Improving Healthcare

Source: The Hitavada      Date: 18 Aug 2017 11:27:45

By JYOTSHNA PANDIT

National Accreditation Board for Hospitals and Healthcare Providers, known as NABH, is a constituent board of Quality Council of India (QCI), which was set up to establish and operate accreditation programme for healthcare organisations. Till date, it has accredited 480 hospitals in India, a country that is home to more nearly 80,000 big and small medical facilities.

THE number of children who died at Gorakhpur’s Baba Raghav Das Medical College Hospital was lesser in 2017 than it was in 2016, a panel of doctors from Delhi has said in its interim report. The panel had gone to Gorakhpur to look into the deaths of the children and has submitted the report to the additional health secretary. As it is, India doesn’t have strong and standardised quality-controlled healthcare.

The Clinical Establishments Act was passed by Parliament on August 17, 2010, to provide for registration and regulation of all clinical establishments in the country with a view to prescribing minimum standards of facilities and services that may be provided by them in order to achieve the mandate of Article 47 of the Constitution for improvement in public health.


The Act has taken effect in the four States namely Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim, and all Union Territories since March 1, 2012, vide Gazette notification dated February 28, 2012. Uttar Pradesh, Rajasthan and Jharkhand have adopted the Act under clause (1) of Article 252 of the Constitution.


The question arises, why did the Act come into existence as late as 2010 and why hasn’t it been adopted by most States yet? It was important to understand that encephalitis is a viral disease and doctors can only cure its symptoms. Therefore, prevention is the only cure. As stated in a Ministry of Health and Family Welfare note titled Operational Guidelines for Clinical Establishments Act: “Healthcare in India suffers from under-regulation subjecting the populace to poor quality of treatment, quackery menace and high costs.

This makes it imperative to enforce minimum standards on clinical establishments in both private and public sector. Technical quality of healthcare depends on factors like competence of personnel involved, adherence to clinical protocols, standard treatment guidelines as well as availability of required facility and infrastructure which are ensured in accredited hospitals but remains suspect in non-accredited institutions.”


National Accreditation Board for Hospitals and Healthcare Providers, known as NABH, is a constituent board of Quality Council of India (QCI), which was set up to establish and operate accreditation programme for healthcare organisations.
Till date, it has accredited 480 hospitals in India, a country that is home to more nearly 80,000 big and small medical facilities.


“In India, if it is a four unit hospital, in each unit, a doctor will prescribe a different drug for the same disease. There is an immediate need to standardise healthcare because our training culture is non-existent,” Dr. K.K. Kalra, former head, NABH, said. From 2003 to 2012, Dr. Kalra headed the Chacha Nehru Bal Chikitsalaya, a super-speciality children’s hospital in New Delhi’s Geeta Colony. Under his guidance, the facility became the first Government hospital to acquire accreditation from NABH.

Public hospitals like AIIMS in Delhi and PGI in Chandigarh are doing a good job because there is accountability towards the patient’s life. It is that accountability that needs to be put into sarkaari hospitals. The Clinical Establishments Act 2010 cannot be limited to statutes and must be enforced in all States, and must go beyond drug stocks and expiry dates of medicines.


Dr. Hema Divakar, former president of FOGSI (Federation of Obstetric and Gynaecological Societies of India) said that nearly 45,000 women die during childbirth and there are 40.5 deaths per 1,000 live births in India. “The reason for this is mainly that the staff is not trained in specialised healthcare techniques,” she added. She also mentioned the Navjaat Sishu Suraksha Karyakram launched by the UPA Government which helped train nurses in handling resuscitation, prevention of infections, hypothermia and other critical measures.

“It is a robust programme for capacity-building, where specialised skills percolated to frontline. We need to re-audit and re-visit this national programme to check retention of skills, train new staff,” she explains.


Quality enhancement in healthcare is a slow and uphill task. Unlike the Clinical Establishments’ Act, which makes big promises on paper, we need to practically understand what is doable and then go ahead and do it. For instance, in FOGSI, out of 240 quality standards for maternal healthcare, we have declared 16 as non-negotiable because we want to scale up from a few hundred to thousands of hospitals,” she highlighted.

Meanwhile, back in Gorakhpur, Rajbhar, a resident from Motipur village of Bihar’s Gopalganj district commenced a dharna seeking justice after the death of his only son on August 11, 2017.

“My son had to be admitted due to symptoms of fever and stomach ache. The supply of oxygen being administered to him was stopped, due to which he struggled and suffered and died before my very eyes. Rajbhar had come to the hospital to get his son treated but the negligence of the hospital led to the death of the child,” father of the baby told, who was still present at the hospital along with his two-year-old daughter. Rajbhar isn’t the first father to have lost a child to medical negligence within a system ailing with weak and infected policies.


In 1973, in West Bengal, there was a large scale outbreak of encephalitis. In 1978, States like Karnataka, Tamil Nadu, Bihar, Assam and Uttar Pradesh grappled with yet another major outburst. In 2005, in Gorakhpur, 5,737 persons were affected in seven districts of eastern Uttar Pradesh, and 1,344 persons lost their lives. It kills children every year and not just in Gorakhpur. It’s policy and not polity that needs that must be talked about, at least now.