Dr J N Srivastava, Dr K Madan Gopal, Dr Swarnika Pal and Dr Abhay Dahiya
The National Health Mission (NHM) has been a significant initiative aimed at achieving universal access to comprehensive healthcare. The NHM focuses on strengthening healthcare infrastructure, enhancing human resources, and ensuring the availability of essential medical supplies, with primary focus on tribal and underserved areas. These efforts collectively reflect India’s dedication to improving public health and making healthcare accessible to every citizen. Through different programmatic interventions, India has made a remarkable improvement in key indicators related to population stabilization, maternal, infant and child health and communicable diseases. The average rate of decline of such indicators in India has been higher than the global average, particularly for maternal, infant and under five mortality rates. However, country’s health system is always challenged with the burgeoning population and newer diseases, variability and appropriateness of care for given clinical conditions and quality of services. Strengthening Healthcare systems and enhancing quality of care. Despite planned programmatic interventions, challenges pertaining to under utilisation of public healthcare facilities, inappropriate and/or unsafe treatment, missed diagnosis and disrespectful services, have been reported attributed to factors like poor infrastructure, shortage of human resources of health (HRH), and sub optimal quality of care. These challenges are directly linked to unexpected, ill-timed preventable deaths, poor health, financial burden to individuals, and loss of trust in public healthcare system.
Cognizant of these issues, the Ministry of Health & Family Welfare adopted a multi-pronged strategy to timely intervene and address the challenges on priority. One of the interventions in this direction is to upgrade the facility-based specification across the levels of care in rural and urban areas through revised Indian Public Health Standards (IPHS), 2022, which provide a comprehensive framework for upgrading components of healthcare delivery system across public health facilities. A critical aspect of the IPHS guidelines is their emphasis on essential (minimum) and achievable (desirable) services. Each level of healthcare facility is required to provide a set of minimum services to ensure assured healthcare delivery. The guidelines specify standards for infrastructure, equipment, drugs, diagnostics, human resources, etc. aiding states/UTs in planning and ensuring consistent and reliable care.
The core objectives of the IPHS are multifaceted and in alignment of National goals in Health care service delivery. While IPHS focusses on improved accessibility by redesigning the population norms to establish health care facilities with a time to care approach, it also provides input for establishing a seamless system for patient referrals and ensuring that healthcare services are delivered in a patient-friendly and dignified manner with reduced financial burden to all. With IPHS providing a set of specifications for each level of care across public health facilities, MoHFW simultaneously prioritizes the need to improve the quality of care to curb inappropriate and unsafe treatment, missed diagnosis and to provide respectable care at public health institutions. MoHFW’ s flagship programme National Quality Assurance Standards (NQAS) has been designed and implemented to ensure that services at public health care facilities are not only safe and patient-centric, but also of assured level of quality. The initiative focusses on addressing the gaps in understanding, measuring and improving quality of health care services. Provision of quality healthcare in the public healthcare facilities is a critical aspect that impacts patient outcomes, safety, and overall patient satisfaction. It also aids in improving the health of the overall community, elevates the patient experiences, and enhances the service provider’s experience by reducing the cost of care. Having assurance of availability of standardised services in public healthcare facilities increases the trust of population in public healthcare facilities,as shown by increased footfalls and better relationships with all stakeholders. NQAS implementation has also ensures the compliances of health facilities to regulatory requirements and preparedness for fire safety, etc.
Ensuring quality in healthcare has also addressed the disparities and ensures that all patients, regardless of their background or circumstances, receive equitable care. This is crucial for achieving health equity and social justice and is aligned with government’s principle of ensuring ease of living for all. Taking learnings from the recent pandemic, and preparing for any future public health emergencies, the Indian Public Health Systems, got the largest pan-India mission on infrastructure support i.e. Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). With prime focus on infrastructure and surveillance activities, and to ensure the accessibility, efficiency, effectiveness, and quality of services through cost-effective laboratory systems Integrated Public Health Lab (IPHL) was designed as a key component within PM-ABHIM.. Not only these laboratories would provide rapid, reliable and accurate test results, but would also establish district and sub-district level linkages for effective diagnosis and surveillance services, thus adding on to India’s step towards building a resilient health system. Having vast geographic and demographic versatility in the country and unique regional healthcare challenges, the Government of India continues to strivein achieving the universal health care through implementation of quality healthcare services which are safe, effective, patient centred, timely, efficient and equitable. To summarise, the IPHS guidelines serve as a beacon of transformation, illuminating the path to a future where health facilities are functional with a defined set of specifications, as required for service delivery at each level of care. By setting uniform standards and ensuring their implementation, the IPHS aims to make healthcare more accessible, affordable, and dignified, particularly for vulnerable and marginalized population subgroups.
In parallel, implementation of National Quality Assurance Standards in public health facilities has resulted in delivery of quality healthcare services which is vital for ensuring safe, effective, and patient-centred care, which leads to better health outcomes, enhanced patient experiences, and more efficient public healthcare system. These transformative initiatives promise to improve health outcomes, reduce the burden of preventable diseases, and foster a renewed sense of trust and reliance on the government’s healthcare system.
(The writers Dr J N Shrivastava is Advisor and Dr Abhay Dahiya is consultant with Quality and Patient Safety Division and Dr K Madan Gopal is Advisor, and Dr Swarnika and Dr Arpita work as Senior Consultant Public Health Administration, National Health Systems Resource Center, MoHFW, Government of India)