National Quality Assurance Standards

Why in News ?

India has crossed a major public health milestone, with 50,373 public health facilities across all States and Union Territories certified under the National Quality Assurance Standards (NQAS). This marks a significant leap in institutionalising quality, safety, and patient-centric care across the public healthcare system.

Background and Context: Quality in India’s Public Healthcare

India’s public healthcare system serves a vast and diverse population, often under conditions of high patient load, limited resources, and regional disparities.
Historically, the focus remained on expanding access—building hospitals, increasing manpower, and rolling out national health programmes—while quality assurance remained uneven.

With rising health awareness, epidemiological transition towards non-communicable diseases, and increased public expectations, quality of care emerged as a critical governance challenge.
In this context, the Ministry of Health and Family Welfare (MoHFW) institutionalised a national framework to move beyond infrastructure and ensure standardised, measurable, and patient-focused healthcare delivery.

What are National Quality Assurance Standards (NQAS) ?

The National Quality Assurance Standards (NQAS) are a comprehensive quality framework developed by the MoHFW to improve and standardise healthcare services in public health facilities.

• Initially introduced for District Hospitals, NQAS has gradually expanded across all tiers of public healthcare.
• The framework is designed not merely as an inspection mechanism, but as a continuous quality improvement tool.
• Facilities voluntarily assess themselves against predefined benchmarks and undergo external evaluation for certification.

The core philosophy of NQAS is to shift public healthcare from service delivery based only on availability to care based on safety, effectiveness, and patient dignity.

Scope and Coverage of NQAS

At present, NQAS standards apply to a wide spectrum of public health institutions:

• District Hospitals (DHs)
• Sub-District Hospitals (SDHs)
• Community Health Centres (CHCs)
  • Ayushman Arogya Mandir – Primary Health Centres (AAM–PHCs)
  • Ayushman Arogya Mandir – Urban PHCs (AAM–UPHCs)
  • Ayushman Arogya Mandir – Sub Health Centres (AAM–SHCs)

Crossing 50,000 certified facilities reflects deep penetration of quality benchmarks from tertiary hospitals to the grassroots level, aligning with the vision of comprehensive primary healthcare under Ayushman Bharat.

Eight Areas of Concern under NQAS

NQAS standards are structured around eight interlinked domains that together define healthcare quality:

1. Service Provision – Availability, accessibility, and continuity of essential health services
2. Patient Rights – Dignity, privacy, informed consent, grievance redressal
3. Inputs – Human resources, drugs, equipment, and infrastructure adequacy
4. Support Services – Laboratory, pharmacy, blood bank, and referral systems
5. Clinical Care – Adherence to standard treatment guidelines and protocols
6. Infection Control – Biomedical waste management, hygiene, and patient safety
7. Quality Management – Internal audits, documentation, and improvement cycles
8. Outcome – Patient satisfaction, service effectiveness, and health outcomes

This structure ensures that certification goes beyond infrastructure to assess processes and outcomes.

Significance of NQAS Certification

Improving Patient Trust

Standardised care protocols and emphasis on patient rights enhance public confidence in government facilities.

Strengthening Ayushman Bharat

NQAS complements the Ayushman Arogya Mandir vision by ensuring that expanded access is matched with assured quality.

Reducing Regional Disparities

Uniform national benchmarks help reduce inter-State and rural–urban variations in healthcare quality.

Capacity Building

The self-assessment and audit process builds managerial and clinical capacity within health institutions.

Global Alignment

NQAS aligns India’s public healthcare quality framework with global best practices in quality assurance.

Challenges and Way Forward

Challenges

• Variations in implementation capacity across States
• Human resource shortages affecting sustained compliance
• Risk of certification becoming a one-time exercise rather than a continuous process

Way Forward

• Strengthen internal quality assurance teams at facility level
• Link NQAS outcomes with health financing and performance incentives
• Integrate digital health tools for real-time monitoring and feedback
• Focus on post-certification mentorship to sustain quality gains