment and
instruments

80 National Quality Assurance Standards for Public Health Facilities | 2020

Standard F5 Physical layout and environmental control of the patient care areas ensures infection prevention

Standard F6 The facility has defined and established procedures for segregation, collection, treatment and disposal
of Bio Medical and hazardous Waste

Area of Concern - G: Quality Management

Standard G1 The facility has defined and established organizational framework and Quality policy for Quality
Assurance

Standard G2 The facility has established system for patient and employee satisfaction

Standard G3 The facility have established system for assuring and improving quality of Clinical and support services
by internal and external program

Standard G4 The facility has established, documented implemented and maintained Standard G4 Standard Operating
Procedures for all key processes and support services

Area of Concern - H: Outcomes

Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National benchmarks

Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark

Standard H3 The facility measures Clinical Care and Safety Indicators and tries to reach State/National benchmark

Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National benchmark

National Quality Assurance Standards for Primary Health Centre (24x7) 81

 Intent of standards AND Measurable elements
FOR pRIMARY hEALTH CENTre (24x7)

Area of Concern - A: Services Provision

Overview
Primary health centres have pivotal role in providing Preventive & Promotive health care to community apart from
limited level of primary curative care. Indian Public Health Standards guidelines (IPHS) have defined minimum
assured service to be provided at Primary Health Centres, which are also hub of the services provided under the
National Health Programmes.
This area of concern measures availability of services, which implies that the services are available to end-users
because mere availability of infrastructure or human resources does not always ensure into availability of the
services. For example, an ANC clinic may be available at the PHC but all the services like mandatory diagnostic
test & service provider may not have provided including nutritional counselling. In this case it is assumed that
ANC services are not completely available at the facility. Compliance to these standards and measurable elements
should be checked, preferably by observing delivery of the services, review of records for utilization of services
and interviewing whether services were given or not to them.
There are following four standards in this area of concern:

Standard A1 Though PHCs are primarily meant for preventive & promotive health care services,
The Facility provides Treatment of common ailments & initial management of the emergencies before
Primary Level Curative referral shall be available at the facility. The standard would include availability of OPD
Services consultation services as well as indoor treatment services for common illness like fever,
cough, diarrhoea etc. as well as minor procedures like dressing, sutures, Incision &
Drainage etc. This standard also measures availability of AYUSH services as well services
required as per local needs. This standard also defines time period for which services
should be available. E.g. At least 6 hours of OPD and 24X7 labour room services.
Standard A2 Delivery of quality RMNCH+A services is major focus area for public health facilities.
The Facility provides RMNCH+A approach covers continuum of care across the life-cycle. There are five
RMNCH+A Services measurable elements in this standard & each represents services pertaining one stage of
life cycle i.e. Reproductive, Maternal, Newborn, Childhood & Adolescent. This standard
measures availability services like ANC check-up, family planning services, intra &
postnatal care, treatment of childhood illnesses & adolescent friendly clinic.
Standard A3 This standard measures availability of diagnostics, pharmacy, Mobile medical unit &
The Facility provides support services like dietary & laundry. There is also a dedicated measurable element for
Diagnostic Services, administrative services like monitoring and supervision of sub centres and community
Para-clinical & support health worker.
Services
Standard A4 This standard measures the availability of the curative as well as preventive & promotive
The facility provides services as per National Health Programmes. There are 15 Measurable elements in
services as mandated these standards; each measures availability of the services under one national health
in the National Health programme.
Programs/State
scheme(s)

82 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - A: Service Provision
Standard A1 The facility provides primary level curative services
ME A1.1 The facility provides treatment of common ailments
ME A1.2 The facility provides Accident and Emergency Services
ME A1.3 The facility provides AYUSH Services
ME A1.4 The Services are available for the time period, as mandated
ME A1.5 The facility provides curative and preventive services for the locally prevalent health problems and
diseases
Standard A2 The facility provides RMNCHA Services
ME A2.1 The facility provides Reproductive Health Services
ME A2.2 The facility provides Maternal Health Services
ME A2.3 The facility provides Newborn Health Services
ME A2.4 The facility provides Child Health Services
ME A2.5 The facility provides Adolescent Health Services
Standard A3 The facility provides Diagnostic Services, Para-clinical and support services
ME A3.1 The facility provides Laboratory Services
ME A3.2 The facility provides other diagnostic services
ME A3.3 The facility provides pharmacy services
ME A3.4 The facility provides medico legal services
ME A3.5 The facility provides Mobile Medical Unit (MMU) services
ME A3.6 The facility provides administrative services
ME A3.7 The facility provides support services
Standard A4 The facility provides services as mandated in the National Health Programmes/State scheme(s)
ME A4.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines
ME A4.2 The facility provides services under Revised National TB Control Programme as per guidelines
ME A4.3 The facility provides services under National Leprosy Eradication Programme as per guidelines
ME A4.4 The facility provides services under National AIDS Control Programme as per guidelines
ME A4.5 The facility provides services under National Programme for control of Blindness as per guidelines
ME A4.6 The facility provides services under Mental Health Programme as per guidelines
ME A4.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines
ME A4.8 The facility provides services under National Programme for Prevention and control of Cancer, Diabetes,
Cardiovascular diseases and Stroke (NPCDCS) as per guidelines
ME A4.9 The facility provides services under Integrated Disease Surveillance Programme as per guidelines
ME A4.10 The facility provide services under National health Programme for prevention and control of deafness
as per guidelines
ME A4.11 The facility provides services under School Health Programme as per guidelines
ME A4.12 The facility provides services under Universal Immunization Programme (UIP) as per guidelines
ME A4.13 The facility provides services under National Iodine deficiency Programme as per guidelines
ME A4.14 The facility provides services under National Tobacco Control Programme as per guidelines
ME A4.15 The facility provides services as per local needs/State specific health programmes as per guidelines

National Quality Assurance Standards for Primary Health Centre (24x7) 83

 Area of Concern - B: Patients’ Rights

Overview
Mere availability of services at a health facility does not necessarily meet the need of community, unless the
available services are accessible to the users, and are provided with dignity and confidentiality. Access includes
physical access as well as financial access. There are evidences to suggest that patients’ experience and outcome
improves, when they themselves are involved in the care. So availability of information is critical for access as
well as enhancing patients’ satisfaction. Patients’ rights also include that health services give due consideration to
patients’ cultural and religious preferences:

Standard B1 The Standard measures information accessibility at the facility. Informational

The facility provides the accessibility includes prominent display of signages, services availability, citizen’s
information to care seekers, charter & IEC Material. This standard also mandates for practices like informed
attendants & community consent and grievance redressal.
about the available services
and their modalities
Standard B2 This standard ensures that the services are sensitive to gender, cultural and
Services are delivered in religious needs of the population. This includes measures taken specially to ensure
a manner that is sensitive comfort and dignity of female patients. This standard also measures the physical
to gender, religious and access of PHC such as availability of all-weather road, ramps, wheelchairs, trolleys
cultural needs, and there etc. and arrangements of people with disability such as disable friendly toilets.
is no barrier on account of
physical, economic, cultural
or social status
Standard B3 This standard measures patient friendliness of the services in terms of ensuring
The facility maintains privacy, privacy, confidentiality and dignity. Measurable elements under this standard
confidentiality & dignity of look for compliances such as provisions of screens and curtains, confidentiality
patient, and has a system for of patients’ clinical information, behaviour of service providers, and also ensuring
guarding patient related specific precautions to be taken, while providing care to patients with HIV
information infection, abortion, teenage pregnancy, etc.
Standard B4 The standard majorly checks that there are no financial barriers to the services.
The facility ensures that Measurable elements under this standard check for availability of drugs, diagnostics
there are no financial and transport free of cost under different schemes, and timely payment of the
barriers to access, and that entitlements under JSY and Family planning incentives.
there is financial protection
given from the cost of
hospital services

84 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - B: Patients’ Rights
Standard B1 The facility provides information to care-seekers, attendants and community about the
available services and their modalities
ME B1.1 The facility has uniform and user-friendly signage system
ME B1.2 The facility displays the services and entitlements available in its departments/sections
ME B1.3 The facility has established citizen’s charter, which is followed by all
ME B1.4 Patients and visitors are sensitised and educated through appropriate IEC/BCC approaches
ME B1.5 Information is available in local language, and it is easy to understand
ME B1.6 There is established procedures for taking informed consent before conducting procedures and
starting treatment
ME B1.7 Information about the treatment is shared with patients and their attendants regularly
ME B1.8 The facility has defined and established grievance redressal system
Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs,
and there are no barrier on account of physical, economic, cultural or social status
ME B2.1 Services at PHC are provided in manner that are sensitive to gender
ME B2.2 Religious and cultural preferences of patients and their attendants are taken into consideration, while
delivering services
ME B2.3 Access to facility is provided without any physical barrier
ME B2.4 There is no discrimination on basis of social and economic status of the patients
Standard B3 The facility maintains privacy, confidentiality and dignity of patient, and has a system
for guarding patient related information
ME B3.1 Adequate visual privacy is provided at every point of care
ME B3.2 Confidentiality of patients’ records and clinical information is maintained
ME B3.3 The facility ensures behaviours of its staff is dignified and respectful, while delivering the services
ME B3.4 The facility ensures privacy and confidentiality to every patient, especially of those conditions having
social stigma, and also it safeguards vulnerable groups
Standard B4 The facility ensures that there are no financial barriers to access, and that there is financial
protection given from the cost of hospital services
ME B4.1 The facility provides cashless services to pregnant women, mothers and neonates and for other
patients on payments as per government schemes in vogue
ME B4.2 The facility ensures that prescribed drugs are available at the Pharmacy and wards
ME B4.3 It is ensured that facilities for the prescribed investigations are available at the PHC
ME B4.4 The facility provide free of cost treatment to Below poverty line (BPL) patients seamlessly
ME B4.5 The facility ensures timely payment of entitlements and reimbursement to the patients

National Quality Assurance Standards for Primary Health Centre (24x7) 85

 Area of Concern - C: Input

Overview
This area of concern predominantly covers the structural part of the facility. Indian Public Health Standards (IPHS)
defines infrastructure, human resources, drugs and equipment requirements for different level of health facilities.
Quality standards given in this area of concern take cognizance of the IPHS requirement. However, focus of the
standards has been in ensuring compliance to minimum level of inputs, which are required for ensuring delivery of
committed level of the services. The words like ‘adequate’ and ‘as per load‘ has been given in the requirements for
many standards & measurable elements, as it would be hard to set structural norms for every level of the facility
that commensurate with patient load.

Standard C1 This standard measures adequacy of infrastructure in terms of space, patient amenities,
The facility has layout, circulation area, communication facilities, etc. It also looks into the functional
infrastructure for aspect of the structure, whether it commensurate with the process flow of the facility
delivery of assured or not.
services, and available
infrastructure meets the Minimum requirement for space, layout and patient amenities are given for some of
prevalent norms departments, but assessors would be expected to use his discretion to see whether
the available space is adequate for the given work-load. Compliance to most of the
measurable elements can be assessed by direct observation except for checking
functional adequacy, where discussion with facility staff may be required to know the
process flow between the departments, and also within a department.
Standard C2 This deals with Physical safety of the infrastructure. It includes seismic safety, electrical
The facility ensures safety, and general condition of infrastructure. This standard also mandates for
physical safety including adequate fire-safety measures being implemented at the facility.
fire-safety of the
infrastructure
Standard C3 This standard measures the numerical adequacy and skill-sets of the staff. It includes
The facility has adequate availability of doctors, nurses, paramedical and support staff. It also ensures that the
qualified and trained staff has been trained as per their job description and responsibilities. There are two
staff, required for components while assessing the staff adequacy - first is the numeric adequacy, which
providing the assured can be checked by interaction with the facility in charge and review of records. Second
services to the current is to access human resources in term of their availability to ensure the service delivery.
caseload For instance, a PHC may have 3 SBA trained ANM/Nursing staff, but if none of them is
available in the night shift, then intent of the standard is not being complied with.
Skill set may be assessed by reviewing training records and staff interview and
demonstration to check whether staff have requisite skills to perform the procedures.
Standard C4 This Standard measures availability of drugs and consumables in different service
The facility provides areas of PHC. This includes vaccines, lab regents and contraceptives. In addition, the
drugs and consumables standard also looks at the availability of drugs in pharmacy. The Standard also expect
required for assured available of committed drugs at PHC under National Health Programmes.
services
Standard C5 This standard is concerned with availability of instruments in various departments
The facility has equipment and service delivery points. Equipment and instruments have been categorized into
& instruments required sub groups as per their use, and measurable elements have been assigned to each
for assured list of sub group, such as examination and monitoring, clinical procedures, diagnostic
services equipment, resuscitation equipment, storage equipment and equipment used for non-
clinical support services. Some representative equipment could be used as tracers and
checked in each category.

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 Area of Concern - C: Inputs
Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure
meets the prevalent norms
ME C1.1 Departments have adequate space as per patient or work load
ME C1.2 Amenities for Patients and Staff are available as per load
ME C1.3 The Departments have layout and demarcated areas as per their functions
ME C1.4 The facility has adequate circulation area and open spaces according to need and local law
ME C1.5 The facility has infrastructure for intramural and extramural communication
Standard C2 The facility ensures the physical safety including fire safety of the infrastructure
ME C2.1 The facility ensures seismic safety of the infrastructure, as per guidelines
ME C2.2 The facility ensures safety of electrical establishment
ME C2.3 Physical condition of buildings is safe for providing patient care
ME C2.4 The facility ensures Fire Safety Measures, including availability fire fighting equipment
Standard C3 The facility has adequate qualified and trained staff, required for providing the assured
services to the current case load
ME C3.1 The facility has adequate medical officers as per service provision and work load
ME C3.2 The facility has adequate nursing staff/Paramedic as per service provision and work load
ME C3.3 The facility has adequate Health workers as per requirement
ME C3.4 The facility has adequate support staff
ME C3.5 The Staff has been imparted necessary trainings/skill set to enable them to meet their roles and
responsibilities
ME C3.6 The Staff is skilled/competent as per job description
Standard C4 The facility provides drugs and consumables required for assured services
ME C4.1 The departments have availability of adequate drugs at point of use
ME C4.2 The departments have adequate consumables at point of use
ME C4.3 Emergency drug trays are maintained at every point of care, where it may be needed
Standard C5 The facility has equipment and instruments required for assured list of services
ME C5.1 Availability of equipment and instruments for examination and monitoring of patients
ME C5.2 Availability of equipment and instruments for undertaking treatment procedures in the facility
ME C5.3 Availability of equipment and instruments for undertaking diagnostic procedures in the facility
ME C5.4 Availability of equipment and instruments for resuscitation of patients
ME C5.5 Availability of equipment for storage
ME C5.6 Availability of functional equipment and instruments for support and outreach services
ME C5.7 Departments have patient furniture and fixtures as per case-load and service provision

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 Area of Concern - D: Support Services

Overview
Support services are the backbone of health care facilities. The expected clinical outcome cannot be envisaged
in absence of sturdy support services. This area of concern includes equipment maintenance, calibration, drug
storage and inventory management, security, facility management, water supply, power backup, dietary services
and laundry. Administrative processes like RKS, Financial management, legal compliances, staff deputation and
contract management have also been included in this area of concern. It also includes various monitoring &
reporting activities done by PHC, especially with regards to National Health Programme.

Standard D1 The first standard of this area of concern is related facility management of
The facility has an established Primary Health Centre. This includes equipment maintenance processes,
Facility Management Program maintenance of infrastructure as well as safety & security of the staff and
for Maintenance & Upkeep of patients. Equipment records should be reviewed to ensure that valid AMC
Equipment & Infrastructure is available for critical equipment and preventive/corrective maintenance is
to provide safe and secure undertaken timely. Calibration records and label on the measuring equipment
environment to staff & Users should also be reviewed to confirm the calibration. Operating Instructions
should be displayed or readily available with the user.
This standard is also concerned with providing safe, secure and comfortable
environment to patients as well service providers. Two aspects should be
observed in this regard - firstly, provision of comfortable work environment in
terms of illumination and temperature control in patient care areas and work
stations, and secondly, arrangement for security of patients and staff. Security
arrangements at patient area should be observed for restriction of visitors and
crowd management
Lastly, the standard is also concerned with adequacy of facility management
processes. This includes appearance of facility, cleaning processes, infrastructure
maintenance, removal of junk and condemned items and control of stray
animals and pest control inside the facility.
Standard D2 This standard is concerned with safe storage of drugs and scientific
The facility has defined management of the inventory, so that drugs and consumables are available
procedures for storage; in adequate quantity in patient care area. Measurable elements of this
inventory management standard look into processes of indenting, procurement, storage, expired
and dispensing of drugs in drugs management, inventory management, stock management in patient
pharmacy and patient care care areas, including storage at optimum temperature. While assessing drug
areas management system, these practices should be looked into each clinical
department, especially at the nursing stations and its complementary process
at drug stores/Pharmacy.
Standard D3 Measurable elements in this standard are concerned with timely availability of
The facility ensures availability appropriate diet to indoor patients; clean linen and power backup in-patient
of diet, linen, water and power care areas. The standard also ensures availability of adequate quantity of
backup as per requirement potable water.
of service delivery & support
services norms
Standard D4 This standard measures processes related to functioning of Rogi Kalyan
The facility has defined and Samiti (RKS) and community participation in the management of PHC. RKS
established procedures for records should be reviewed to assess frequency of the meetings, and issues
promoting public participation discussed there. Participation of the non-official members of RKS in the
in management of hospital meetings should be checked. This standard also measures the supportive &
with transparency and monitoring processes related with community health workers, viz. ASHA.
accountability

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Standard D5 This standard is concerned with the financial management of the funds/grants,
Hospital has defined and received from different sources including funds received under the NHM.
established procedures for Assessment of the financial management processes should not be equated
Financial Management and with financial or accounts audit. Facility incharge and clerk department can be
monitoring of quality of interacted to know process of utilization of funds, timely payment of salaries,
outsourced services entitlements and incentives to different stakeholders and process of receiving
funds and submitting utilization certificates. An assessment of resource
utilisation and prioritisation should be undertaken.
Standard D6 This is concerned with compliances to statuary and regulatory requirements.
The facility is compliant with It also looks into availability of requisite licenses, updated copies of acts and
all statutory and regulatory rules, and adherence to the legal requirements as applicable to Public Health
requirement imposed by local, Facilities.
state or central government
Standard D7 This standard is concerned with the processes staff management and their
Roles & Responsibilities of deployment in the departments of a facility. This includes availability of the
administrative and clinical job descriptions for different cadre of staff, processes regarding preparation
staff are determined as per of duty rosters and staff discipline. Staff can be interviewed to assess about
Government regulations awareness of their job description. It should be assessed by observation and
and Standards Operating review of the records. Adherence to dress code should be observed during the
Procedures assessment.
Standard D8 This standard is concerned with timely and adequate reporting under different
Hospital has defined and national health programmes. The Assessor should review the records of such
established procedure for reporting in term of record’s quality and adequacy.
monitoring & reporting of
National Health Program as
per state specifications

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 Area of Concern - D: Support Services
Standard D1 The facility has a established Facility Management Programme for Maintenance and Upkeep
of Equipment and Infrastructure to provide safe and Secure environment to staff and Users
ME D1.1 The facility has system for maintenance of critical Equipment
ME D1.2 The facility has procedure for calibration of measuring Equipment
ME D1.3 Operating and maintenance instructions are available with the users of equipment
ME D1.4 The facility provides adequate illumination level in patient care areas and as well as within its
premises
ME D1.5 The facility ensures comfortable environment for patients and service providers
ME D1.6 Exterior of the facility building is maintained appropriately
ME D1.7 The facility maintains clean and hygienic environment, especially patient care areas
ME D1.8 The facility infrastructure is adequately maintained
ME D1.9 The facility open areas are landscaped and well maintained
ME D1.10 The facility has a policy of removal of condemned junk material, and the policy has been implemented
ME D1.11 The facility has established procedures for pest and rodent control, and there is no access by animals
ME D1.12 The facility has security system in place in patient care areas
ME D1.13 The facility has established measures for safety and security of female staff
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of
drugs in pharmacy and patient care areas
ME D2.1 There is established procedure for Estimation, indenting and Procurement of drugs and consumables
ME D2.2 The facility ensures proper storage of drugs and consumables
ME D2.3 The facility ensures management of expiry and near expiry drugs
ME D2.4 The facility has established procedure for inventory management techniques
ME D2.5 There is a procedure for storage of vaccines and other drugs, requiring controlled temperature and it
is being followed
Standard D3 The facility ensures availability of diet, linen, water and power backup as per requirement of
service delivery and support services norms
ME D3.1 The facility has adequate arrangement storage and supply for potable water in all functional areas
ME D3.2 The facility ensures adequate power backup in all patient care areas as per requirement
ME D3.3 The facility provides diets according to nutritional requirements of the patients
ME D3.4 The facility provides Clean and adequate linen as per requirement
Standard D4 The facility has defined and established procedures for promoting public participation in
management of hospital with transparency and accountability
ME D4.1 The facility has established procedures for management of activities of Rogi Kalyan Samiti
ME D4.2 The facility has established procedures for community based monitoring of its services
ME D4.3 The facility has established procedure for supporting and monitoring activities of community health
work - ASHA
Standard D5 Hospital has defined and established procedures for Financial Management and monitoring
of quality of outsourced services
ME D5.1 The facility ensures the proper utilization of fund provided to it
ME D5.2 The facility ensures proper planning and requisition of resources based on its need

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ME D5.3 There is established system for contract management for out-sourced services
ME D5.4 There is a system of periodic review of quality of out-sourced services
Standard D6 The facility is compliant with all statutory and regulatory requirement imposed by local, state
or central government
ME D6.1 The facility has requisite licences and certificates, as required for operation of a health facility
ME D6.2 Updated copies of relevant laws, regulations and government orders are available at the facility
ME D6.3 The facility ensures its processes are in compliance with statutory and legal requirement
Standard D7 Roles and Responsibilities of administrative and clinical staff are determined as per govt.
regulations and standards operating procedures
ME D7.1 Job-description of all category of staff is defined in the facility
ME D7.2 The facility has a established procedure for duty roster and deputation to different departments
ME D7.3 The facility ensures the adherence to dress-code as mandated by the department
Standard D8 Hospital has defined and established procedure for monitoring and reporting of National
Health Program as per state specifications
ME D8.1 The facility provides monitoring and reporting services under National Vector Borne Disease Control
Programme as per guidelines
ME D8.2 The facility provides services monitoring and reporting services under Revised National TB Control
Programme, as per guidelines
ME D8.3 The facility provides monitoring and reporting services under National Leprosy Eradication
Programme as per guidelines
ME D8.4 The facility provides services under National AIDS Control Programme, as per guidelines
ME D8.5 The facility provides monitoring and reporting services under National Programme for control of
Blindness as per guidelines
ME D8.6 The facility provides monitoring and reporting services under Mental Health Programme, as per
guidelines
ME D8.7 The facility provides monitoring and reporting services under National Programme for the health
care of the elderly as per guidelines
ME D8.8 The facility provide monitoring and reporting service for prevention and control of Cancer, diabetes,
cardiovascular disease and stroke as per guidelines
ME D8.9 The facility provide monitoring and reporting service for Integrated Disease Surveillance Programme,
as per guidelines
ME D8.10 The facility provide services under National Programme for prevention and control of deafness, as
per guidelines
ME D8.11 The facility provides monitoring and reporting services under School Health Programme, as per
guidelines
ME D8.12 The facility provides monitoring and reporting services under Universal Immunization Programme, as
per guidelines
ME D8.13 The facility provides monitoring and reporting services under National Iodine deficiency Programme,
as per guidelines
ME D8.14 The facility provides monitoring and reporting services under National tobacco Control Programme,
as per guidelines
ME D8.15 The facility Reports data for Mother and Child Tracking System as per Guidelines
ME D8.16 The facility Reports data for HMIS System as per Guidelines

National Quality Assurance Standards for Primary Health Centre (24x7) 91

 Area concern - E: Clinical care

Overview
The ultimate purpose of existence of a health care facility is to provide clinical care. Therefore, clinical processes are
the most critical and important. These are the processes that define directly the outcome of services and quality
of care. The Standards under this area of concern could be grouped into three categories. First, six standards are
concerned with those clinical processes that ensure adequacy of care to the patients. It includes processes such as
registration, admission, consultation, clinical assessment, continuity of care, nursing care, prescription practices,
safe drug administration, maintenance of clinical records and discharge from the facility.
Subsequent two standards measure the quality of emergency & diagnostic services, as relevant within scope of
services of a primary health centre.
The last set of seven standards is concerned with specific clinical processes for Maternal, Newborn, Child,
Adolescent & Family Planning services and National Health Programmes. These standards are based on the
technical guidelines published by the Government of India on respective programmes and processes.
It may be difficult to assess clinical processes, as direct observation of clinical procedure may not always be
possible at time of assessment. Therefore, assessment of these standards would largely depend upon many inputs,
such as review of the clinical records, interaction with the staff to know their skill level and how they practice
clinical care (Competence testing). Assessment of these standards would require thorough domain knowledge.

Standard E1 This standard is concerned with the registration and admission processes in a facility.
The facility has It also covers OPD consultation processes. The Assessor should review the records to
defined procedures verify that details of patients have been recorded, and patients have been given unique
for registration, identification number. OPD consultation may be directly observed, followed by review of
consultation and OPD tickets to ensure that patient history, examination details, etc. have been recorded
admission of patients on the OPD ticket. The Staff should be interviewed to know, whether there is any fixed
admission criteria especially in critical care department.
Standard E2 Primary Health Centres are usually first point of contact where patient can get qualified
The facility has medical attention. Hence, role of PHCs in ensuring continuity of care is of utmost
procedures for importance. This standard includes process of assessment, reassessment, referral to
continuity of care of another facility, deputation of staff for the care, and linkages with higher institutions
patient and follow-up of patients discharged from higher centres. The facility staff should be
interviewed to know the referral linkages, how they communicate with the referral
hospital about the patients and arrangement for the vehicles and follow-up care.
Standard E3 Standard E3 measures adequacy and quality of nursing care for the patients. It includes
The facility has defined processes for identification of patients, timely and accurate implementation of treatment
and established plan, nurses’ handover processes, maintenance of nursing records and monitoring of the
procedures for patients. The staff should be interviewed and patients’ records should be reviewed for
nursing care assessing how drug distribution takes place, how its administration is ensured and its
record, and other procedures like sample collection and dressing have been done on time
as per treatment plan. Handing-over of patients is a critical process, and should be assessed
adequately. Review BHT for patient monitoring & nursing notes should be done.
Standard E4 This standard is concerned with assessing that patients are prescribed drugs according
The facility has standard treatment guidelines and protocols. Patient records are assessed to ascertain
defined & follows that prescriptions are written in generic name only. This standard is also concerned with
procedure for drug the safety of drug administration. It includes legibility of medical orders, process for
administration, and checking drugs before administration and processes related to self-drug administration.
standard treatment Patient’s records should be reviewed for legibility of the writing and recording of date
guidelines, as defined and time of orders. Safe injection practices like use of separate needle for multi-dose vial
by the government should be observed.

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Standard E5 This standard is concerned with the processes of maintaining clinical records systematically
The facility has defined and adequately. Compliance to this standard can be assessed by comprehensive review
and established of the patients’ record.
procedures for
maintaining, updating
of patients’ clinical
records and their
storage
Standard E6 This standard measures adequacy of the discharge process. It includes pre-discharge
The facility has defined assessment, adequacy of discharge summary, pre-discharge counselling and adherence
and established to standard procedures, if a patient is leaving against medical advice (LAMA) or is found
procedures for absconding. Patients’ record should also be reviewed for adequacy of the discharge
discharge of patient summary.
Standard E7 This standard is concerned with emergency clinical processes and procedures. It includes
The facility has defined triage, adherence to emergency clinical protocols, disaster management, processes
and established related to ambulance services, handling of medico-legal cases, etc. Availability of the
procedures for buffer stock for medicines and other supplies for disaster and mass casualty needs to be
Emergency Services and found out.
Disaster Management
Standard E8 This standard deals with technical procedures related to the diagnostic services. It includes
The facility has defined pre-testing, testing and post-testing procedures. It needs to be observed that samples in
and established the laboratory are properly labelled, and instructions for handling samples are available.
procedures for The process for storage and transportation of samples needs to be ensured. Availability
diagnostic services of critical values and biological references should also be checked.
Standard E9 This Standard is concerned with the processes, which ensure that adequate and quality
The facility has antenatal care is provided at the facility. It includes measurable elements for ANC
established procedures registration, processes during check-up, identification of High Risk pregnancy, management
for Antenatal care as of anaemia and counselling services. Staff at ANC clinic should be interviewed and
per guidelines records should be reviewed for maintenance of MCP cards and registration of pregnant
women. For assessing quality and adequacy of ANC check-up, direct observation may
be undertaken after obtaining requisite permission. ANC records can be reviewed to
see findings of examination and diagnostic tests are recorded. The assessment of follow-
up of Anaemia cases should be reviewed. Beneficiaries and staff can be interacted for
counselling on the nutrition, birth preparedness, family planning, etc.
Standard E10 This Standard measures the quality of intra-natal care. It includes clinical process for
The facility has normal delivery as well primary management of complications before referral to First
established procedures Referral Unit. The facility staff can be interviewed to know their skill and practices
for Intranatal care as regarding management of different stages of labour, especially Active Management of
per guidelines Third stage of labour. Staff may be interacted for demonstration of resuscitation and
essential newborn care. Competency of the staff for managing obstetric emergencies,
interpretation of partograph, APGAR score should also be assessed.
Standard E11 This standard is concerned with adherence to post-natal care of mother and newborn
The facility has within the facility. Observe to ensure that postnatal protocols of prevention of Hypothermia
established procedures and breastfeeding are adhered to at the health facility. Mothers may be interviewed to
for postnatal care as know that proper counselling have been provided
per guidelines
Standard E12 This is concerned with adherence to clinical protocols for newborn and child health. It
The facility has covers immunization, emergency triage, management of newborn and childhood illnesses
established procedures like malnutrition Pneumonia and diarrhoea at Primary Health Centres. Immunization
for care of newborn, services are majorly assessed at immunization clinic. Staff interview and observation
infant and child as per should be done to assess availability of diluents, adherence to protocols of reconstitution
guidelines of vaccine, storage of VVM labels and shake test. Adherence to clinical protocols for
management of different illnesses in newborn and child should be done by interaction
with the doctors and nursing staff.

National Quality Assurance Standards for Primary Health Centre (24x7) 93

 Standard E13 This Standard is concerned with providing safe and quality family planning and abortion
The facility has services. This includes standard practices and procedures for Family planning counselling,
established procedures spacing methods, and procedures for abortion. Quality and adequacy of counselling
for abortion and services can be assessed by exit interview with the clients. The staff at family planning
family planning as per clinic may be interacted to assess adherence to the protocols for IUD insertion, precaution
government guidelines & contraindication for oral pills, etc.
and law
Standard E14 This Standard is concerned with services related to adolescent Reproductive and Sexual
The facility provides health (ARSH) guidelines. It includes promotive, preventive, curative and referral
Adolescent services under the ARSH. The facility staff should be interviewed, and records should be
Reproductive and reviewed.
Sexual Health services
as per guidelines
Standard E15 This Standard pertains to adherence for clinical guidelines under the National Health
The facility provides Programmes. For each national health programme, availability of clinical services as per
National Health respective guidelines should be assessed. For every national health programme, there is
Programmes as per dedicated measurable element having relevant checkpoints as per technical guidelines
Operational/Clinical of respective program.
Guidelines of the
Government

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 Area of Concern - E: Clinical Services
Standard E1 The facility has defined procedures for registration, consultation and admission of patients
ME E1.1 The facility has established procedure for registration of patients
ME E1.2 The facility has a established procedure for OPD consultation
ME E1.3 There is established procedure for admission of patients
Standard E2 The facility has procedures for continuity of care of patient
ME E2.1 There is established procedure for initial assessment, and reassessment of patients
ME E2.2 The facility provides appropriate referral linkages for transfer to other/higher facilities to assure the
continuity of care.
ME E2.3 The facility ensures follow up of patients, discharged from the higher facilities
Standard E3 The facility has defined and established procedures for nursing care
ME E3.1 Procedure for identification of patients is established at the facility
ME E3.2 Procedure for ensuring timely and accurate nursing care as per treatment plan is established at the
facility
ME E3.3 There is established procedure of patient hand over, whenever staff duty change happens
ME E3.4 Nursing records are maintained properly
Standard E4 The facility has defined and follow correct procedure for drug administration and follows
standard treatment guidelines defined by state/Central government
ME E4.1 Medication orders are written legibly and adequately
ME E4.2 There is a procedure to check drug before administration/dispensing
ME E4.3 There is a system to ensure right medicine is given to right patient and documented
ME E4.4 The Patients are counselled for self drug administration
ME E4.5 The facility ensures that drugs are prescribed in generic name only
ME E4.6 There is procedure of rational use of drugs
ME E4.7 Drugs are prescribed according to Standard Treatment Guidelines
Standard E5 The facility has defined and established procedures for maintaining, updating of patients’
clinical records and their storage
ME E5.1 All the assessments, re-assessment and investigations are recorded and periodically updated
ME E5.2 Treatment plans are recorded in the patient’s records
ME E5.3 Procedures performed are written on patients records
ME E5.4 Adequate form and formats are available at point of use
ME E5.5 Register/records are maintained as per guidelines
ME E5.6 The facility ensures safe and adequate storage and retrieval of medical records
Standard E6 The facility has defined and established procedures for discharge of patient
ME E6.1 Discharge is done after assessing patient readiness for the discharge
ME E6.2 Case summary and follow-up instructions are provided at the discharge
ME E6.3 Counselling services are provided, whenever required
ME E6.4 The facility has established procedure for patients leaving the facility against medical advice,
absconding, etc.

National Quality Assurance Standards for Primary Health Centre (24x7) 95

 Standard E7 The facility has defined and established procedures for Emergency Services and Disaster
Management
ME E7.1 There is procedure for receiving of casualties and their triage
ME E7.2 Emergency protocols are defined and implemented
ME E7.3 The facility has disaster management plan in place
ME E7.4 The facility ensures adequate and timely availability of ambulance services
ME E7.5 There is a procedure for handling medico legal cases
Standard E8 The facility has defined and established procedures for diagnostic services
ME E8.1 There are established procedures for Pre-testing Activities
ME E8.2 There are established procedures for testing Activities
ME E8.3 There are established procedures for Post-testing Activities
ME E8.4 There are established procedures for Laboratory Diagnosis of Tuberculosis as per prevalent
Guidelines
ME E8.5 There are established procedures for Laboratory Diagnosis of Malaria as per prevalent Guidelines
Maternal and Child Health Services
Standard E9 The facility has established procedures for Antenatal care as per guidelines
ME E9.1 There is an established procedure for Registration and follow up of pregnant women
ME E9.2 There is an established procedure for History taking, Physical examination, and counselling of each
antenatal woman, visiting the facility.
ME E9.3 The facility ensures of drugs and diagnostics are prescribed as per protocol
ME E9.4 There is an established procedure for identification of High risk pregnancies, and their timely referral.
ME E9.5 There is an established procedure for identification and management of anaemia
ME E9.6 Counselling of pregnant women is done as per standard protocol and gestational age
Standard E10 The facility has established procedures for Intranatal care as per guidelines
ME E10.1 Established procedures and standard protocols for management of different stages of labour, and
AMTSL (Active Management of third Stage of labour) are followed at the facility
ME E10.2 There is established procedure for management/Referral of Obstetrics Emergencies as per scope of
services.
ME E10.3 There is an established procedure for new born resuscitation and newborn care.
Standard E11 The facility has established procedures for postnatal care as per guidelines
ME E11.1 Post partum Care is provided during postnatal period
ME E11.2 The facility ensures adequate stay of mother and newborn in a safe environment as per standard
Protocol
ME E11.3 There is an established procedure for Post partum counselling during postnatal period
Standard E12 The facility has established procedures for care of new born, infant and child as per guidelines
ME E12.1 The facility provides immunization services as per guidelines
ME E12.2 Triage, Assessment and Management of newborns having emergency signs are done as per
guidelines
ME E12.3 Management of Newborn Illness is done as per relevant protocols
ME E12.4 Management of children presenting with fever, cough/breathlessness is done as per guidelines
ME E12.5 Management of children with severe Acute Malnutrition is done as per guidelines
ME E12.6 Management of children presenting with diarrhoea is done per guidelines

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Standard E13 The facility has established procedures for abortion and family planning as per government
guidlines and low
ME E13.1 Family planning counselling services provided as per guidelines
ME E13.2 The facility provides spacing method of family planning as per guidelines
ME E13.3 The facility provides IUD service for family planning as per guidelines
ME E13.4 The facility provide counselling services for Medical Termination of Pregnancy as per guidelines
ME E13.5 The facility provide abortion services for 1st trimester as per guidelines
Standard E14 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines
ME E14.1 The facility provides Promotive ARSH Services
ME E14.2 The facility provides Preventive ARSH Services
ME E14.3 The facility provides Curative ARSH Services
ME E14.4 The facility provides Referral Services for ARSH
National Health Programmes
Standard E15 The facility provides National health Programme as per operational/Clinical Guidelines of the
Government
ME E15.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines
ME E15.2 The facility provides services under Revised National TB Control Programme as per guidelines
ME E15.3 The facility provides services under National Leprosy Eradication Programme as per guidelines
ME E15.4 The facility provides services under National AIDS Control Programme as per guidelines
ME E15.5 The facility provides services under National Programme for control of Blindness as per guidelines
ME E15.6 The facility provides services under Mental Health Programme as per guidelines
ME E15.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines
ME E15.8 The facility provides service under National Programme for Prevention and Control of cancer,
diabetes, cardiovascular diseases and stroke (NPCDCS) as per guidelines
ME E15.9 The facility provide service for Integrated disease surveillance Programme as per guidelines
ME E15.10 The facility provide services under National Programme for prevention and control of deafness as per
guidelines
ME E15.11 The facility provides services under School Health Programme as per guidelines
ME E15.12 The facility provides services under Universal Immunization Programme as per guidelines
ME E15.13 The facility provides services under National Iodine deficiency Programme as per guidelines
ME E15.14 The facility provides services under National Tobacco Control Programme as per guidelines

National Quality Assurance Standards for Primary Health Centre (24x7) 97

 Area of Concern - F: Infection Control

Overview
The first principle of health care is “to do no harm”. As Public health facility usually have high occupancy, the
Infection control practices become more critical to avoid cross-infection and its spread. This area of concern covers
Infection control practices, hand-hygiene, antisepsis, personal protection, processing of equipment, environment
control, and Biomedical Waste Management.

Standard F1 This standard is concerned with the implementation of Infection control

The facility has Infection programme at the facility. It is includes periodic medical check-up and
Control Programme, and immunization of staff and monitoring of Infection control Practices.
there are procedures in place
for prevention, Control and
measurement of Hospital
Associated Infections
Standard F2 This standard is concerned with practices of hand washing and antisepsis.
The facility has defined and Availability of Hand washing facilities with soap and running water should be
Implemented procedures observed at the point of use. Technique of the hand washing for assessing the
for ensuring hand hygiene practices, and effectiveness of training may be observed.
practices and antisepsis
Standard F3 This standard is concerned with usage of Personal Protection Equipment (PPE)
The facility ensures availability such as gloves, mask, apron, etc. Interaction with staff may reveal the adequacy
of material for personal of supply of PPE. Assessor should also observe the whether staff uses correct
protection, and facility staff method of wearing personal protection equipment.
follows standard precaution
for personal protection
Standard F4 This Standard is concerned with standard procedures, related to processing of
The facility has standard equipment and instruments. There should be processes to include adequate
procedures for processing for decontamination, cleaning, disinfection and sterilization of equipment
Disinfection and Sterilization of and instruments. These practices should be observed and staff should be
equipment and instruments interviewed for compliance to certain standard procedures.
Standard F5 The standard pertains to environment cleaning. It assesses whether layout
Physical layout and and arrangement of processes is conducive for the infection control or not.
environmental control of Environment cleaning processes like mopping, decontamination of surfaces
the patient care areas ensure and spill management are covered here.
infection prevention
Standard F6 This standard is concerned with Management of Biomedical waste
The facility has defined and management including its segregation, transportation, disposal and
established procedures for management of sharps. Availability of equipment and practices of segregation
segregation, collection, can be directly observed. Staff should be interviewed about the procedure
treatment and disposal of Bio- for management of the needle stick injuries. Storage and transportation of
medical and hazardous Waste waste should be observed and records are verified.

98 National Quality Assurance Standards for Public Health Facilities | 2020

 Area of Concern - F: Infection Control
Standard F1 The facility has infection control Programme and procedures in place for prevention, control,
and measurement of hospital associated infection
ME F1.1 There is Provision of Periodic Medical Check-up and immunization of the staff
ME F1.2 The facility has established procedures for regular monitoring of infection control practices, and
infection rates are calculated
Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and
antisepsis
ME F2.1 Hand hygiene facilities are provided at point of use
ME F2.2 The facility staff is trained in hand washing and hand rub practices and they adhere to standard hand
washing and hand rub practices
ME F2.3 The facility ensures availability of material for ensuring antisepsis
Standard F3 The facility ensures availability of material for personal protection, and facility staff follow
standard precaution for personal protection
ME F3.1 The facility ensures availability personal protection Equipment as per requirements
ME F3.2 The facility staff adheres to standard personal protection practices
Standard F4 The facility has standard procedures for processing for Disinfection and sterilization of
equipment and instruments
ME F4.1 The facility ensures availability of materials for decontamination and cleaning of instruments, and
standard practices are followed in procedure areas
ME F4.2 The facility ensures standard practices and materials for disinfection and sterilization of instruments
and equipment
Standard F5 Physical layout and environmental control of the patient care areas ensures infection
prevention
ME F5.1 Layout of the department is conducive for the infection control practices
ME F5.2 The facility ensures availability of standard materials for cleaning and disinfection of patient care
areas
ME F5.3 The facility ensures standard practices are followed for cleaning and disinfection of patient care areas
Standard F6 The facility has defined and established procedures for segregation, collection, treatment and
disposal of Bio Medical and hazardous Waste
ME F6.1 The facility Ensures segregation of Bio Medical Waste as per guidelines and ‘on-site’ management of
waste is carried out as per guidelines
ME F6.2 The facility ensures management of sharps as per guidelines
ME F6.3 The facility ensures transportation and disposal of waste as per guidelines

National Quality Assurance Standards for Primary Health Centre (24x7) 99

 Area of Concern - G: Quality Management

Overview
Quality management requires a set of interrelated activities that assure quality of services according to set
standards and strive to improve upon it through a systematic planning, implementation, checking and acting
upon the compliances. The standards in this area concern are the opportunities for improvement to enhance
quality of services and patient satisfaction. These standards are in synchronization with facility based quality
assurance programme given in ‘Operational Guidelines for Quality Assurance in Public Health facilities.

Standard G1 Standard G1 is concerned with creating a Quality Team at the facility and making it
The facility has defined functional. Assessor may review the document and interact with Quality Team members
and established to know how frequently they meet and responsibilities have been delegated to them.
organizational Quality team meeting records may be reviewed. This standard is also concerned with
framework & Quality establishment and dissemination of quality policy and objectives in the PHC. The staff
policy for Quality may be interviewed to know their awareness of Quality policy and Objectives. Review
Assurance of records should be done for assessing that Quality objectives meet SMART criteria,
and have been reviewed periodically.
Standard G2 This standard is concerned with having a system of measurement of patient and
The facility has employee satisfaction. This includes periodic patients’ satisfaction survey, analysis of the
established system for feedback and preparing action plan. Assessors should review the records pertaining to
patient and employee patient satisfaction and employee satisfaction survey to ascertain that Patient feedback
satisfaction is taken at prescribed intervals and adequate sample size is adequate.
Standard G3 This Standard pertains to the processes of internal assessment, medical and death
The facility has audit at a defined periodicity. Review of Internal assessment and clinical audit records
established system for may reveal their adequacy and periodicity. This standard is also concerned with
assuring and improving implementation of quality assurance programmes within departments such as EQAS
quality of Clinical & of diagnostic services, daily round and use of departmental check-lists, EQUAS records
support services by at laboratory, etc.
internal & external
programme
Standard G4 This standard is concerned with availability and adequacy of Standard operating
The facility has procedures and work instructions with the respective process owners. Display of work
established, documented instructions and clinical protocols should be observed during the assessment.
implemented and
maintained Standard
Operating Procedures
for all key processes and
support services

100 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - G: Quality Management
Standard G1 The facility has defined and established organizational framework and Quality policy for
Quality Assurance
ME G1.1 The facility has a quality team in place
ME G1.2 The facility has defined quality policy and it has been disseminated
ME G1.3 Quality objectives have been defined, and the objectives are reviewed and monitored
periodically
ME G1.4 The facility reviews quality of its services at periodic intervals
Standard G2 The facility has established system for patient and employee satisfaction
ME G2.1 Patient satisfaction surveys are conducted periodically
ME G2.2 The facility analyses patient feed-back, and root-cause analysis is undertaken periodically
ME G2.3 The facility prepares the action plans for the areas, contributing to low satisfaction of patients
Standard G3 The facility have established system for assuring and improving quality of Clinical and support
services by internal and external program
ME G3.1 The facility has established internal quality assurance programme
ME G3.2 The facility has established external assurance programmes
ME G3.3 The facility conducts the periodic prescription/medical/death audits
ME G3.4 The facility ensures non compliances are enumerated and recorded adequately
ME G3.5 Action plan is made on the gaps found in the assessment/audit process
ME G3.6 Corrective and preventive actions are taken to address issues, observed in the assessment and audit
ME G3.7 The facility uses method for quality improvement in services
ME G3.8 The facility uses tools for quality improvement in services
Standard G4 The facility has established, documented implemented and maintained Standard Operating
Procedures for all key processes and support services
ME G4.1 Departmental standard operating procedures are available with the users
ME G4.2 Standard Operating Procedures adequately describes process and procedures
ME G4.3 The Staff is trained on SOPs, and they are aware of the procedures
ME G4.4 The Work instructions are displayed at point of their use

National Quality Assurance Standards for Primary Health Centre (24x7) 101
 Area of Concern - H: Outcome

Overview
Measurement of the quality is critical to improvement of processes and outcomes. This area of concern has four
standard measures for quality - Productivity, Efficiency, Clinical Care and Service quality in terms of measurable
indicators. Every standard under this area has two aspects – Firstly, there is a system of measurement of indicators
at the health facility; and secondly, how the facility meets the benchmark. It is realised that in the beginning, many
indicators given in these standards may not be getting measured across all facilities, and therefore it would be
difficult to set benchmark beforehand. However, with the passage of time, the state can set their benchmarks,
and evaluate performance of health facilities against the set benchmarks.

Standard H1 This standard is concerned with the measurement of Productivity indicators and
The facility measures meeting the benchmarks. This includes utilization indicators like daily OPD & Deliveries
Productivity Indicators conducted in the night. Assessor should review these records to ensure that theses
and ensures compliance indictors are getting measured at the health facility.
with State/National
benchmarks
Standard H2 This standard pertains to measurement of efficiency indicators and meeting benchmark.
The facility measures This standard contains indicators that measure efficiency of processes, such as
Efficiency Indicators and turnaround time, and efficiency of human resource like OPD per doctor. Review of
ensure to reach State/ records should be done to assess that these indicators have been measured correctly.
National Benchmarks
Standard H3 This Standard is concerned with the indicators of clinical quality, such as average length
The facility measures of stay and complication rates. Record review should be done to see the measurement
Clinical Care & Safety of these indicators.
Indicators and tries to
reach State/National
benchmarks
Standard H4 This standard is concerned with indicators measuring service quality and patient
The facility measures satisfaction like Patient satisfaction score and waiting time and LAMA rate.
Service Quality
Indicators and
endeavours to reach
State/National
benchmarks

102 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - H: Outcomes
Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National
benchmarks
ME H1.1 The facility measures productivity Indicators on monthly basis
ME H1.2 The facility measures equity indicators periodically
ME H1.3 The facility ensures compliance of key productivity indicators with national/state benchmarks
Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark
ME H2.1 The facility measures efficiency Indicators on monthly basis
ME H2.2 The facility ensures compliance of key efficiency indicators with national/state benchmarks
Standard H3 The facility measures Clinical Care and Safety Indicators and tries to reach State/National
benchmark
ME H3.1 The facility measures Clinical Care and Safety Indicators on monthly basis
ME H3.2 The facility ensures compliance of key Clinical Care and Safety with national/state benchmarks
Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National
benchmark
ME H4.1 The facility measures Service Quality Indicators on monthly basis
ME H4.2 The facility ensures compliance of key Service Quality with national/state benchmarks

National Quality Assurance Standards for Primary Health Centre (24x7) 103
National Quality Assurance
Standards for Urban Primary
Health Centre
 national QUALITY ASSURANCE STANDARDS FOR
uRBAN pRiMARY hEALTH CENTre

Area of Concern - A: Service Provision

Standard A1 The facility provides Promotive, preventive and curative services
Standard A2 The facility provides RMNCHA Services
Standard A3 The facility provides Diagnostic Services, Para-clinical & support services.
Standard A4 The facility provides services as mandated in National Health Programmes.
Standard A5 The facility provides services as per local needs/State specific health Programmes as per guidelines
Area of Concern - B: Patients’ Rights
Standard B1 The service provided at facility are accessible
Standard B2 The service provided at facility are acceptable
Standard B3 The service provided at facility are affordable
Area of Concern - C: Inputs
Standard C1 The facility has adequate & Safe infrastructure for delivery of assured services and meets the
prevalent norms
Standard C2 The facility has adequate qualified and trained staff, required for providing the assured services to
the current case load
Standard C3 The facility provides drugs and consumables required for assured services.
Standard C4 The facility has equipment & instruments required for assured list of services.
Area of Concern - D: Support Services
Standard D1 The facility has established facility management programme for maintenance & upkeep of
equipment & infrastructure to provide safe & secure environment to staff & users
Standard D2 The facility has defined procedure for storage, Inventory Management & dispensing of drugs in
pharmacy
Standard D3 The facility has defined & established procedure for Community Participation for providing assured
services
Standard D4 The facility has defined procedure for Governance & work Management
Standard D5 The facility has procedure for collecting & Reporting of the health facility related information
Area of Concern - E: Clinical Services
Standard E1 The facility has defined procedures for registration and consultation of patients.
Standard E2 The facility has defined procedure for primary management and continuity of care with appropriate
maintenance of records
Standard E 3 The facility has defined & implemented procedures for Drug administration and standard treatment
guideline as mandated by Govt.
Standard E4 The facility has defined & establish procedure for Diagnostic Services
Standard E5 The facility has establish procedure for Maternal health care as per guideline
Standard E6 The facility has established procedure for care of New born & Child as per guideline

National Quality Assurance Standards for Urban Primary Health Centre 107
 Standard E7 The facility has establish procedure for Family Planning as per Govt guideline
Standard E8 The facility provides Adolescent reproductive & sexual health services as per guideline
Standard E9 The facility provides National Health Programmes as per operational/clinical guidelines of the
Government
Area of Concern - F: Infection Control
Standard F1 The facility has defined & implemented procedure for ensuring Hand hygiene practices & asepsis
Standard F2 The facility ensures availability of Personal Protective equipment & follows standard precautions.
Standard F3 The facility has standard procedure for disinfection &sterilization of equipment
& instrument
Standard F4 The facility has defined & establish procedure for segregation, collection, treatment
& disposal of Bio medical &hazardous waste
Area of Concern - G: Quality Management
Standard G1 The facility has established quality Assurance Programme as per state/National guidelines
Standard G2 The facility has established system for Patients and employees satisfaction
Standard G3 The facility has established, documented & implemented standard operating procedure system for
its all key processes.
Area of Concern - H: Outcomes
Standard H1 The facility measures its productivity, efficiency, clinical care & service Quality indicators
Standard H2 The facility endeavours to improve its performance to meet bench marks

108 National Quality Assurance Standards for Public Health Facilities | 2020
 Intent of standards AND Measurable
elements FOR uRBAN pRiMARY hEALTH CENTre

Area of Concern - A: Service Provision

Overview
This area of concern related to ‘Service Provision’ measures availability of committed services being available at
the UPHC. It implies that all services, which are supposed to be available at an UPHC are available or alternative
arrangements for their meaningful availability have been made. It needs to be appreciated that mere availability
of human resources (who are capable of delivering the committed services), infrastructure, human resources,
equipment, etc. does not necessarily ensure availability of the services.

Standard A1 Compliance to this standard essentially include availability of OPD consultation for
Facility provides commonly treatable illnesses like Respiratory Tract Infections, GI Infections, Conjunctivitis,
Promotive, Preventive etc. as well as availability of minor procedures such as stitching, Incision & drainage
and Curative Services under local anaesthesia, Nebulisation, suture removal, etc. The facility is also expected to
provide detection of NCD such as Diabetes Mellitus, Hypertension, etc. as well as follow-up
treatment of such conditions.
Standard A2 RMNCH+A services to the extent of its delivery as applicable to an OPD facility like UPHC
Facility provides need to be available at the facility. RMNCH+A approach covers continuum of care across the
RMNCHA Services life-cycle. There are five measurable elements in this standard & each represents the services
pertaining to one stage of life cycle i.e. Reproductive, Maternal, Newborn, Childhood &
Adolescent. Under this standard, an UPHC is expected to provide services like ANC check-
up, Stabilisation of Complicated delivery & referral, Family Planning services, Post-natal
care, treatment of Newborn, Infants and Childhood illnesses & Adolescent Health.
Standard A3 This standard mandates the UPHC to provide commensurate pharmacy, diagnostics, medico-
Facility provides legal and support services at the facility, so that all mandated functions are undertaken,
Diagnostic Services, as per need. If the diagnostic services are not available within the UPHC, there should
Para-clinical & be a robust functional linkage with other facilities (Govt/Private), so that only approved
Support services expenditure (as per norm of the UPHC) is incurred in availing such facilities and required
reports are available for making decisions for treatment & referral. The UPHC is expected
to be the first port of call for treatment. Therefore, other than rendering primary treatment
and referral, the UPHC would have facility for medico-legal examination within the facility,
or there is a linkage with another institution, where such cases.
would be referred. The Standard also mandates that the facility would not deny the
available treatment to needy patients merely on the ground that medico-legal facilities are
not available at the same UPHC.
Standard A4 Most of the National Health Programmes have a set of interventions, which are required to
The facility provides be undertaken by UPHC at two locations – (a) Within the Geographical boundary of UPHC,
services as mandated and (b) Out-reach Activities, which are directly or indirectly mentored or supervised by the
in the National Health UPHC. Compliance to this standard ensures availability of the both set of services under the
programmes various National Health Programmes. The measurable elements in these standards measure
availability of the services under the National Health Programme, as applicable at UPHC.
Standard A5 The UPHC is expected to address to the need of specific local health issues/conditions,
The facility provides prevalent in a defined geographical area. Under this Standard, compliance to such
services as per local requirement is measured. It is acknowledged that checkpoints for this Standard and
needs/State specific supporting measurable elements would need additional inclusion during the customisation
health programmes as stage, so as to capture the compliance of the Health Facility to this standard.
per guidelines

National Quality Assurance Standards for Urban Primary Health Centre 109
 Area of Concern - A: Service Provision
Standard A1 The facility provides Promotive, preventive and curative services
ME A1.1 The facility provides treatment of common ailments
ME A1.2 The facility provides Accident & Emergency Services
ME A1.3 The facility provides AYUSH Services
ME A1.4 Services are available for the time period as mandated
Standard A2 The facility provides RMNCHA Services
ME A2.1 The facility provides Reproductive health Services
ME A2.2 The facility provides Maternal health Services
ME A2.3 The facility provides Newborn health Services
ME A2.4 The facility provides Child health Services
ME A2.5 The facility provides Adolescent health Services
Standard A3 The facility provides Diagnostic Services, Para-clinical & support services
ME A3.1 The facility provides Pharmacy services
ME A3.2 The facility provides diagnostic services
ME A3.3 The facility provides medico legal and administrative services
ME A3.4 The facility provides support services
Standard A4 The facility provides services as mandated in National Health Programmes
ME A4.1 The facility provides services under National Vector Borne Disease Control Programme as per
guidelines
ME A4.2 The facility provides services under Revised National TB Control Programme as per guidelines
ME A4.3 The facility provides services under National Leprosy Eradication Programme as per guidelines
ME A4.4 The facility provides services under National AIDS Control Programme as per guidelines
ME A4.5 The facility provides services under National Programme for prevention and control of Blindness as
per guidelines
ME A4.6 The facility provides services under Mental Health Programme as per guidelines
ME A4.7 The facility provides services under National Programme for the health care of the elderly as per
guidelines
ME A4.8 The facility provides services under National Programme for Prevention and control of Cancer,
Diabetes, Cardiovascular diseases & Stroke (NPCDCS) as per guidelines
ME A4.9 The facility provides services under Integrated Disease Surveillance Programme as per Guidelines
ME A4.10 The facility provides services under National health Programme for deafness
ME A4.11 The facility provides services under Universal Immunization Programme (UIP) as per guidelines
ME A4.12 The facility provides services under National Iodine deficiency Programme as per guidelines
ME A4.13 The facility provides services under National Tobacco Control Programme as per guidelines
ME A4.14 The facility provides services under National Oral Health Care Programme
Standard A5 The facility provides services as per local needs/State specific health Programmes as per
guidelines
ME A5.1 The facility maps its vulnerable population enabling micro-planning for outreach services
ME A5.2 The facility provides services as per local needs/state specific health Programmes as per guidelines

110 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - B: Patients’ Rights

Overview
The ‘Area of Concern: B’ relates to patients’ rights in a Health Facility. This includes many dimension of patients’
interface with the Health System – the services are accessible, acceptable and affordable. Accessibility of the
Services has many dimensions – User-friendly signage system, display of information pertaining to entitlements,
citizen’s charter & system of complaint management & grievance redressal. Under this area of concern, the facility
needs to ensure service delivery with dignity without any differentiation on account of caste, economic status,
religion, and gender. Confidentiality of patient related information and records are preserved. The information is
assessed by the authorised personnel on ‘Need to know’ basis. Standards under this area of concern also assesses,
whether the services provided at UPHC are affordable to beneficiaries, without having any financial exclusion.
Physical Access is equally important dimension of Patients’ Rights. Therefore, a ramp at entrance, disable friendly
toilets & railings, appropriate siting of medicine counter, etc. would all be required at UPHC to comply with
Quality Standards under this Area of Concern.

Standard B1 This Standard defines obligation of the UPHC with regards to signage, so that a
The services provided at the visitor can reach the facility, and desired department within the facility. Therefore,
facility are accessible one of the key points is ‘user-friendliness’. All the signage’s are expected to be
bilingual. However, Local Government order may take precedence in exceptional
circumstances. The structure of the facility is required to be disable-friendly, and as
well as patient-friendly. The facility should have ‘citizen’s charter’ and information,
which a patient may need during the course of visit to health facility, should be
readily displayed. It should also include information pertaining to Grievance redressal
system, put in place at the health facility. The service providers are also expected
to obtain consent from the beneficiaries before commencement of treatment or
procedure. Type of consent could vary, largely depending upon the condition &
circumstances, such implied consent, expressed, informed consents. The standard
also expected that patients and visitors would be educated in the facility through
appropriate IEC/BCC intervention.
Standard B2 This standard pertains to ensure that UPHC has a sensitive system for gender related
The services provided at the issue in place. This also ensures providing adequate visual and verbal privacy of all
facility are acceptable patients. Information and records pertaining to patients are protected and disclosed
only to those who ‘need to know’. Religious and cultural preferences of patients
are always considered, at every point of interface between patients & relatives and
service providers. One of the important requirements under this standard is that
service providers’ behaviour with service seekers is always dignified, respectful and
emphatic. This dimension of the standard attains further importance at Public Health
Facilities in India, where often, one comes across issues pertaining to un-courteous
behaviour of service providers.
Standard B3 Under this Standard, the Public Health Facilities at all levels are required to meet
The service provided at the obligations under the National Health Programmes. Under the RMNCH+A approach,
facility is affordable the care is meant to be free of cost. Additionally, the states have social & health
protection scheme, so that Out of Pocket expenditure (OPE) is minimized first and
eliminated altogether, primarily for BPL population. The standard also demands that
facility would be meeting its obligation of providing free diagnostic and drugs as per
Essential Drug List (EDL).

National Quality Assurance Standards for Urban Primary Health Centre 111
 Area of Concern - B: Patients’ Rights
Standard B1 The service provided at facility are accessible
ME B1.1 The facility has uniform and user-friendly signage system
ME B1.2 The facility displays the services and entitlements available
ME B1.3 The facility has established citizen charter
ME B1.4 Patients & visitors are sensitized and educated through appropriate IEC/BCC approaches
ME B1.5 Information is available in bi-lingual signage and easy to understand
ME B1.6 The facility has defined and established grievance redressed system in place
ME B1.7 Information about the treatment is shared with patients or attendants and consent is taken
wherever required
ME B1.8 Access to facility is provided without any physical barrier
Standard B2 The service provided at facility are acceptable
ME B2.1 Services are provided in manner that are sensitive to gender
ME B2.2 Adequate visual privacy is provided at every point of care
ME B2.3 Confidentiality of patients’ records and clinical information is maintained
ME B2.4 The facility ensures the behaviour of staff is dignified and respectful, while delivering the services
ME B2.5 Religious and cultural preferences of patients and attendants are taken into consideration while
delivering services
Standard B3 The service provided at facility are affordable
ME B3.1 The facility provides cashless services to all patients including pregnant women, mothers and sick
children as per prevalent government schemes
ME B3.2 The facility provide free of cost treatment to Below poverty line patients without administrative
hassles
ME B3.3 The facility ensures that the drugs prescribed are available in the pharmacy
ME B3.4 The facility ensure investigation prescribed are available at the Laboratory

112 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - C: Inputs

Overview
A viable Quality Assurance System requires three components – Structure, Process and Outcome. The area of
concern ‘C’ predominantly covers structural requirement of the facility. Separate quality standards under this group
look at compliance of UPHC to availability of ‘Input’ component. Thus, there should be availability of minimum
infrastructure which is safe, staffs is available in adequate number and the staff has knowledge and skill to deliver
the UPHC mandated services, adequate quantity of drugs & consumable are available, and required equipment
& instruments are there. Quality standards given in this area of concern take cognizance of the requirement of
facility, which are ‘essential’ for the delivery of mandated health care. However, the focus is on ensuring presence
of minimum level of inputs, which is needed for given case-load. The words like ‘adequate’ and ‘as per load ‘has
been given in the requirements for many standards & measurable elements, as it would be hard to have uniform
norm for every level of the facility.

Standard C1 This standard measures adequacy of the facility’s infrastructure in terms of space,
The facility has adequate patient amenities, layout, circulation area, communication facilities etc. Minimum
& safe infrastructure for requirement for space, layout and patient amenities are given for some of
delivery of assured services, departments, but assessors are expected to use their judgement to assess whether
and it meets the prevalent the available space is adequate for the given work-load. Compliance to most of the
norms measurable elements can be assessed by direct observation except for checking
functional adequacy, where discussion with facility staff may be required to know
the process flow between the departments, and also within a department.
This also deals with Physical safety of the infrastructure and includes seismic
safety, electrical safety, and general condition of infrastructure. This standard also
mandates for adequate fire-safety measures being implemented at the facility
Standard C2 This standard measures the numerical adequacy and skill-sets of the staff. It
The facility has adequate includes availability of doctors, nurses, paramedical and support staff. It also
qualified and trained staff, assesses whether the staff has been trained as per their job description &
required for providing responsibilities, and have the appropriate skill sets to carry out their duties. Skill
the assured services to the sets may be assessed by reviewing training records, taking staff interviews and
current caseload through demonstration to check whether the staff has requisite skills to perform
procedures/their duties.
Standard C3 This Standard measures availability of drugs and consumables at different service
The facility provides drugs areas of UPHC. This includes drugs (including drugs required for Emergency
and consumables required for treatment), IV Fluids, splints, Oxygen, vaccines, lab reagents and contraceptives.
assured services In addition, the standard also looks at the availability of drugs at every point of
use, including adequate quantity of EDL at the pharmacy. It is expected under
this standard that drugs under National Health Programmes would also be
available at UPHC as per programme guidelines.
Similarly, other consumables would also be available at every point of use.
Standard C4 This standard is concerned with the availability of necessary equipment
The facility has equipment and instruments in the facility. The instruments and equipment have been
& instruments required for categorized into sub groups as per their use, and measurable elements have
assured list of services been assigned to each sub group, such as examination and monitoring, clinical
procedures, diagnostic equipment, resuscitation equipment, storage equipment
and equipment used for non-clinical and support services.
The standard also looks at the availability of required furniture & fixture in usable
condition within the facility. Since one of the major activities, undertaken by
UPHC, pertains to out-reach sessions in community. Therefore, the standard
warrants that the facility would have equipment, instrument and furniture &
fixtures, which are required for out-reach activities.

National Quality Assurance Standards for Urban Primary Health Centre 113
 Area of Concern - C: Inputs
Standard C1 The facility has adequate & Safe infrastructure for delivery of assured services and meets
the prevalent norms
ME C1.1 Departments have adequate space as per patient load
ME C1.2 Amenities for Patients & Staff are available as per load
ME C1.3 Departments have layout and demarcated areas as per functions
ME C1.4 The facility has infrastructure for intramural and extramural communication
ME C1.5 The facility ensures safety of electrical installations
ME C1.6 Physical condition of buildings are safe for providing patient care
ME C1.7 The facility ensures fire safety measures including firefighting equipment
Standard C2 The facility has adequate qualified and trained staff, required for providing the assured
services to the current case load
ME C2.1 The facility has adequate medical officers as per service provision and work load
ME C2.2 The facility has adequate nursing staff/Paramedics as per service provision and work load
ME C2.3 The facility has adequate support staff/Health Workers as per service provision and workload
ME C2.4 The Staff has been imparted necessary trainings/skill set to enable them to meet their roles &
responsibilities
ME C2.5 The Staff is skilled and competent as per job description
Standard C3 The facility provides drugs and consumables required for assured services.
ME C3.1 The facility has availability of adequate drugs at point of use
ME C3.2 The facility has availability of adequate consumables at point of use
Standard C4 The facility has equipment & instruments required for assured list of services.
ME C4.1 Availability of equipment & instruments for examination & monitoring of patients
ME C4.2 Availability of equipment & instruments for treatment procedures, being undertaken in the facility
ME C4.3 Availability of equipment & instruments for diagnostic procedures being undertaken in the facility
ME C4.4 Availability of equipment for storage
ME C4.5 Availability of patient furniture and fixtures as per load and service provision
ME C4.6 Availability of functional equipment and instruments for support & outreach services

114 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - D: Support Services

Overview
The expected clinical outcome cannot be envisaged in absence of sturdy support services. Support Services
have an important role in ensuring that PUHC delivers all mandated services qualitatively. This area of concern
includes maintenance of critical equipment and the facility having comfortable, conducive and safe environment
for patients and facility staff. The available space is clutter-free. Safe & potable drinking water is available. There
is a system for calibration of measurable equipment, drug storage and inventory management, security services,
facility management and power back up. The Standards for Administrative processes under this area of concern
look at the functioning of RKS, Financial management and legal compliances. The staff deputation and contract
management have also been included here, which also includes various monitoring & reporting activities of
UPHC, especially with regards to the National Health Programmes.

Standard D1 The standard has many dimensions, starting with maintenance programme of
The facility has an established critical equipment, creating comfortable environment for patients & relatives,
Facility management etc. and it culminates into the requirement of having power back up. It has
Programme for maintenance been commonly observed that valuable space inside a health facility is occupied
and upkeep of equipment and by Junk Material and unserviceable. The Standard also expects that the facility
infrastructure to provide safe would a system in place to address this issue. Illumination level in different areas
and secure environment to of the health facility is required to be maintained as per norm. Maintenance of
staff and the users infrastructure as well as safety & security of the staff and patients also needs to
be ensured to attain compliance under the standard. Equipment at the facility
is required to have a maintenance programme either AMC/CMC, more so for
the critical equipment, so that care of patients is not adversely affected due to
unservice ability of equipment. Calibration records and labels on the measuring
equipment are also required to be maintained to confirm the calibration.
Operating instructions should be displayed or should be readily available with
the users of the equipment.
The Standard also expects that the facility would provide clean and conducive
environment for patients and as well for the service providers. Thus proper
ventilation, maintenance of ‘comfort zone’ temperature, safety & security,
mosquito-free environment, etc. are required to be ensured under this standard.
The standard is also concerned with adequacy of facility management system
such as facility’s cleaning processes, infrastructure maintenance, and control of
stray animals, pest control inside the facility, etc. including power back-up.
Standard D2 A health facility is expected to have a scientific system for demand forecasting
The facility has defined and indenting of drugs and consumables. This standard is also concerned with
procedures for storage; safe storage of drugs and scientific management of the inventory, so that drugs
inventory management and consumables are available in adequate quantity in patient care areas,
and dispensing of drugs at without over-stocking of drugs or medicines getting expired. The standard has
pharmacy many dimensions such as processes of indenting, procurement, storage, expired
drugs management, inventory/stock management in patient care areas. While
assessing the drug management system, these practices should be looked for in
the patient areas, dispensary and store.
Standard D3 A large number of activities do take place in out-reach setting for the targeted
The facility has defined & beneficiaries. This standard measures processes related to functioning of Mahila
established procedure for Arogya Samit (MAS), Rogi Kalyan Samiti (RKS) and community participation in
community participation for the management of UPHC. Under the Communitisation, Rogi Kalyan Samitis are
providing assured services expected to have a greater role in management of UPHC, so that community
has a voice in the facility and its expectations are met. Participation of the non-
official members in RKS meetings should especially be ensured. AHSA plays an
important role as mobiliser, facilitator and link-worker between community

National Quality Assurance Standards for Urban Primary Health Centre 115
 and UPHC. Thus, it is expected under this standard that functioning of ASHA
would be supported, mentored and monitored by the UPHC. Quality of support
in functioning of Mahila Arogya Samitis (MAS) within the targeted population
would also be important as a part of compliance to this standard.
Standard D4 This standard looks at the compliance of UPHC to those managerial functions,
PHC has defined procedure which may not have direct bearing in delivery of healthcare per se, but
for Governance & work attributes of this standard have far-reaching implications, in term of utilisation
management of funds, management of outsourced services, compliance of Govt. guidelines
and statutory requirements, etc. Beneficiaries at UPHC may also need a medical
certificate for the sickness, which often needed by their employers.
This standard is also concerned with the processes of staff management and their
deployment. This includes availability of the job descriptions for different cadre
of staff, processes regarding preparation of duty rosters and staff discipline. Staff
can be interviewed to assess their awareness of the job functions. It should be
assessed by observation and review of the records. Adherence to dress code
should be observed during the assessment.
Standard D5 Statistical information plays a critical role in planning and monitoring of health
Hospital has defined and services in a given geographical area. This standard is concerned with timely and
established procedure for adequate reporting of Quality data, as required under the applicable National
collecting & reporting Health Programmes, and State’s/UTs initiatives, programmes and departmental
of Health facility related instructions. The Assessor should review the records of such reporting in term
information of record’s quality, timeliness, adequacy and meeting the need of the health
systems.

116 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - D: Support Services
Standard D1 The facility has established facility management programme for maintenance & upkeep of
equipment & infrastructure to provide safe & secure environment to staff & users
ME D1.1 The facility has system for maintenance of critical Equipment
ME D1.2 The facility ensures comfortable environment for patients and service providers
ME D1.3 Patient care areas are clean and hygienic
ME D1.4 The facility infrastructure is adequately maintained
ME D1.5 The facility has policy of removal of condemned junk material
ME D1.6 The facility maintains both the internal and open area of the facility.
ME D1.7 The facility provides adequate illumination level at patient care areas
ME D1.8 The facility provides Clean and adequate linen as per requirement
ME D1.9 The facility has adequate arrangement for storage and supply of potable water in all functional
areas
ME D1.10 The facility ensures adequate power backup
Standard D2 The facility has defined procedure for storage, Inventory Management & dispensing of
drugs in pharmacy
ME D2.1 The facility has established procedures for estimation, indenting and procurement of drugs and
consumables
ME D2.2 The facility ensures proper storage of drugs and consumables
ME D2.3 The facility ensures management of expiry and near expiry drugs
ME D2.4 The facility has established procedure for inventory management techniques
ME D2.5 There is process for storage of vaccines and other drugs, requiring controlled temperature &
storage environment
ME D2.6 The facility has established procedure for dispensing of drugs
Standard D3 The facility has defined & established procedure for Community Participation for providing
assured services
ME D3.1 The facility has established procedures for management of activities of Rogi Kalyan Samiti
ME D3.2 The facility has established procedures for community based monitoring of its services
ME D3.3 The facility has established procedure for supporting and monitoring activities of community health
work - ASHA
ME D3.4 The facility has established procedure for supporting and monitoring activities of Mahila Arogya
Samiti
Standard D4 The facility has defined procedure for Governance & work Management
ME D4.1 The facility ensures the proper utilization of fund provided to it
ME D4.2 There is established system for contract management for out-sourced services
ME D4.3 The facility has established job description as per Govt. guidelines
ME D4.4 The facility has an established procedure for duty roster and deputation of staff
ME D4.5 The facility ensures the adherence to dress code as mandated by the department
ME D4.6 The facility has requisite licenses and certificates, as required for operation of a health facility
ME D4.7 The facility ensures its processes are in compliance with statutory and legal requirement
ME D4.8 The facility has a defined protocol for the issue of medical certificates

National Quality Assurance Standards for Urban Primary Health Centre 117
 Standard D5 The facility has procedure for collecting & Reporting of the health facility related
information
ME D5.1 The facility provides monitoring and reporting services under National Vector Borne Disease
Control Programme as per guidelines
ME D5.2 The facility provides services monitoring and reporting services under Revised National TB Control
Programme, as per guidelines
ME D5.3 The facility provides monitoring and reporting services under National Leprosy Eradication
Programme as per guidelines
ME D5.4 The facility provides services under National AIDS Control Programme, as per guidelines
ME D5.5 The facility provides monitoring and reporting services under National Programme for control of
Blindness as per guidelines
ME D5.6 The facility provides monitoring and reporting services under Mental Health Programme, as per
guideline
ME D5.7 The facility provides monitoring and reporting services under National Programme for the health
care of the elderly as per guidelines
ME D5.8 The facility provide monitoring and reporting service for prevention and control of Cancer,
diabetes, cardiovascular disease and stroke as per guidelines
ME D5.9 The facility provide monitoring and reporting service for Integrated Disease Surveillance
Programme, as per guidelines
ME D5.10 The facility provide services under National Programme for prevention and control of deafness, as
per guidelines
ME D5.11 The facility provides monitoring and reporting services under Universal Immunization Programme,
as per guidelines
ME D5.12 The facility provides monitoring and reporting services under National Iodine deficiency
Programme, as per guidelines
ME D5.13 The facility provides monitoring and reporting services under National tobacco Control
Programme, as per guidelines
ME D5.14 The facility Reports data for Mother and Child Tracking System as per Guidelines
ME D5.15 The facility Reports data for HMIS System as per Guidelines

118 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - E: Clinical Services

Overview
This Area of Concern ‘E’: Clinical Services pertains to organisation core functions, which are essentially undertaken
to ensure for delivery of patient related services at the UPHC. Thus, the standards under this area of concern are
directly ‘Patient – centric’, thereby endeavouring to put a system in place which is in consonance with patient flow
in a health facility. The Standards under this area of concern have been grouped into three categories. First four
standards are concerned with those clinical processes that ensure adequacy of care for the patients and include
procedures for registration, consultation, clinical assessment, continuity of care, referral services, prescription
practices, safe drug administration, maintenance of clinical records and diagnostic services by the facility.
The next sets of four standards are concerned with specific clinical processes for Maternal, Newborn, Child, Adolescent
& Family Planning services, which are obvious priority programme interventions in our country. The last standard
pertains to the National Health Programmes. These standards are based on the technical guidelines published by
the Government of India on respective programmes and processes. However, it needs to be acknowledged here that
gradually a shift from ‘programme based approach’ to health system’s approach is taking place.
It may be difficult to assess clinical processes, as direct observation of clinical procedures may not always be
possible and conducive at the time of assessment of health facility. Therefore, assessment of these standards
would largely also depend upon collating information from many sources such as review of the clinical records and
interaction with the staff and beneficiaries, elucidation of which require utmost care and sensitivity.

Standard E1 This standard is concerned with the registration process and OPD consultation
The facility has defined process in facility. Usually registration counter is the first interface between
procedures for registration the beneficiaries and the health facility. Hence, other than reviewing records,
and consultation of patients direct observation of prevalent system including time taken in reaching the
counter (in queue) and thereafter time taken for completing the registration,
crowd management, behaviour of registration clerk, and subsequently his/her
facilitation in reaching the OPD area, waiting & consultation come within the
purview of this standard. The Assessor should review the records to verify that
necessary details of patients have been recorded, and that the patients have
been given unique identification numbers. OPD consultation may be directly
observed, followed by review of OPD tickets to ensure that patient history,
examination details, provisional diagnosis etc. have been recorded on the
OPD ticket.
Standard E2 Primary Health Centres are usually the first point of contact where patient can get
The facility has procedures qualified medical attention. This standard includes process of initial assessment,
for primary management reassessment and referral to another facility (if required), triage if more than one
and continuity of care of patient is received, linkages with higher institutions and follow-up of patients
patients with appropriate discharged from higher centres. The facility staff should be interviewed about
maintenance of records the referral linkages, how they communicate with the referral hospital. Timely
arrangement of correct type of ambulance/vehicle as required for the clinical
condition of patient would also be required under this standard. Safe storage and
easy retrival of Medical records is also part of this standards.
Standard E3 This standard is concerned with assessing whether the patients are prescribed
The facility has defined & drugs according to the standard treatment guidelines and protocols. Patient
implemented procedures prescriptions are assessed to ascertain that prescriptions are written in generic
for Drug administration, names only. This standard is also concerned with the process for checking drugs
and Standard Treatment before administration and those related to self-medication. Patient’s records
Guidelines, as mandated by should be reviewed for legibility of the writing, and recording of date and time of
the Government prescription orders. Safe injection practices like use of separate needle for multi-
dose vial should be observed.

National Quality Assurance Standards for Urban Primary Health Centre 119
 Standard E4 This standard deals with technical procedures related to organisation of work
The facility has defined and within laboratories and other diagnostic services. It includes pre-testing, testing
established procedures for and post-testing procedures. Generally pre-testing activities entail labelling of
Diagnostic Services samples, system of tracing, handling of samples, processing, are few of key activities
under this standard. The process for storage and transportation of samples needs
are also covered under this standard, including personnel authorised to release
the reports. Availability of critical values and biological references should also
be ensured to maintain Internal & External Quality Assurance Procedure. Since
Malaria & Tuberculosis are important Health Problems in the country. The
programme guidelines have detailed procedures for availability of services and a
system of validation. Diagnostic Services requirement of Malaria and Tuberculosis
programmes have been included in this Standard.
Standard E5 This Standard is concerned with the processes, which ensure that adequate
The facility has established and quality antenatal and post-natal care are provided at the facility. It
procedures for Maternal includes measurable elements for ANC registration, processes during check-up,
health care as per guidelines identification of High Risk pregnancy, management of anaemia and counselling
services. Staff at the ANC clinic should be interviewed and records should be
reviewed for maintenance of MCP cards and registration of pregnant women.
For assessing quality and adequacy of ANC check-up, direct observation may be
undertaken after obtaining requisite permission. ANC records can be reviewed
to see findings of examination and diagnostic tests are recorded. The assessment
of follow-up of Anaemia cases should be reviewed. Beneficiaries and staff can be
interacted for counselling on the nutrition, birth preparedness, family planning
etc. Processes for Post-natal care are also part of this standard.
Standard E6 This is concerned with adherence to clinical protocols for newborn and child
The facility has established health. It covers immunization, management of newborn and childhood illnesses
procedures for care of like malnutrition, Pneumonia and diarrhoea. Immunization services are majorly
newborn and child as per assessed at immunization clinic. Staff interviews and observation should be done
guidelines to assess availability of diluents, adherence to protocols of reconstitution of
vaccine, storage of VVM labels and shake test.
Adherence to clinical protocols for management of different illnesses in newborns
and children should be done by interaction with the doctors and nursing staff.
Particular attention is paid to early detection of Malnutrition cases. UPHC has
significant role in delivery of Rashtriya Bal Swasthya Karyakram. Its compliance is
checked under this standard.
Standard E7 This Standard is concerned with providing safe and quality family planning and
The facility has established abortion services. This includes standard practices and procedures for Family
procedures for family planning counselling, spacing methods, and procedures for abortion (including
planning as per government emergency contraceptive and mifeprestone/mifeprostol pills). Quality and
guidelines adequacy of counselling services can be assessed by exit interview with the
beneficiaries. The staff at family planning clinic may be interacted to assess
adherence to the protocols for IUCD insertion, precaution & contraindication for
oral pills etc.
Standard E8 This Standard is concerned with services related to adolescent Reproductive and
The facility provides Sexual health (ARSH) guidelines. It includes promotive, preventive, curative and
adolescent Reproductive and referral services under the ARSH. The records of such services should be checked,
Sexual Health services as per facility staff be interviewed, and records are reviewed.
guidelines
Standard E9 This Standard looks at adherence for programme guidelines and clinical care (as
The facility provides expected in a PUHC) under the National Health Programmes. For each of the
services under National National Health Programmes, availability of clinical services as per respective
Health programmes as guidelines should be assessed. Compliance to measurable elements having relevant
per Operational/clinical checkpoints could be ‘tracer’ at facility based care and also outreach services.
Guidelines of the Government

120 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - E: Clinical Services
Standard E1 The facility has defined procedures for registration and consultation of patients
ME E1.1 The facility has established procedure for registration of patients
ME E1.2 The facility has an established procedure for OPD consultation
Standard E2 The facility has defined procedure for primary management and continuity of care with
appropriate maintenance of records
ME E2.1 There is established procedure for initial assessment & Reassessment of patients
ME E2.2 The facility provides appropriate referral linkages for transfer to other/higher facilities to assure the
continuity of care.
ME E2.3 The facility ensures follow up of patients
ME E2.4 The facility has establish procedure for Triage & disaster Management
ME E2.5 Emergency protocols are defined and implemented
ME E2.6 The facility ensures adequate and timely availability of ambulances services
ME E2.7 Clinical records are updated for care provided
ME E2.8 The facility ensures that standardized forms and formats are used for all purposes including
registers
ME E2.9 The facility ensures safe and adequate storage and retrieval of medical records
Standard E 3 The facility has defined & implemented procedures for Drug administration and standard
treatment guideline as mandated by Government
ME E3.1 Medication orders are written legibly and adequately
ME E3.2 There is a procedure to check drug before administration & dispensing
ME E3.3 Patient is counselled for self-drug medication
ME E3.4 The facility ensures that drugs are prescribed in generic name only
ME E3.5 There is procedure of rational use of drugs
ME E3.6 Drugs are prescribed according to Standard Treatment Guidelines
Standard E4 The facility has defined & establish procedure for Diagnostic Services
ME E4.1 There are established procedures for Pre-testing Activities
ME E4.2 There are established procedures for testing Activities
ME E4.3 There are established procedures for Post-testing Activities
ME E4.4 There are established procedures for laboratory diagnosis of Tuberculosis as per prevalent
guidelines
ME E4.5 There are established procedures for laboratory diagnosis of Malaria as per prevalent guidelines
Standard E5 The facility has establish procedure for Maternal health care as per guideline
ME E5.1 There is an established procedure for Registration and follow up of pregnant women.
ME E5.2 There is an established procedure for History taking, Physical examination, and counselling of each
antenatal woman, visiting the facility.
ME E5.3 The facility ensures of drugs & diagnostics are prescribed as per protocol
ME E5.4 There is an established procedure for identification of High risk pregnancy and appropriate &
Timely referral.
ME E5.5 There is an established procedure for identification and management of anaemia
ME E5.6 Counselling of pregnant women is done as per standard protocol and gestational age

National Quality Assurance Standards for Urban Primary Health Centre 121
 ME E5.7 There is an established procedures for Postnatal visits & counselling of Mother and Child
Standard E6 The facility has established procedure for care of New born & Child as per guideline
ME E 6.1 Post-natal visit & counselling for New born care is provided as per guideline
ME E 6.2 Triage, Assessment & Management of Newborn having emergency signs are done as per guidelines
ME E 6.3 Management of children presenting with fever, cough/breathlessness is done as per guidelines
ME E 6.4 Management of children with severe Acute Malnutrition is done as per guidelines
ME E 6.5 Management of children presenting diarrhoea is done per guidelines
ME E 6.6 Screening & Referral of children as per guidelines of Rashtriya Bal Swasth Karyakram
Standard E7 The facility has establish procedure for Family Planning as per Govt guideline
ME E7.1 Family planning counselling services provided as per guidelines
ME E7.2 The acility provides spacing method of family planning as per guideline
ME E7.3 The facility provides IUCD service for family planning as per guidelines
ME E7.4 The facility provide counselling services for Medial Termination of Pregnancy as per guideline
ME E7.5 The facility provide abortion services for 1st trimester as per guideline
Standard E8 The facility provides Adolescent reproductive & sexual health services as per guideline
ME E8.1 The facility provides Promotive ARSH Services
ME E8.2 The facility provides Preventive ARSH Services
ME E8.3 The facility provides Curative ARSH Services
ME E8.4 The facility provides Referral Services for ARSH
Standard E9 The facility provides National Health Programmes as per operational/clinical guidelines of
the Government
ME E9.1 The facility provides service under National Vector Borne Disease Control Programme as per
guidelines
ME E9.2 The facility provides services under Revised National TB Control Programme as per guidelines
ME E9.3 The facility provides service under National Leprosy Eradication Programme as per guidelines
ME E9.4 The facility provides service under National AIDS Control Programme as per guidelines
ME E9.5 The facility provides services under National Programme for control of Blindness as per guidelines
ME E9.6 The facility provides service under Mental Health Programme as per guidelines
ME E9.7 The facility provides service under National programme for the health care of the elderly as per
guidelines
ME E9.8 The facility provides service under National Programme for Prevention and Control of cancer,
diabetes, cardiovascular diseases & stroke (NPCDCS) as per guidelines
ME E9.9 The facility provide service for Integrated disease surveillance Programme
ME E9.10 The facility provide services under National Programme for prevention and control of deafness
ME E9.11 The facility provides services under Universal Immunization Programme as per guidelines
ME E9.12 The facility provides services under National Iodine deficiency Programme as per guidelines
ME E9.13 The facility provides services under National Tobacco Control Programme as per guidelines
ME E9.14 The facility provides services under National Oral Health Programme as per guideline

122 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - F: Infection Control

Overview
Prevalence of Hospital Acquired Infections remains unacceptably high in the country. The first principle of health
care is “to do no harm”. Generally, Public health facilities have high caseload and infrastructure norms are not
always met. Therefore, probability of acquiring infection remains high, unless a robust system for Infection control
has been put in place. This area of concern cuts across many departments and hospital practices and looks at the
Infection control practices, hand-hygiene, asepsis, personal protection, processing of equipment, environment
control, and management of Biomedical Waste & Hazardous waste.

Standard F1 This standard is concerned with availability of material in the hand-washing

The facility has defined and area, so that health providers have ready access to material. It also looks at
implemented procedures the practice of hand washing. Availability of soap & running water are critical
for ensuring hand hygiene inputs for ensuring ‘Hand – Hygiene’. This needs to be supported by correct
practices and asepsis knowledge and attitude among facility staff for the hand-hygiene. Technique
of hand washing may be observed directly. Periodical Medical Examination
of Facility workers are another important intervention to promote infection
prevention and safety of workers at the UPHC. This standard looks at this
aspect as well.
Standard F2 This standard is concerned with usage of Personal Protection Equipment (PPE)
The facility ensures availability such as gloves, mask, apron, etc. Interaction with staff may reveal adequacy of
of personal protection, and the supplies, required for the PPE. Assessor should also observe whether the
follows standard precautions staffs are using correct method of wearing personal protection equipment.
Standard F3 This Standard is concerned with standard procedures, related to processing of
The facility has standard equipment and instruments. There should be processes to include adequate
procedures for processing for decontamination, cleaning, disinfection and sterilization of equipment and
disinfection and Sterilization instruments. Source of information for assessing compliance to this standard
of equipment and instruments may come from many sources – directly observing the procedures, and staff
interview, etc.
Standard F4 This standard is concerned with Management of Biomedical waste management
The facility has defined and including its segregation, ‘on-site’ disinfection as per protocol, transportation,
established procedures for disposal, and management of sharps. Availability of equipment and practices
segregation, collection, of segregation can be directly observed. Staff should be interviewed about
treatment and disposal of the procedure for management of the needle stick injuries. Storage and
Bio-medical and hazardous transportation of waste are observed. Waste generation, its collection by CWTF
Waste operator, record of injuries, referral of such cases and regulatory compliances are
verified through review of record.

National Quality Assurance Standards for Urban Primary Health Centre 123
 Area of Concern - F: Infection Control
Standard F1 The facility has defined & implemented procedure for ensuring Hand hygiene practices &
asepsis
ME F1.1 Hand washing facilities are provided at point of use
ME F1.2 Staff is trained and adhere to standard hand washing practices
ME F1.3 The facility ensures standard practices for maintaining asepsis
Standard F2 The facility ensures availability of Personal Protective equipment & follows standard
precautions
ME F2.1 The facility ensures adequate personal protection equipment as per requirements
ME F2.2 Staff adheres to standard personal protection practices
Standard F3 The facility has standard procedure for disinfection &sterilization of equipment &
instrument
ME F3.1 The facility ensures standard practices and materials for decontamination and cleaning of
instruments and procedures areas
ME F3.2 The facility ensures standard practices and materials for disinfection and sterilization of instruments
and equipment
Standard F4 The facility has defined & establish procedure for segregation, collection, treatment &
disposal of Bio medical & hazardous waste
ME F4.1 The facility ensures segregation of Bio Medical Waste as per guidelines
ME F4.2 The facility ensures management of sharps as per guidelines
ME F4.3 The facility ensures transportation and disposal of waste as per guidelines

124 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - G: Quality Management

Overview
Quality management requires a set of interrelated activities, which are required to be undertaken at the Health
Facility, so that implemented Quality System is internalised and sustained. The Quality system also contributes
towards building a system of ‘Continual’ improvement. Therefore, Quality Standards under this area of concerns
looks at the formation of a Quality team, development of Quality Policy & Objectives, activities for internal
Quality assurance, medical & prescription audits, etc. A Quality system needs to be ‘patient-centric’. Therefore,
the facility needs to institutionalise patient satisfaction survey (PSS). Satisfaction of employee is also of paramount
importance. Hence, the facility is expected to have institutional arrangement of conducting ‘Employee Satisfaction
Survey (ESS). One of the standards under this area of concern looks at the working with SOPs and protocols,
which are needed for delivery of services at the facility.

Standard G1 Standard G1 is concerned with constituting a Quality Team at the facility and
The facility has established making it functional. Assessor may review the document and interact with
Quality Assurance Programme the Quality Team members to know how frequently they meet and whether
as per State/National responsibilities have been delegated to them. Quality team meeting records
guidelines may be reviewed. This standard is also concerned with establishment and
dissemination of quality policy and objectives in the UPHC. The staff may be
interviewed to know their awareness of Quality policy and its objectives. Review
of records should be done to ascertain that the set Quality objectives at the
facility are meeting SMART criteria. The standard also looks at the system of
periodical review of Quality objectives.
Standard G2 This standard is concerned with having a system of measurement of patient
The facility has established and employee satisfaction. This includes periodic patients’ satisfaction survey,
systems for patient and analysis of the feedback and preparing action plan. Assessors should review the
employee satisfaction records pertaining to patient satisfaction and employee satisfaction survey to
ascertain that Patient feedback is taken at prescribed intervals and the sample
size is adequate.
Standard G3 Standard G3 is concerned with availability and adequacy of Standard operating
The facility has established, procedures and work instructions with the respective process owners. Display
documented and implemented of work instructions and clinical protocols should be observed during the
Standard Operating Procedure assessment.
System for its all key processes

National Quality Assurance Standards for Urban Primary Health Centre 125
 Area of Concern - G: Quality Management
Standard G1 The facility has established quality Assurance Programme as per state/National guidelines
ME G1.1 The facility has a quality team in place
ME G1.2 The facility has defined quality policy and it has been disseminated
ME G1.3 Quality objectives have been defined, and the objectives are reviewed and monitored
ME G1.4 The facility reviews quality of its services at periodic intervals
ME G1.5 The facility has established internal quality assurance programme
ME G1.6 The facility has established external assurance Programmes
ME G1.7 The facility conducts the periodic prescription/medical audits
ME G1.8 The facility ensures that non compliances are enumerated and recorded adequately
ME G1.9 Action plan is made on gaps found in the assessment/audit process
ME G1.10 Corrective and Preventive actions are taken to address the issues observed in the assessment and
audit
Standard G2 The facility has established system for Patients and employees satisfaction
ME G2.1 Patient Satisfaction surveys are conducted at periodic intervals
ME G2.2 Employee satisfaction Surveys are conducted at periodic intervals
ME G2.3 The facility prepares the action plans for the areas of low satisfaction
Standard G3 The facility has established, documented & implemented standard operating procedure
system for its all key processes
ME G3.1 Standard Operating procedures are prepared, distributed and implemented for all key processes
ME G3.2 Respective staff is trained in Standard Operating Procedures (SOPs)
ME G3.3 Work instructions are displayed at the point of work
ME G3.4 The facility uses methods and tools for Quality Improvement

126 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - H: Outcome

Overview
Conventionally, a Quality System has three important pillars – Structure, Process & Outcome. Measurement of
the quality is critical to improvement of processes and outcomes. This area of concern has two standards. First
Standard measures performance of health facility in term of Productivity, Efficiency, Clinical Care and Service
Quality and the second Standard pertains to performance improvement to meet the bench-marks (set by the
facility or allotted externally by the State/District/ULB). It is realised that the facility may not be measuring all
indicators pertaining to performance of UPHC. Hence, setting a process of recording of critical data elements,
which are required for KPI/Quality indicators, would be a good beginning. Subsequently, the facilities are expected
to work resolutely in improving the achieved target.

Standard H1 Productivity is defined as total output while efficiency is a level of performance

The facility measures its that uses the lowest amount of inputs to create the highest amount of outputs.
productivity, efficiency, clinical Broadly, this standard expects that the health facility would put a system in
care and service quality place to start recording data elements, which are required for the Quality KPI for
indicators UPHC. Few data elements may already be part of existing data reporting system.
Generation of additional data elements would be dependent upon the putting a
system in place for recording of such data elements. For instance, a UPHC would
be required to put a system for recording Patients Satisfaction and analysing
them, which would generate a composite patient satisfaction score.

Standard H2 One of the key essences of quality system is ‘continual improvement’ in all spheres
The facility endeavours to of facility’s Operations. In order to channelize the efforts for the ‘improvement’,
improve its performance and benchmarks are set for objectivity, transparency and maintaining the ‘system
meeting benchmarks approach’. Compliance to this standard reflects commitment of the management
toward ‘improvement’ process.

National Quality Assurance Standards for Urban Primary Health Centre 127
 Area of Concern - H: Outcomes
Standard H1 The facility measures its productivity, efficiency, clinical care & service Quality indicators
ME H1.1 The facility measures Productivity Indicators on monthly basis
ME H1.2 The facility measures efficiency Indicators on monthly basis
ME H1.3 The facility measures Clinical Care & Safety Indicators on monthly basis
ME H1.4 The facility measures Service Quality Indicators on monthly basis
Standard H2 The facility endeavours to improve its performance to meet bench marks
ME H2.1 The facility meets benchmarks set by the state/District for Key Indicators
ME H2.2 The facility strives to improve indicators from its current performance

128 National Quality Assurance Standards for Public Health Facilities | 2020
National Quality Assurance
Standards for Health and
Wellness Centre (Sub-centre)
 National Quality Assurance Standards for
Health and Wellness Centre (Sub-centre)

Area of Concern - A: Service Provision

Standard A1 The facility provides Comprehensive Primary Healthcare Services
Standard A2 The facility provides drugs and diagnostic services as mandated
Area of Concern - B: Patient Rights
Standard B1 The facility provides information to care seeker, attendants & community about available services
& their modalities
Standard B2 Facility ensures services are accessible to care seekers and visitors including those required some
affirmative action
Standard B3 Services are delivered in a manner that are sensitive to gender, religious & cultural needs and there
is no discrimination on account of economic or social reasons
Standard B4 The facility maintains privacy, confidentiality & dignity of patient
Standard B5 The facility ensures all services are provided free of cost to its users
Area of Concern - C: Inputs
Standard C1 The facility has adequate and safe infrastructure for delivery of assured services as per prevalent
norms and it provides optimal care and comfort to users
Standard C2 The facility has adequate qualified and trained staff required for providing the assured services as
per current case load
Standard C3 Facility has a defined and established procedure for effective utilization, evaluation and augmentation
of competence and performance of staff
Standard C4 The facility provides drugs and consumables required for assured services
Standard C5 Facility has adequate functional equipment and instruments for assured list of services
Area of Concern - D: Support Services
Standard D1 The facility has established Programme for maintenance and upkeep of the facility
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs
Standard D3 The facility has defined and established procedure for clinical records and data management with
progressive use of digital technology
Standard D4 The facility has defined and established procedures for hospital transparency and accountability.
Standard D5 The facility ensures health promotion and disease prevention activities through community
mobilization
Standard D6 The facility is compliant with statutory and regulatory requirement
Area of Concern - E: Clincal Care
Standard E1 The facility has defined procedures for registration, consultation, clinical assessment and
reassessment of the patients
Standard E2 The facility has defined and established procedures for continuity of care through two way
referral

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 131
 Standard E3 The facility has defined and established procedures of diagnostic services.
Standard E4 The facility has defined procedures for safe drug administration.
Standard E5 The facility follows standard treatment guidelines and ensures rational use of drugs
Standard E6 The facility has defined and established procedures for nursing care.
Standard E7 The facility has defined and established procedures for Emergency care
Standard E8 The facility has defined & established procedures for management of ophthalmic, ENT and Oral
ailments as per operational/clinical guidelines
Standard E9 The facility has defined & established procedure for screening & basic management of Mental
Health ailments as per Operational/clinical guidelines
Standard E10 The facility has defined & established procedures for management of communicable diseases as per
operational/clinical guidelines
Standard E11 The facility has defined & established procedures for management of non-communicable diseases
as per operational/clinical guidelines
Standard E12 Elderly & palliative health care services are provided as per guidelines
Standard E13 The facility has established procedures for care of new born, infant and child as per guidelines
Standard E14 The facility has established procedures for family planning as per government guidelines and law.
Standard E15 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines.
Standard E16 The facility has established procedures for Antenatal care as per guidelines
Standard E17 The facility has established procedure for intranatal care as per guidelines
Standard E18 The facility has established procedure for post natal Care
Area of Concern - F: Infection Control
Standard F1 The facility has established program for infection prevention and control
Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices
Standard F3 The facility ensures standard practices and equipment for Personal protection
Standard F4 The facility has standard procedures for disinfection and sterilization of equipment and instruments.
Standard F5 The facility has defined and established procedures for segregation, collection, treatment and
disposal of Bio Medical and hazardous Waste.
Area of Concern - G: Quality Management Systems
Standard G1 The facility has established organizational framework for quality improvement.
Standard G2 The facility has established system for patient and employee satisfaction
Standard G3 The facility has established, documented, implemented and updated Standard Operating Procedures
for all key processes and support services.
Standard G4 The facility has established system of periodic review of clinical, support and quality management
processes
Standard G5 Facility has defined Mission, Values, Quality policy and Objectives, and approved plan to achieve them.
Area of Concern - H: Outcome
Standard H1 The facility measures Productivity Indicators
Standard H2 The facility measures efficiency Indicators.
Standard H3 The facility measures Clinical Care Indicators.
Standard H4 The facility measures Service Quality Indicators

132 National Quality Assurance Standards for Public Health Facilities | 2020
 INTENT OF STANDARDS AND MEASURABLE ELEMENTS
FOR HEALTH AND WELLNESS CENTRE (SUB-CENTRE)

AREA OF CONCER - A: SERVICE PROVISION

Overview
Health and Wellness Centre (Sub-centre) plays a pivotal role in ensuring provision of comprehensive primary care
to the population in its catchment area. It requires to span preventive, promotive, curative, rehabilitative and
palliative aspects of care as per scope of services offered by HWC-SC. The scope of service provision has increased
from previous
06 packages of care to 12 packages of care. Along with this, emphasis has been given on inclusion of services
which shall lead the community more towards wellness e.g. conduction of Yoga Sessions. Another important
aspect of service provision is, Health promotion and disease prevention by undertaking multisectoral convergence
activities like campaigns, meetings of VHSNC, Self-help groups, Patient support groups etc.
The Area of Concern - Services Provision measures availability of functional services in HWC-SC. “Availability” of
functional services means, services are functional and are being utilised by the end-users because mere availability
of infrastructure or human resources does not always ensure availability of the functional services. For example,
as per staff, the facility may have functional NCD services, but if there are hardly any diagnostic test undertaken
or medicines provided or regular assessments being done for ensuring continuity of care at the HWC, it may be
assumed that the services are either not available or non-accessible to users. Compliance to these standards and
measurable elements should be checked, preferably by observing delivery mechanism of the services, reviewing
the relevant records and checking outcomes after delivery of the service.

Standard A1 Health and Wellness Centre primarily intent to provide preventive,

The facility provides promotive, rehabilitative and palliative care services as per extended
Comprehensive Primary range of services. So, Standard aim to measure holistically the availability
Healthcare Services
of selected services package. Although checklist contains measurable
elements and checkpoints of whole range of extended services, but
facility will be evaluated only for applicable/applied services. E.g. if X
HWC (SC) has chosen 6 basic services and NCD (as opted by state), they
will be assessed for total 7 chosen services out of 12 expanded services.
Apart from the assessment of the functional packages the standard also
measures availability of services for health promotion activities & wellness
viz conduction of Yoga sessions, provision of AYUSH services, promotion
activities through campaigns etc.
Standard A2 Standard measures the availability of basic diagnostic and drugs in HWC. It
The facility provides drugs measures availability of point of care diagnostics through rapid diagnostic
& diagnostic services as kit and referral at the Central Diagnostic Unit-HUB/appropriate higher
mandated
facility. Standard also measures drug dispensing services including re-
fills as service provision. It also measures timely availability of drugs and
diagnostic reports.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 133
 Area of Concern - A: Service Provision
Standard A1 The facility provides Comprehensive Primary Healthcare Services
ME A1.1 The facility provides care in Pregnancy & childbirth services
ME A1.2 The facility provides Neonatal & Infant Health services
ME A1.3 The facility provides Child & Adolescent health services
ME A1.4 The facility provides Family Planning services
ME A1.5 The facility provides services for promotion, prevention and treatment of communicable diseases as
mandated under National Health Program/state scheme
ME A1.6 The facility provides services for acute simple illness & minor ailments
ME A1.7 The facility provides services for promotion, prevention and treatment of non-communicable diseases
as mandated under National Health Program/state scheme
ME A1.8 The facility provides services for common eye ailments
ME A1.9 The facility provides services for common ENT ailments
ME A1.10 The facility provides service for oral health ailments
ME A1.11 The facility provides Elderly & Palliative care services
ME A1.12 The facility provides emergency medical care, including for trauma and burn
ME A1.13 The facility provides services for Screening & Management of Mental Health illness
ME A1.14 The facility provides services for health promotion activities & wellness
Standard A2 The facility provides drugs and diagnostic services as mandated
ME A2.1 The facility provides laboratory services as mandated
ME A2.2 The facility provides services for drug dispensing including medicine refills

134 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - B: Patients’ Rights
Mere availability of services at a health facility does not necessarily meet the need of community, unless the
available services are accessible to the users, and are provided with dignity and confidentiality. Access includes
physical access as well as financial access. There are evidences to suggest that patients’ experience and outcome
improves, when they themselves are involved in the care. So, availability of information is critical for access as well
as enhancing patients’ satisfaction. Area of concern Patients’ rights include parameters such as health services
give due consideration to patients’ cultural and religious preferences.
Patient Rights has five (5) standards. These standards measure different aspects of patients’ rights i.e. availability,
access, privacy & confidentiality and also ensures availability of mandated free services and provisioning of
financial protection.

Standard B1 The standard measures information accessibility at the

The facility provides information to the care- facility. Informational accessibility includes prominent
seeker, attendants and community about display of; signages; services which are available; citizen
available services & their modalities charter; insurance benefits under Ayushman Bharat & IEC
Material etc. This standard also mandates for practices like
informed consent and grievance redressal.
Standard B2 The standard measures physical access to HWC. It includes
Facility ensures that the services are availability of all-weather road, without congestion &
accessible to the care-seekers and visitors encroachment etc. It also includes availability of ramps,
including those requiring some affirmative wheelchairs, disabled friendly services etc with in the
action facilities. The standard also measures affirmative actions
taken by the facility to ensure provision of safe and dignified
access for vulnerable & marginalized patients like, terminally
ill patient, domestic violence cases, orphan, destitute etc.
Standard B3 The Standard ensure services provided are sensitive to gender,
Services are delivered in a manner that are religious & cultural needs. It includes specific precautions to
sensitive to gender, religious & cultural needs be taken, while providing care to vulnerable patients viz.
and there is no discrimination on account of HIV, leprosy infection, abortion, teenage pregnancy, etc.
economic or social reasons The standard measures the awareness among patients and
the community about patients’ rights and responsibilities.
The standard also ensures establishment of defined protocol
and procedures for grievance redressal.
Standard B4: The standard measures services in term of ensuring privacy,
The facility maintains privacy, confidentiality confidentiality and dignity. The standard look for compliances
and dignity of patient such as provisions of screens and curtains (visual privacy),
confidentiality of patients’ clinical information is maintained
(information if any is shared with patients kin only). It also
focuses empathetic behaviour of service providers and
ensure comfort & dignity of female patients is maintained
while providing services.
Standard B5: The standard majorly ensures that there is no financial
The facility ensures all services are provided barrier to the services. It checks for availability of free
free of cost to its users drugs & diagnostics services as mandated. It also ensures
community get specific entitlements, incentives under
various schemes and check robustness of mechanisms and
linkages for availing health insurance (PM JAY or any state
specific health insurance scheme) benefits.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 135
 Area of Concern - B: Patients’ Rights
Standard B1 The facility provides information to care seeker, attendants & community about available services
& their modalities
ME B1.1 The facility displays its services and entitlements
ME B1.2 Patients & visitors are sensitized and educated through appropriate IEC/BCC approaches
ME B1.3 Information about the treatment is shared with patients or attendants
Standard B2 Facility ensures services are accessible to care seekers and visitors including those required
some affirmative action
ME B2.1 The facility is accessible from community and referral centre
ME B2.2 Access to facility is provided without any physical barrier & friendly to people with disability
ME B2.3 There is affirmative action to ensure that vulnerable and marginalized sections can access services
Standard B3 Services are delivered in a manner that are sensitive to gender, religious & cultural needs and
there is no discrimination on account of economic or social reasons
ME B3.1 Services are provided in manner that are sensitive to gender religious & cultural need
ME B3.2 Staff is aware of Patient’s rights and responsibilities
ME B3.3 The facility has defined and established procedure grievance redressal system in place
Standard B4 The facility maintains privacy, confidentiality & dignity of patient
ME B4.1 Adequate visual privacy is provided at every point of care
ME B4.2 Confidentiality of patients’ records and clinical information is maintained
ME B4.3 The facility ensures behaviours of its staff is dignified and respectful, while delivering the services
Standard B5 The facility ensures all services are provided free of cost to its users
ME B5.1 The facility provides cashless services as per prevalent government schemes/norms

136 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - C: Inputs
In an effort to provide required services, it becomes pertinent to ensure availability of requisite infrastructure,
drugs & consumables, equipment, human resource etc. So, area of concern: Inputs, covers the structural part of
the facility predominantly. Standards have been framed in concurrence with Operational Guidelines for Health and
Wellness Centre and Indian Public Health Standards (IPHS) norms. While assessing the infrastructure component
one may encounter the term-viz. ‘adequate’ and ‘as per load‘ has been given in the requirements for many standards
& measurable elements, as it would be hard to set structural norms for facility as that should commensurate with
the patient load.

Standard C1 The standard measures adequacy of infrastructure in terms of adequate space for
The facility has adequate wellness, patient amenities, circulation area etc. Although minimum requirement
and safe infrastructure for for space, layout and patient amenities are given, but assessors are expected to use
delivery of assured services their judgement to assess whether the available space is adequate for the given
as per prevalent norms and workload. Compliance to standard can be mostly assessed by direct observation.
it provides optimal care and
comfort to the users Standard also deals with Physical safety of the infrastructure and includes general
condition of infrastructure, electrical safety, fire safety and seismic safety etc.
It includes providing safe, secure and comfortable environment to patients as
well service providers in terms of illumination, temperature control and crowd
management.
As mandated for health and wellness centres, various activities like population
enumeration and empanelment, provision of telemedicine services etc requires
an ICT setup within the facility eg tablet/laptops, internet connectivity, portals
etc. in this standard measurable element and commensurate checkpoints have
been placed to check their provision as well.
Standard C2 The Standard measures the adequacy and availability of CHO, MPW (Male &
The facility has adequate female), ANM, ASHA & support staff as per requirement and state mandate.
qualified and trained staff Numerical adequacy can be checked by review of records for sanctioned versus
required for providing vacant post. The standard also requires that staff is effectively utilized which can
the assured services as per be done by on-job supportive supervision. Similarly, it becomes pertinent to check
current case load availability compliance to roster and uniform dress code is followed by all staff.
Standard C3 The standard is concerned with evaluation of staff’s competency that too
The facility has a defined periodically at pre-defined interval and takes necessary actions for maintaining
and established procedure it. These criteria should be defined based on job description for each cadre of
for effective utilization, staff. The defined criteria may be converted into simple checklist that can work
evaluation and augmentation as tools for competency assessment. Competency assessment of HWC-SC may
of competence and be done by PHC-MO/equivalent. These criteria may be linked with predefined
performance of staff indicators used for measuring productivity and efficiency of the staff. Based on
these competence assessment and performance evaluation training needs are
identified and training plans are prepared.
Standard C4 The standard measures availability of drugs & consumables for services provided
The facility provides drugs at health & wellness centre. This includes availability of drugs, vaccines, lab
and consumables required for reagents, contraceptives etc. The Standard also expect availability of emergency
assured services medical drugs and drugs for follow up patients, National Health Programmes i.e.
communicable and non-communicable diseases including ENT, Oral, Mental health
and palliative care etc. As an assessor one must ensure that drugs and consumables
are available at the HWC (SC) as per the state’s Essential Drug List (EDL).
Standard C5 The standard is concerned with availability of equipment and instruments as per
The facility has adequate requirement. Equipment’s & instruments have been categorized into subgroups
functional equipment and as per their use such as examination and monitoring, clinical procedures (for ENT,
instruments for assured list oral etc.). Also, the standard will support assessment of adequate availability of
of services furniture and fixtures as per the requirement of HWC (SC).

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 137
 Area of Concern - C: Inputs
Standard C1 The facility has adequate and safe infrastructure for delivery of assured services as per prevalent
norms and it provides optimal care and comfort to users
ME C1.1 Facility has adequate infrastructure, space and amenities as per patient or workload
ME C1.2 The facility ensures physical safety including electrical and fire safety of infrastructure
ME C1.3 The facility ensures availability of information & communication technologies
Standard C2 The facility has adequate qualified and trained staff required for providing the assured services
as per current case load
ME C2.1 The facility ensures availability of Community Health officer
ME C2.2 The facility has adequate frontline health workers and support staff as requirement
ME C2.3 The facility has established procedure for duty roster for facility and community staff
Standard C3 Facility has a defined and established procedure for effective utilization, evaluation and
augmentation of competence and performance of staff
ME C3.1 Competence assessment and performance evaluation of all staff is done on predefined criteria
ME C3.2 The staff is provided training as per defined core competencies and training plan
Standard C4 The facility provides drugs and consumables required for assured services
ME C4.1 The facility have availability of adequate drugs
ME C4.2 The facility have adequate consumables as per requirement
Standard C5 Facility has adequate functional equipment and instruments for assured list of services
ME C5.1 The facility ensures availability of equipment and instruments for examination and monitoring of
patients
ME C5.2 The facility has adequate furniture and fixture as per service provision

138 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - D: Support Services
The support services are backbone of healthcare facilities and desired clinical outcome cannot be envisaged in
absence of support services. Area of Concern-Support Services includes maintenance and upkeep of infrastructure
& equipment; storage & dispensing of drugs, secured record keeping and data management using digital
technology.
It also gives emphasis on, creating the transparent and accountable system, conduction of regular meetings for
Jan Arogya Samitis’, Village Health Sanitation and Nutrition Committee (VHSNCs), Patient support groups and
Self-Help Groups (SHGs) etc.

Standard D1 The standard is related to facility management and equipment/instrument

The facility has established maintenance in HWC (SC). Standard include overall appearance, cleanliness
programme for maintenance status, infrastructure maintenance, removal of junk and condemned material etc.
and upkeep of the facility It also includes processes for line-listing, maintenance and inhouse calibration of
equipment & instruments.
Standard D2 The standard includes safe storage of drugs and management of the inventory,
The facility has defined so that adequate quantity of drugs and consumables are available in HWC
procedures for storage, (SC). Standard also look into processes of indenting, procurement, storage,
inventory management and management of expired drugs, stock management, proper storage including
dispensing of drugs optimum temperature maintenance in HWC (SC) and dispensing.
Standard D3 The standard is concerned about creating and regular updating of data pertaining
The facility has defined and to ambulatory care & management, public health and managerial functions eg.
established procedure for Information regarding illnesses and minor ailments; RMNCHA; NCD and CD,
clinical records and data referred in and out cases, Apart from this checkpoints to assess the quality
management with progressive of population coverage and its entry in the portal, reporting of the outcomes
use of digital technology and performance of the facility. The standard also covers an important aspect
of data’s safe storage, maintenance and retrieval. Assessor should review the
records of reporting in term of information’s quality, timeliness, adequacy and
appropriateness.
The standard covers one of the major aspect of HWC (SC) which is provision
of telemedicine services. Here the process pertaining to its functioning shall be
evaluated on the defined checkpoints.
Standard D4 The standard measures processes related to functioning of the Jan Arogya
The facility has defined Samitis, whether the same has been constituted or not, members’ awareness
and established procedure about their roles and responsibilities, regular conduction of the meetings, their
for the transparency and role in conduction of the promotional activities. Another important mechanism of
accountability conduction of social audits and Jan Sunwayis (public hearing) as per the mandate
shall also be evaluated. Not only this for quality services it becomes pertinent to
check what actions/measures were taken post hearings and meetings.
Similarly in order to ensure quality of services it becomes important for CHO
to support the task done by the community health workers by providing on
job mentoring & supervision for household meetings, VHSNDs or campaign.
Similarly, mentoring cum monitoring visit by MO-PHC is also important for the
smooth functioning of the HWC (SC).
The Assessor should review such aspects like monthly meeting minutes of JAS,
social audits etc, untied fund expenditure (submission of utilisation certificates),
monthly calendars of activities of health workers to check compliance of
supportive & monitoring processes.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 139
 Standard D5 One of the mandate of Primary care services is to place health in the hands’ of
The facility ensures health community. In this aspect the role of HWC (SC) becomes important to create
promotion and disease awareness leading the demand generation for health. For this it becomes
prevention activities through important for HWC (SC) team to undertake various activities for the community
community mobilization mobilization. These activities shall be undertaken through existing VHSNC, so
it becomes important to assess their functionality. Similarly other community
level interventions like celebration of VHNDs; convergence of activities of ASHA,
AWW and ANM; proper planning and conduction of Monthly campaign and
undertaking feedbacks during such activities for further quality improvement
becomes important.
Another important aspect which shall be reviewed through exclusive checkpoints
is the efforts taken by the HWC (SC) for undertaking multisectoral convergence
activities like collaboration with the Education, WCD, ICDS, rural development/
municipal bodies, FSSAI & ICDS etc. Identification and conduction of training
sessions with the support of Ayushman ambassadors in schools. For HWC (SC)
it becomes important to create a pool of local yoga instructors and conduct
regular classes for community yoga trainings
Standard D6 The standard is concerned with statutory & regulatory requirement. It
The facility is compliant with investigates availability of requisite NOCs, updated copies of acts and rules,
statutory and regulatory and adherence to the legal requirements as applicable to HWC (SC).
requirement

140 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - D: Support Services
Standard D1 The facility has established Programme for maintenance and upkeep of the facility
ME D1.1 The facility has established system for infrastructure maintenance
ME D1.2 The facility has established system for maintaining sanitation and hygiene
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of
drugs
ME D2.1 There is established procedure for estimation and indenting of drugs and consumables as per
requirement
ME D2.2 The facility ensures proper storage of drugs and consumables
ME D2.3 The facility ensures management of expiry and near expired drugs
Standard D3 The facility has defined and established procedure for clinical records and data management
with progressive use of digital technology
ME D3.1 Information regarding ambulatory care & management, public health and managerial functions are
recorded and updated through IT platforms
ME D3.2 The facility ensures safe storage, maintenance and retrieval of information & records of services
ME D3.3 The facility has established procedure for providing consultation using telemedicine
Standard D4 The facility has defined and established procedures for hospital transparency and
accountability
ME D4.1 The facility has established procedure for management of activities of Jan Aarogya Samiti
ME D4.2 The facility has established procedures for community based monitoring of its services
ME D4.3 The facility has established procedure for supporting and monitoring activities of Community health
workers
Standard D5 The facility ensures health promotion and disease prevention activities through community
mobilization
ME D5.1 The HWC (SC) felicitate planning & implementation of health promotion and disease prevention activities
through community level interventions
ME D5.2 The facility has Patient Support Groups (PSG) as per the issues/diseases in its catering population
ME D5.3 The facility ensure multisectoral convergence for health promotion and primary prevention
Standards D6 The facility is compliant with statutory and regulatory requirement
ME D6.1 The facility ensures its processes are in compliance with statutory and legal requirement

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 141
 Area of Concern - E: Clinical Services
Clinical services form one of the major Area of Concern as the ultimate purpose of existence of a health care
facility is to provide clinical care. The area of concern is focused on assessment of quality of services provided by
HWCs which include early identification primary Clinical management, Care coordination for ensuring Continuity
of care, Provision of Basic diagnostic and dispensing of medicines. It also includes adherence to Clinical protocols
while delivering the services, ensuring continuity of care, safe drug administration practices, no over-prescription,
rational use of drugs, regular monitoring and follow up of critical, NCD & defaulter cases etc.
There are total eighteen (18) standards that measure quality of clinical services. Standard E1 to E7 are covering
the general clinical process ranging from registration, consultation, assessment/re-assessment, continuity of care
(referral), medication safety, usage of standard treatment guidelines (STGs), nursing care, diagnostic services and
emergency services including disaster management. E8 to E12 cover extended packages viz. ophthalmic, oral,
ENT, mental health, disease control programme, elderly and palliative care etc while E13 to E18 cover clinical
processes related to antenatal care, intranatal care, post-natal care, newborn care, child health, adolescent health,
and family planning i.e. RMNCHA.
It may be difficult to assess clinical processes, as direct observation of clinical procedure may not always be
possible at time of assessment. Therefore, assessment of these standards would largely depend upon many inputs,
such as review of the clinical records, interaction with the staff to know their skill level and how they practice
clinical protocols etc. Assessment of these standards would require thorough domain knowledge.

Standard E1 The Standard is concerned with empanelment & registration of individual and
The facility has defined families, and consultation, clinical assessment & re-assessment of patient at HWC
procedures for registration, (SC). The Assessor should review the records to verify the details of patients and
consultation, clinical ensure patients have been given unique identification number, the demographic
assessment and reassessment details have been recorded, the OPD consultations have been provided and if
of the patients required proper referral procedure has been followed, reassessments are done
at follow ups. OPD consultation may be directly observed, followed by review
of OPD tickets, patient digital/paper records to ensure that patient history,
examination details, follow up etc. have been taken, recorded & updated.
Standard E2 The standard is related with continuity of care for patient’s ailments. It includes
The facility has defined and process of referral to and from higher centre, deputation of staff for the care,
established procedures for transfer of patient to functionally linked hospitals. The staff should be interviewed
continuity of care through to know the referral linkages, how they inform the referral hospital about the
two-way referral referred patients and ensure follow-up care. Records should be reviewed for
confirming that referral in & out records of patients.
Standard E3 The standard deal with procedures related to diagnostic service available in
The facility has defined and HWC (SC). It includes labelling of samples, instructions for handling samples
established procedure of during inhouse testing or transfer samples to higher centres and sharing of
diagnostic services investigation report with service users. It also includes implementation of internal
quality control for test as per manufacturer’s instructions. Assessor must check
availability of critical values and biological references.
Standard E4 The standard is concerned with safety of drug administration including high alert
The facility has defined drugs administration, legibility of medical orders, process for checking drugs
procedure for safe drug and processes related to self-drug administration etc. Patient’s records should
administration be reviewed for legibility, appropriateness and recording of date of orders. Safe
injection practices like use of separate needle for multi-dose vial should be
observed.
Standard E5 The standard is concerned about assessing that, drugs are prescribed according
The facility follows standard to standard treatment guidelines and protocols. Patient records are assessed to
treatment guidelines and ascertain that medicines have been dispensed as per treatment plan provided by
ensures rational use of drugs CHO/PHC-MO/equivalent.

142 National Quality Assurance Standards for Public Health Facilities | 2020
Standard E6 The standard measure adequacy & quality of patient care provided in HWC
The facility has defined and (SC). It includes processes for identification of patients, timely and accurate
established procedure for implementation of the prescribed treatment plan, maintenance of records and
nursing care monitoring of the patients as directed by referral centre. The staff should be
interviewed, and patients’ records should be reviewed for assessing how drug
distribution takes place, how its administration is ensured and its record, and
other procedures like sample collection and dressing have been done on time as
per treatment plan.
Standard E7 The standard pertains to primary management of emergency cases like injuries,
The facility has defined and fractures, bites, poisoning, burns, respiratory arrest, cardiac arrest and acute
established procedure for gastrointestinal conditions etc. It also includes early identification, pre referral
emergency care stabilization and referral of cases for surgical correction. It includes prompt
referral, involvement of HWC (SC) staff in triage while managing the disaster
and emergency conditions in their catering area.
Standard E8 The standard pertains to adherence of clinical guidelines for management of
The facility has defined & ophthalmic, ENT, Oral & Mental health ailments. The staff should be interviewed
established procedure for to know the availability of services in terms of screening, prevention, health
management of Ophthalmic, promotion and management, referral linkages, follow up of referred cases and
ENT, Oral ailments as per follow-up care from HWC (SC) through outreach activities. Records should be
Operational/Clinical reviewed for confirming treatment is given as per plan.
guidelines
Standard E9 The standard pertains to adherence of clinical guidelines for screening and basic
The facility has defined & management of Mental health ailments. The staff should be interviewed to know
established procedures for the availability of services in terms of screening, prevention, health promotion
screening & basic management and management, referral linkages, follow up of referred cases and follow-up
of Mental health ailments care from HWC (SC) through outreach activities. Records should be reviewed for
as per Operational/Clinical confirming treatment is given as per plan.
guidelines
Standard E10 The standard pertains to adherence of clinical guidelines for management of
The facility has defined & communicable diseases. Each National Health Programme should be assessed for
established procedures for quality of clinical services as per scope of respective programs. As per technical
management of communicable guidelines of these health program dedicated & relevant checkpoints have been
diseases as per Operational/ made to assess the service holistically.
Clinical guidelines
Standard E11 The standard pertains to adherence of clinical guidelines for management of
The facility has defined & non-communicable diseases. Each programme should be assessed for quality of
established procedures for clinical services as per respective technical protocols. The standard also checks
management of availability & usage of Yoga and Ayush services for wellness & Health promotion.
non-communicable diseases The functionality of services should be confirmed through staff interview &
as per Operational/Clinical record review.
guidelines
Standard E12 The standard measures adequacy & quality of elderly & palliative care provided
Elderly & palliative health care by HWC (SC). Standard include assessment of process to ensure screening
services are provided as per of palliative cases, arrangement of home care visits as per patient’s need,
guidelines management of pain, bed sores and availability of established system for provision
of care to terminal cases etc. Staff and patient party should be interviewed &
record should be reviewed for holistic assessment.
Standard E13 The standard is concerned with adherence to clinical guidelines for new-born
The facility has established & child health. It covers immunization, emergency triage, management of
procedure for care of new- high-risk babies, new-born and childhood illnesses like ARI and diarrhoea etc.
born, infant and child as per Immunization services are majorly assessed at immunization clinic. Staff interview
guidelines and observation should be done to assess availability of required vaccines,
adherence to protocols for reconstitution of vaccine, their storage, monitoring of
VVM labels etc. Standard also include identification of low birth, sick new-born
& malnourished children & ensure their timely referral and treatment.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 143
 Standard E14 The standard is related to ensure safe & quality family planning services. This
The facility has established includes standard practices and procedures for Family planning counselling,
procedures for family spacing methods. Quality and adequacy of counselling services can be assessed
planning as per government by exit interview with the clients. The staff at family planning clinic need to be
guidelines and law interacted to assess adherence to the protocols for IUD insertion, precaution &
contraindication for oral pills, etc.
Standard E15 The standard is related to services of ARSH. It includes promotive, preventive,
The facility provides curative and referral services under program. The facility staff should be
Adolescent Reproductive and interviewed, and records should be reviewed.
Sexual Health services as per
guidelines
Standard E16 The standard is concerned with adequacy & quality of antenatal care is provided
The facility has established at the facility. It includes checkpoints for ANC registration, identification of High-
procedures for Antenatal care Risk pregnancy, management of anaemia and counselling services. Staff at ANC
as per guidelines clinic should be interviewed, and records should be reviewed for maintenance
of MCP cards and registration of pregnant women. For assessing quality and
adequacy of ANC check-up, direct observation may be undertaken after
obtaining requisite permission. ANC records can be reviewed to see findings of
examination and diagnostic tests are recorded. The assessment and follow up of
Anaemia cases should be reviewed. Beneficiaries and staff can be interacted for
counselling on the nutrition, birth preparedness, family planning, etc.
Standard E17 This standard shall be applicable only to Type B sub-centre where there will be
The facility has established availability of intranatal services. HWC (SC) shall be assessed for availability and
procedure for intranatal care compliance to established procedures and standard protocols for management
as per guidelines of different stages of labour including AMTSL (Active Management of third
stage of labour), routine care of new-born immediately after birth & newborn
resuscitation and procedure for management/referral of Obstetrics Emergencies
as per scope of services.
Standard E18 The standard pertains to provision of Post-partum Care to the mothers after
The facility has established delivery. HWC
procedure for post-natal Care
(SC) - Type B, shall be assessed for compliance to established procedures and
standard protocols for management of mother and baby during post-partum
period.

144 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - E: Clinical Services
Standard E1 The facility has defined procedures for registration, consultation, clinical assessment and
reassessment of the patients
ME E1.1 The facility has established procedure for empanelment & registration of individual and families
ME E1.2 The facility has established procedure for registration & consultation in HWC
ME E1.3 The facility has established procedure for follow up/re-assessment of patients
Standard E2 The facility has defined and established procedures for continuity of care through two-way
referral
ME E2.1 The facility has established procedure for continuity of care
ME E2.2 The facility has established procedure for undertaking referred in & referred out of the cases
Standard E3 The facility has defined and established procedures of diagnostic services
ME E3.1 The facility has established procedure for laboratory diagnosis as per guidelines
Standard E4 The facility has defined procedures for safe drug administration
ME E4.1 Facility follows protocols for safe drug administration
ME E4.2 There is process for identifying and cautious administration of high alert drugs
Standard E5 The facility follows standard treatment guidelines and ensures rational use of drugs
ME E5.1 There is procedure of rational use of drugs
ME E5.2 Facility has system in place to periodically monitor the treatment provided by CHO
Standard E6 The facility has defined and established procedures for nursing care
ME E6.1 There is established procedure for identification & periodic monitoring of the patients
ME E6.2 Prescribed treatment plan and procedure performed are recorded in patient’s record
ME E6.3 Adequate forms, formats and records are available as per services mandate
Standard E7 The facility has defined and established procedures for Emergency care
ME E 7.1 Emergency protocols are defined and implemented
ME E 7.2 The facility has disaster management plan at place
Standard E8 The facility has defined & established procedures for management of ophthalmic, ENT, Oral
health ailments as per operational/guidelines ENT, Oral health aliments as per operational/
clinical guidelines
ME E8.1 The facility provides services for Ophthalmic ailments including blindness and refractive errors as per
guidelines
ME E8.2 The facility provides services for ENT ailments as per guidelines
ME E8.3 The facility provides service for oral health ailments
Standard E9 The facility has defined & established procedures for screening & basic management of Mental
health ailments as per operational/clinical guidelines
ME E9.1 The facility provides services under mental health Program as per guidelines
Standard E10 The facility has defined & established procedures for management of communicable diseases as
per operational/clinical guidelines
ME E10.1 The facility provides services under National vector Borne disease control programme as per
guidelines
ME E10.2 The facility provides services under National Tuberclosis Elimination Program
ME E10.3 The facility provides services under National Leprosy Eradication Program as per guidelines
ME E10.4 The facility provides services under National AIDS Control Program as per guidelines
ME E10.5 The facility provides services under Integrate Disease Surveillance Programme as per guidelines
ME E10.6 The facilities provide services for National Viral Hepatitis Control Programme

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 145
 Standard E11 The facility has defined & established procedures for management of non-communicable diseases
as per operational/clinical guidelines
ME E11.1 The facility provides services for hypertension as per guidelines
ME E11.2 The facility provides services for Diabetes as per guidelines
ME E11.3 The facility provides services for cancer screening and referral as per guidelines
ME E11.4 The facility provides services for de addiction, and locally prevalent health diseases as per guidelines
ME E11.5 The facility promotes services for health & wellness
Standard E12 Elderly & palliative health care services are provided as per guidelines
ME E12.1 The facility provides services for elderly care as per guidelines
ME E12.2 The facility provides services for Palliative care as per guidelines
Standard E13 The facility has established procedures for care of newborn, infant and child as per guidelines
ME E13.1 Post-natal visit & counselling for newborn & infant care is provided as per guideline
ME E13.2 The facility provides immunization services as per guideline
ME E13.3 Management of children for ARI, diarrhoea, malnutrition and other illness
Standard E14 The facility has established procedures for family planning as per government guidelines and
law
ME E14.1 Family planning counselling services are provided as per guidelines
ME E14.2 The facility provides spacing methods for family planning as per guidelines
ME E14.3 The facility provides limiting methods for family planning as per guidelines
Standard E15 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines
ME E15.1 The facility provides promotive, preventive & curative service for adolescent
Standard E16 The facility has established procedures for Antenatal care as per guidelines
ME E16.1 There is an established procedure for Registration and follow up of pregnant women
ME E16.2 There is an established procedure for History taking, Physical examination, and counselling of each
antenatal woman, visiting the facility
ME E16.3 The facility ensure drugs & diagnostics are prescribed as per protocol
ME E16.4 There is an established procedure for identification of High-risk pregnancy and appropriate & timely
referral
ME E16.5 Counselling of pregnant women is done as per standard protocol and gestational age
Standard E17 The facility has established procedure for intranatal care as per guidelines
ME E17.1 Established procedures and standard protocols for management of different stages of labour including
AMTSL (Active Management of third Stage of labour) are followed at the facility
ME E17.2 Facility staff adheres to standard procedures for routine care of new-born immediately after birth and
new-born resuscitation
ME E17.3 There is established procedure for management/Referral of Obstetrics Emergencies as per scope of
services
Standard E18 The facility has established procedure for post-natal care
ME E18.1 Postpartum Care is provided to the mothers
ME E18.2 There is a established procedures for Postnatal visits & counselling of Mother and Child

146 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - F: Infection Control
The first principle of health care is “to do no harm”, so it becomes pertinent to ensure laying down the infection
prevention practices and its conformance. The Area of Concern - Infection Control, pertains to the monitoring of
basic infection control practices, ensuring compliance to hand hygiene practices and usage of Personal Protective
Equipment (PPE) etc. It also covers standard practices for maintenance of hygiene, sterilisation and disinfectant
practices as well as management of Bio-Medical Waste.

Standard F1 The standard is concerned with implementation of infection control program at

The facility has established facility. It includes functional infection control team and monitoring of Infection
program for infection control practices.
prevention and control
It also covers periodic medical check-up and immunization of staff. Records
should be reviewed for confirming status of staff immunization, training of staff
for infection management of environment protection.
Standard F2 The standard is concerned with practices of hand washing. It also ensures
The facility has defined and availability of hand washing facilities viz. soap and running water etc at the point
implemented procedure of use. Assessor may observe the technique of hand washing for assessing the
for ensuring hand hygiene practices, and effectiveness of training.
practices
Standard F3 The standard is concerned with availability & use of PPE like gloves, masks, apron
The facility ensures standard etc. Assessor may check the adequacy of supplies through records & observe the
practices and equipment for adherence and practice of using PPE.
personal protection
Standard F4 The standard is concerned with decontamination, cleaning, disinfection and
The facility has standard sterilization of equipment and instruments. These practices should be observed,
procedure for disinfection and staff should be interviewed for compliance to standard procedures and
and sterilization equipment records should be checked.
and instruments
Standard F5 The standard is concerned with Bio-Medical Waste & its management at HWC
The facility has defined and (SC) and during outreach activities. It includes segregation, transportation,
established procedures for storage and disposal of Bio-Medical Waste. Availability of equipment and
segregation, collection, practices of segregation can be directly observed.
treatment and disposal of Bio-
Medical and hazardous Waste Staff should be interviewed about the procedure for management of the needle
stick injuries. Storage and transportation of waste should be observed, and
records are verified. Standard give special emphasis to ensure management of
bio-medical & general waste produced in community during outreach activities.
Assessor should observe how final disposal of waste take place from HWC.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 147
 Area of Concern - F: Infection Control
Standard F1 The facility has established program for infection prevention and control
ME F1.1 Facility ensures that staff is working as team and monitor the infection control practices
Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices
ME F2.1 Hand Hygiene facilities are provided at point of use & ensures adherence to standard practices
Standard F3 The facility ensures standard practices and equipment for Personal protection
ME F3.1 The facility ensures availability of personal protection equipment and ensures adherence to standard
practices
Standard F4 The facility has standard procedures for disinfection and sterilization of equipment and
instruments
ME F4.1 The facility ensures availability of material and adherence to Standard Practices for decontamination and
cleaning of instruments and followed by procedure/patient care areas
ME F4.2 The facility ensures standard practices and materials for disinfection and sterilization of instruments and
equipment
Standard F5 The facility has defined and established procedures for segregation, collection, treatment and
disposal of Bio-Medical and Hazardous Waste
ME F5.1 The facility ensures segregation and storage of Bio-Medical Waste as per guidelines
ME F5.2 The facility ensures management of sharps as per guidelines
ME F5.3 The facility ensures management of hazardous & general waste
ME F5.4 The facility ensures transportation & disposal of waste as per guidelines

148 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - G: Quality Management
Quality management requires a set of interrelated activities that assure quality of services according to set
standards and strive to improve upon it through a systematic planning, implementation, monitoring, assessment,
identification of non-compliances and acting upon them. The standards in this area of concern are the opportunities
for improvement to enhance quality of services and patient satisfaction.
Area of Concern-Quality Management cover aspects like establishment of organizational framework for quality
improvement, measurement, assessment and usage of patient satisfaction; compliance to display and usage of
work instructions; regular audit using NQAS, Kayakalp and other checklists for the improvement and sustenance
of Quality.

Standard G1 The standard is concerned with formulation and assessing functionality of

The facility has established Primary health care quality team at facility. Assessor may review the document
organizational framework and interact with team members to know about their roles and responsibilities
for quality improvement and how frequently they meet and review their functioning records.
Standard G2 The standard is concerned with having measurement of patient and employee
The facility has established satisfaction. This includes periodic patients’ (including the health seekers from
system for patient and community, relatives of patients’) satisfaction survey, analysis of the feedback
employee satisfaction and preparing action plan. Assessors should review the records pertaining to
patient and employee satisfaction survey to ascertain that feedback of the
patients and employees are taken at prescribed intervals.
Standard G3 The standard is concerned with availability and adequacy of work instructions
The facility has established, (WI) with the respective process owners viz. CHO, MPW, ANM etc. Display
documented, implemented and of critical work instructions and clinical protocols should be observed in
updated Standard Operating HWC (SC).
Procedures (SOPs) for all key
processes and support services
Standard G4 The standard pertains to establish system for internal assessments in defined
The facility has established intervals for clinical and non-clinical processes including audits viz prescription
system of periodic review of monitoring, referral audits etc. Assessor should review the records to ensure
clinical, support and quality adequacy and periodicity of audits/assessment. The gaps are identified, root
management processes cause analysis is done for the critical issues and HWC (SC) uses PDCA approach
for the improvement.
Standard G5 The standard ensure purpose of the organization is articulated in form of mission
Facility has defined Mission, statement and it is communicated to its internal & external stakeholders. It
Values, Quality policy and also ensures core values of organization is defined and are part of all policies,
Objectives, and approved plan procedures & always consider while realizing the services to its users.
to achieve them
The standard make sure organization determine its Quality policy and ensure it
provide framework for Quality objectives. Assessment of the standard can be
done by reviewing the records pertaining to mission, core values, Quality policy
& objectives. Assessor may interview staff about their awareness of mission,
values, policies & objectives etc.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 149
 Area of Concern - G: Quality Management
Standard G1 The facility has established organizational framework for quality improvement
ME G1.1 The facility has a quality improvement team and it review its quality activities at periodic intervals

Standard G2 The facility has established system for patient and employee satisfaction
ME G2.1 The facility ensures mechanism for conducting patient and employee satisfaction survey

Standard G3 The facility has established, documented, implemented and updated Standard Operating
Procedures for all key processes and support services
ME G3.1 Updated work instructions for all key clinical processes are available
Standard G4 The facility has established system of periodic review of clinical, support and quality management
processes
ME G4.1 Handholding support and supervision is provided to HWC (SC) by PHC, block/district/state teams
ME G4.2 The facility conducts periodic internal assessment
ME G4.3 The facility ensures non compliances are recorded adequately and action plan is made on the gaps found
in the assessment/review process using quality improvement methods
Standard G5 Facility has defined Mission, Values, Quality policy and Objectives, and approved plan to achieve
them
ME G5.1 The facility has defined Quality policy and quality objectives

150 National Quality Assurance Standards for Public Health Facilities | 2020
 Area of Concern - H: Outcome
Measurement of the quality is critical for improvement of processes and outcomes. For the desirous functioning of facility,
it becomes imperative to measure its indicators which can help in knowing the productivity, efficiency and utilization
of the facility as a unit. These indicators not only show the “outcomes” of the service delivery but also support the team
to carry out improvement by implementing change ideas as per the requirement. Area of concern-outcome
measures overall productivity, efficiency, clinical and services quality indicators for HWC (SC). These indicators
may be reported through portal/dedicated IT platform. Other than just measuring indicators it is important to
analyse the data for overall improvement of healthcare facilities.
There are following four standards in this area of concern:

Standard H1 This standard is concerned with measurement of productivity indicators like

The facility measures daily OPD of new and old cases, target population covered as per enumeration,
productivity indicators no. of cases started the treatment etc. Assessor should review these records to
ensure that these indicators are getting measured at HWC (SC) regularly.
Standard H2 This standard contains indicators that measure efficiency of processes and human
The facility measures resources working in HWC (SC)such as OPD per MLHP, Home visits conducted
efficiency indicators by ASHA/MPW/ANM, time taken from identification of the cases to initiation of
treatment etc. Review of records should be done to assess that these indicators
have been measured correctly.
Standard H3 The standard is concerned with clinical Quality such as early identification,
The facility measures clinical correct diagnosis, initiation of treatment, Chronic illness patient with treatment
care indicators compliance, follow up of the cases under treatment, timely referral at appropriate
facility etc. Record review should be done to see the measurement of these
indicators.
Standard H4 This standard is concerned with indicators measuring service quality provided
The facility measures service by HWC (SC) like Patient/relatives perception about services provided, Waiting
quality indicators time, availability of drugs & diagnostics, availability of information etc.

National Quality Assurance Standards for Health and Wellness Centre (Sub-centre) 151
 Area of Concern - H: Outcomes
Standard H1 The facility measures Productivity Indicators
ME H1.1 The facility measures productivity indicators for essential services on monthly basis
ME H1.2 The facility ensures compliance of key productivity indicators with National/State benchmarks
Standard H2 The facility measures efficiency Indicators
ME H2.1 The facility measures efficiency indicators on monthly basis
ME H2.2 The facility ensures compliance of key efficiency indicators with National/State benchmarks
Standard H3 The facility measures Clinical Care Indicators
ME H3.1 The facility measures clinical care indicators on monthly basis
ME H3.2 The facility ensures compliance of key clinical care indicators with National/State benchmarks
Standard H4 The facility measures service Quality Indicators
ME H4.1 The facility measures service quality indicators on monthly basis
ME H4.2 The facility ensures compliance of key service quality indicators with National/State benchmarks

152 National Quality Assurance Standards for Public Health Facilities | 2020
National Quality Assurance Standard
for AEFI Surveillance Program
 AEFI Quality Assurance Standards

Area of Concern - A: Notification and Reporting

Standard A1 The primary responsibility for notifying AEFI cases is defined and communicated at each level
Standard A2 There is an established procedure for routine reporting of AEFI cases
Standard A3 There is an established procedure for immediate reporting of serious/severe AEFI cases
Standard A4 Preliminary and Final case investigation formats are reported as per defined protocol
Standard A5 There is an established procedure to ensure recording and reporting of AEFI cases from the private
sector
Area of Concern - B: Investigation
Standard B1 Criteria for AEFI cases to be investigated is defined and communicated
Standard B2 Preliminary Investigation of cases is done as per guidelines
Standard B3 Final case investigation report is prepared as per guidelines
Standard B4 A standard procedure is followed for special investigation
Standard B5 There is an established procedure for collection of samples for lab investigation
Area of Concern - C: Causality Assessment
Standard C1 Case selection for AEFI causality assessment is done as per established criteria
Standard C2 Causality question is defined as per protocol
Standard C3 Causality assessment is done using predefined tools and algorithms
Standard C4 There is an established procedure for organizing causality assessment as per defined timelines.
Standard C5 There is an established procedure for taking appropriate action on outcome of causality assessment
Area of Concern - D: Operational Management
Standard D1 AEFI committees at district, state and national level are constituted and functional
Standard D2 There is an established procedure for functioning of National AEFI Secretariat
Standard D3 Roles and responsibilities of stakeholders at different administrative levels are defined and effectively
communicated
Standard D4 There are established procedures for training and capacity building of personnel involved in AEFI
Surveillance
Standard D5 Immunization sites are prepared for preventing and treating any adverse event following immunization
Area of Concern - E: Communication
Standard E1 There are established procedures for regular communication to build and maintain confidence in the
Universal Immunization Programme in community
Standard E2 There are established procedures for communication in case of serious AEFI event

National Quality Assurance Standard for AEFI Surveillance Program 155

 Standard E3 There is a defined strategy for media management at district, state and national level
Standard E4 There are defined procedures for management of information on social media
Standard E5 There is an established procedure for capacity building of key personnel responsible for communication
at each level of administration
Area of Concern - F: Convergence
Standard F1 There are established procedures for coordination with partner agencies
Standard F2 There are established procedures for coordination with drug regulatory authorities
Standard F3 There are established procedures for coordination with Pharmacologically Programme
Standard F4 There are established procedures for coordination with professional associations, academic institutions
and collaborating centres
Standard F5 There are established procedures for coordination with civil administration and law enforcement
agencies
Area of Concern - G: Monitoring and Feedback
Standard G1 Key performance indicators for AEFI programme are defined, monitored and analyzed
Standard G2 There are established procedures for scanning of different sources for identifying signals for AEFI cases
Standard G3 There is an established procedure for providing timely feedback on reports submitted
Standard G4 There is an established procedure for providing feedback to the states regarding outcome of findings of
causality assessments and trend analysis.
Standard G5 There is an established procedure to follow up with non-reporting states and districts
Area of Concern - H: Quality Management System
Standard H1 Quality policy and objectives are defined and disseminated
Standard H2 Standard Operating Procedures are defined, documented and established at each level
Standard H3 There are established procedures for internal assessment and periodic reviews
Standard H4 Continuous Quality Improvement is practiced at each level of AEFI surveillance programme
Standard H5 There is an established procedure to identify and mitigate risks in relation to AEFI programme

156 National Quality Assurance Standards for Public Health Facilities | 2020
National Quality Assurance
Standard for Comprehensive
Lactation Management Centres
 COMPREHENSIVE LACTATION MANAGEMENT
CENTRES AND LACTATION MANAGEMENT UNIT

Area of Concern - A: Service Provision

Standard A1 Services for promotion and adherence to early and exclusive breastfeeding are provided as per prevalent
guidelines
Standard A2 Services for collection, processing, storage and dispensing of Donor Human Milk are available
Area of Concern - B: Patient Rights
Standard BI There are no Physical, Informational or Financial barriers in availing the services.
Standard B2 Services are provided in dignified manner ensuring privacy & confidentiality as well as respecting
societal and cultural preferences
Area of Concern - C: Inputs
Standard C1 Comprehensive Lactation Management centre has adequate infrastructure and optimal layout for
providing the mandated services.
Standard C2 Physical and fire safety measures have been implemented
Standard C3 Adequate qualified and trained staff for rendering the mandated services are available
Standard C4 Equipment and consumables for collection, processing and storage of Human milk are available as per
defined norm and case load
Area of Concern - D: Support Services
Standard D1 Maintenance and Upkeep processes are effectively implemented.
Standard D2 Procedures established for estimating the demand of donor human milk and maintaining the buffer
stock to avoid stock out
Standard D3 Safe and comfortable environment is provided to donors and as well as to the staff of lactation
management centre
Standard D4 Compliance to applicable statutory and legal requirements are ensured.
Area of Concern - E: Clinical Services
Standard E1 Procedures established as per guidelines for recruitment of Donors
Standard E2 Procedures established as per guidelines for screening of Donors
Standard E3 Implementation of optimal and scientific milk collection processes are ensured as per guidelines
Standard E4 Labelling and pre-pasteurization storage of collected milk is done as per established protocols
Standard E5 Pooling and Aliquoting of milk is done as per established protocols
Standard E6 Pasteurization of Donor Human Milk is done as per protocol.
Standard E7 Post Pasteurization testing of milk is done as per established protocol
Standard E8 Storage of pasteurized donor human milk is done as per established protocols.
Standard E9 Established procedures for Intramural issue of Donor Human Milk
Standard E10 Optimal feeding practices are ensured in attached NICU/SNCU
Area of Concern - F: Infection Control
Standard F1 Hand Hygiene and personal protection ensured during handling of Human Milk.
Standard F2 Sterility of processing and storage equipment are ensured
Standard F3 Microbiological testing data are analysed for improving the infection control practices

National Quality Assurance Standard for Comprehensive Lactation Management Centres 159
 Area of Concern - G: Quality Management System
Standard G1 Quality Policy and objectives have been defined and communicated to staff and users
Standard G2 Hazard Analysis and Critical Control Point (HACCP) practices have been implemented as per guidelines
Standard G3 Lactation management centre has documented and implemented Standard Operating Procedures
Standard G4 Periodic review and Quality Improvement Processes are implemented
Area of Concern - H: Outcomes
Standard H1 Key performance indicators (KPI) are measured

160 National Quality Assurance Standards for Public Health Facilities | 2020
 Amendments made under National Quality
Assurance Standards

List of Amendments done (2016)

Added

Reference No Standards (2016) Measurable Elements (2016)

1 B6 ME B6.1 – ME B6.11

2 C7 ME C7.1 – ME C7.11

3 G9 ME G9.1 – ME G9.6

4 G10 ME G10.1 – ME G10.10

Deleted

1 C4 ME C4.6 & ME C4.7

2 E9 ME E9.4

3 E16 ME E16.3

Rephrased

1 G7 ME G7.1 – ME G7.4 to ME G7.1 – ME G7.7

List of Amendments done (2018)

Added

Reference No Standards (2018) Measurable Elements (2018)

1 A4 ME A4.12

2 E18 ME E18.1, 18.2, 18.3, 18.5, 18.6, 18.7, 18.8, 18.9, 18.11

3 E19 ME E19.3

4 E20 ME E20.5, ME E20.6, ME E20.10

Deleted

1 E18 ME E18.1, ME E18.3

2 H1 ME H1.3

Rephrased

1 G6 ME G6.5

2 E18 ME E18.10

3 E19 ME E19.1, ME E19.3

4 E20 ME E20.4

National Quality Assurance Standard for Comprehensive Lactation Management Centres 161
 List of amendments done (2020)
Added
Reference No Standards Measurable Elements
1 B6 ME B6.12
2 E2 ME E2.3
3 E6 ME E6.3
4 G3 ME G3.4 & ME 3.5
5 G10 ME G10.1, 10.2, 10.3, 10.4, 10.5, 10.6 & 10.7
Rephrased
1 G4 ME G4.4
2 E23 ME E23.2
3 E2 Standard Statement
4 E6 Standard Statement
5 G3 Standard Statement
Deleted
1 G6 ME G6.1, 6.2, 6.3, 6.4, 6,4 & 6.5

162 National Quality Assurance Standards for Public Health Facilities | 2020
 BIBLIOGRAPHY

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2002
29. IS 15461, Performance Guidelines for Quality Assurance in Hospital Services up to 100-Bedded Hospitals,
2004 22. IS 4347, Code of practice for Hospital lighting, 1967
30. ISO 15189, Medical Laboratories - Particular requirements for quality and competence, Second edition.
31. ISO 9001, Quality Management System requirement, Fourth Edition
32. Janani Suraksha Yojana, Govt of India, Ministry of Health and Family Welfare, Maternal Health Division
33. Joint Commission International Accreditation Standard for Hospital, 4th Edition
34. National Accreditation Board for Hospital and Healthcare Provider, 3rd Edition
35. National Guideline for Improvement of Quality and Safety of Healthcare Institutions (For Line Ministry and
Provincial Hospital, First Edition.
36. ICU Planning and Designing in India – Guidelines 2010, Indian Society for Critical Care Medicine
37. Quality Indicators for ICU, 2009, Indian Society of Critical Care Medicine
38. National List of Essential List, 2011, Ministry of Health & Family Welfare, Government of India
39. Guidelines and Space Standards for Building Barrier Free Built Environment for disabled and elderly
persons,1998 CPWD, Ministry of Urban Affairs and Employment
40. Fundamental elements of Quality of Care, A simple framework, Judith Bruce, Studies in family planning
1990
41. Quality Management in Public Health Facilities – An Implementation Handbook, National Health Systems
Resource Centre, New Delhi
42. Quality Management in Public Health Facilities - Traversing Gaps, National Health Systems Resource Centre
43. Essential Standards of Quality and Safety, Guidance about compliance, March 2010, Care Quality Commission,
United Kingdom
44. Principles of Best Practices in Clinical Audit, National Institute of Clinical Excellence, United Kingdom
45. Operational Guidelines for Integrated Counselling and testing Center, 2007, National AIDS Control
organization
46. Operational Guidelines for ART Centers, National AIDS control organization, MoHFW, Government of India
47. Operational Guidelines for Facility Based Management of Children with Severe Acute Malnutrition, 2011,
MoHFW, Government of India

164 National Quality Assurance Standards for Public Health Facilities | 2020
48. Handbook for Vaccine and Cold Chain Handlers, 2010, MoHFW, Government of India
49. Twelfth Five Year Plan, Social Sectors, 2012-2017, Planning Commission, Government of India
50. Quality Management in Hospitals, S. K. Joshi, Jaypee Publishers, New Delhi
51. Health Care Case Laws in India, entre for Enquiry into Health and Allied Themes (CEHAT)
52. Infection Management and Environment Plan, Guidelines for Healthcare workers for waste management
and infection control in community health centres
53. Practical Guidelines for Infection Control in Health Care Facilities, World Health Organization
54. IWA1, Quality Management Systems – Guidelines for Processes improvements in health services
organizations, 2005, International Organization for Standardization
55. ISO 19011: 2011, Guidelines for auditing management systems, International Organization for
Standardization
56. Navjaat Sishu Surakasha Karyakram, Training Manual, MoHFW, Government of India
57. Technical and Operational Guidelines for TB Control, Central TB Division, MoHFW, Government of India
58. Guidelines for Diagnosis and treatment of malaria in India, 2011, National Vector Born disease control
program, GoI, MohFW
59. Guidelines for Eye ward & Operation theatre, National Program for control of Blindness, MoHFW, GoI
60. Operational Guidelines on National Programme For Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases & Stroke (NPCDCS), MoHFW, Government of India
61. Training Manual for Medical Officers for Hospital Based disease Surveillance, Integrated Disease Surveillance
Project, National Centre for Disease Control
62. Disability prevention and medical rehabilitation, Guidelines for Primary, Secondary and Tertiary level care,
National Leprosy Eradication Program, MoHFW, Government
63. A strategic approach for reproductive, maternal, new born, child and adolescent health (RMNCH+A) in
India, MoHFW, Government of India
64. Rashtriya Bal Swasthya Karyakram (RBSK), Operational Guidelines, MoHFW, 2013, Government of India
65. Operational Guidelines for Rogi Kalyan Samitis, Health & Family Welfare Department, Government of
West Bengal
66. Maternal & Newborn Health Kit, Maternal Health Division, Ministry of Health & Family welfare, Government
of India
67. Infection Prevention Practices in Emergency Obstetric Care, EnganderHealth
68. Laboratory Safety Manual, Third Edition, 2004, World Health Organization
69. Crossing The Quality Chasm: A New Health System for the 21st Century, Institute on Medicine, USA
70. Accreditation of Public Health Facilities, Evaluating the impact of the initiatives taken on improving service
delivery, documenting the challenges and successful practices, 2012, Deloitte India
71. Quality & Accreditation of Health Services – A Global Review, ISQUA & WHO
72. Gender Analysis in Health –A review of selected tools, World Health Organization
73. Governing Public Hospitals, Reform strategies and the movement towards institutional autonomy, 2011,
World Health Organization

National Quality Assurance Standard for Comprehensive Lactation Management Centres 165
 74. Environmentally sound management of mercury waste in Health Care Facilities, Central Pollution Control Board
75. ICD 10 -International Statistical Classification of Diseases and Related Health problems, 2010 Edition, World
Health organization
76. Infection Prevention, Guidelines for Healthcare facilities with limited resources, JHPIEGO
77. Manual for Medical officers, dealing with child victims of trafficking and commercial sexual exploitation,
UNICEF
78. Medical records Manual, A Guide for Developing Country, World Health Organization
79. Evaluating the quality of care for severe pregnancy complications, The WHO near miss approach for
maternal health, World Health Organization
80. Guidelines for Hospital Emergency Preparedness Planning, National Disaster Management Division, Ministry
of Home affairs, Government of India
81. Diagnostic Audit Guide 2002, Guide to Indicators, Operation Theatres, Audit Commission, National Health
Services, UK
82. Determinants of patient satisfaction in public hospitals and their remediabilities, Nikhil Prakash, Parminder
Gautam, JN Srivastava, BMC Proceedings 2012
83. Measuring efficiency of emergency processes using value stream maps at Sick Newborn Care unit, Nikhil
Prakash, Deepika Sharma, JN Srivastava, EMS 2013
84. Safe blood & Blood Products, Indicators and Quality of Care, World Health Organization
85. Site assessment and strengthening for maternal health and new born health programs, JHPIEGO
86. Women - Friendly health services experience in maternal care, World Health organization
87. The Quality Improvement Tool book, National Health Systems Resource Center
88. Toyota Production system, Beyond Large Scale Production, 1988 Taiichi Ohno
89. Value Stream Mapping for Healthcare Made Easy, Cindy jimerson, CRC press, New York
90. Mistake proofing: the design of Health care – AHRQ, USA
91. The Quality Tool Box, Nancy R Tague, ASQ Quality Press
92. To Err is Human: Building a safer health system, Institute of Medicine
93. Safety code for medical diagnostic x-ray equipment and installations, 2001, Atomic Energy Regulation Board
94. Guidelines for Good Clinical Laboratory Practices (GCLP), 2008, Indian Council of Medical Research
95. Hutchinson Clinical Methods, 23rd Edition, Saunders Ltd.2012
96. Surgical care at District Hospital, World Health Organization
97. District Quality Assurance Programme for Reproductive Health Services, An Operational Manual, 2006
Department of Health and Family Welfare Government of Gujarat
98. Healthcare Quality Standards, Process Guide, National Institute of Clinical Excellence, United Kingdom
99. Bio Medical Waste (Management & Handling) 1998
100. Medical Termination of Pregnancy Act 1971
101. Pre Conception & Pre Natal Diagnostic Test Act 1996
102. Person with Disability act 1995

166 National Quality Assurance Standards for Public Health Facilities | 2020
 Quality Improvement
Publications

1. Operational Guidelines for Improving Quality in Public Healthcare Facilities

2. Assessor’s Guidebook for Quality Assurance in District Hospitals Volume I & II
3. Assessor’s Guidebook for Quality Assurance in Community Health Centres
4. Assessor’s Guidebook for Quality Assurance in Primary Health Centres
5. Quality Standards for Urban Primary Health Centre
6. Assessor’s Guidebook for Health and Wellness Centre (Sub-centre)
7. National Quality Assurance Standards for AEFI Surveillance Program
8. LaQshya Labour Room Quality Improvement Initiative
9. MusQan Ensuring Child Friendly Services in Public Health Facilities
10. Kayakalp – Award to Public Health Facilities

Link for QI website: https://nhsrcindia.org/quality-improvement

Twitter link: twitter.com/qnhsrc?s=11

National Quality Assurance Standard for Comprehensive Lactation Management Centres 167
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168 National Quality Assurance Standards for Public Health Facilities | 2020