Quality Assurance Programme in Public Health Facilities - Issue of Adoption Notification and Guidelines

GOVERNMENT OF TELANGANA
A B S T R A C T
Health, Medical and Family Welfare Department - National Health Mission- Quality Assurance Programme in Public Health Facilities - Issue of Adoption Notification and Guidelines – Orders - Issued.


HEALTH, MEDICAL & FAMILY WELFARE (D1) DEPARTMENT
G.O.MS.No. 17. Dated:19.02.2015

Read the following:-
1. Manual for “Operational Guidelines for Quality Assurance in Public Health Facilities, 2013.
2. D.O.Lr.No. NHSRC/13-14/QI/01/QAP, Dated 12.12.2014 of Deputy Commissioner (MH),
Ministry of Health and Family Welfare, GOI.
                                     * * *
ORDER:
The Dy Commissioner, Ministry of Health & Family Welfare, Govt. of India, New Delhi, in the reference 2 nd read above, has stated that various steps need to be taken like states’s Notification on adapting QA Guidelines, formation of state and district QA Committees and arms, empanelment of assessors, training of all stakeholders, including program officers and service providers, assessment of gaps in service delivery at health facility and preparing a road – map for time bound actions to fill these gaps. He has requested to closely monitor the implementation of steps envisaged under the Quality Assurance (QA) Guidelines. This will not only improve our technical standards and protocols but also lead to client satisfaction.

2.  In the reference 1 st read above, the Ministry of Health and Family Welfare (MOHFW) has developed a system of quality assurance and prepared guidelines for addressing the concerns of Public, and also the technical components of service delivery in a comprehensive manner which can be operationalised through the institutional mechanism and platforms of NHM. 

3.  The successful implementation of NRHM since its launch in 2005 is clearly evident by the many fold increase in OPD, IPD and other relevant services being delivered in public health institutions. However, the quality of services being delivered still remains an issue. The offered services should not only be judged by its technical quality but also from the perspective of service seekers. An ambient and bright environment where the patients are received with dignity and respect along with prompt care are some of the important factors of judging quality from the clients’ perspective. Quality of care can only be sustained if there is an inbuilt system within the institution along with ownership by the providers working
in the facility.

4.  Quality Assurance (QA) is a cyclical process which needs to be continuously monitored against defined standards and measurable elements. Regular assessment of health facilities by their own staff and state level functionaries, ‘ effective action-planning’ for traversing the observed gaps and periodic assessment to improve the Quality is the only way in having a viable Quality Assurance Programme in Public Health.

5.  In accordance with the guidelines and strategic frame work, the State Government is committed to support and facilitate the Quality Assurance Programme, which meets the needs of the Public Health system in the State. The sustainable focus of the Quality Assurance Programme would be enhancing the satisfaction level among users of the government health facilities and reposing trust in the Public Health System. Therefore, Government hereby notifies that, National Quality Assurance Programme has been adapted by the state by constituting the following committee for further implementation.

A. STATE LEVEL

A. State level Quality Assurance Committee (SQAC):
In order to implement the Programme in a comprehensive manner and in accordance with the national guidelines, State level Quality Assurance Committee is hereby reconstituted with the following members. The broad responsibility of this committee will be to oversee the quality assurance activities across the state in accordance with the national & state guidelines, and also ensure regular and accurate reporting of the various key indicators. Terms of Reference of the committee are as per the national guidelines for Quality Assurance.

A.1. Composition of the State Level Quality Assurance Committee (SQAC):
1. Principal Secretary, Dept. of Health Medical & Family Welfare : Chairperson
2. Mission Director (NHM) : Vice Chairperson
3. Commissioner, Health & Family Welfare / Director, Family Welfare : Convenor.
4. Managing Director, TSMSIDC  : Member
5. The Chief Executive Officer, Aarogyasri Health Care Trust : Member
6. Director of Medical Education  : Member
7. Director of Public Health – Co-Convener : Member
8. Commissioner, Vaidya Vidhana Parishad : Co-convener
9. Nodal Officer, Quality Assurance Programme  : Member
10. Director, Institute of preventive Medicine  : Member
11. Director , Indian Institute of Health and Family Welfare( IIHFW) : Member
12. Chief Planning Officer, NHM : Member
13. One empanelled Gynacologist from (Public Institutions)
14. One empanelled Surgeon from (Public Institutions)
15. One Anesthetist (From Public Institutions)
16. One Pediatrician (From Public Institutions)
17. One Medical Super Specialist (From Public Institutions)
18. One nominated Medical Superintendent (or equivalent) of (District Health)
19. One each incharge of (PHC, CHC & AH)
20. State Nursing Advisor (Equivalent) : Member
21. One member from an Accredited private sector hospital/NGO (Health care sector)
22. One representative from the State Legal Cell : Member
23. One representative from medical professional bodies
e.g. FOGSI/IMA/IAP/IAPSM/ Association of Public Health : Member
24. Any other member or representatives of public health organizations of eminence as nominated by the state government

A.2. State Family Planning Indemnity Subcommittee:
The Quality Assurance Committee as laid down in the “Quality Assurance Manual for
Sterilization Services’ shall stand subsumed within the QAC mentioned above. However, a five-member “State Family Planning Indemnity Subcommittee” from within the SQAC would redress, dispose and disburse claims/complaints received through the DQAC, to the district health society as per procedure and time frame laid down in the manual on “Family Planning Indemnity Scheme 2013”.

The subcommittee comprise of the following:
1. Mission Director, NHM  : Chairperson
2. Commissioner, Health & Family Welfare / Director, Family Welfare/ Director, Public Health : Convener
3. Additional / Joint Diector (MCH / MNH / FW) / Equivalent : Member Secretary
4. Empanelled Gynaecologist - from Public Institutions
5. Empanelled General Surgeon - from Public Institutions

A.3. State Q u a l i t y A ss u r a n c e U n i t:
SQAU is the working arm under SQAC that will be responsible for undertaking various activities as per ToRs of the unit, and other tasks, as entrusted to them from time to time by the SQAC. The SQAU is hereby reconstituted as follows:

1. Additional / Joint Director (FW) / Deputy Director (FW) / Equivalent Officer in Vaidya Vidhana Parishad designated by the state government / NHM as the Nodal Officer for the State Quality Assurance (QA) Unit : Member Secretary
2. Additional Director, MCH/ Planning :  Member
3. Joint Commissioner, Medical, TVVP :  Member
4. Chief Planning Officer, NHM :  Member
5. Joint Director (MHN) :  Member
6. Joint Director (CHI) :  Member
7. Joint Director (Trainings) :  Member
8. Joint Director (PS & SP) :  Member
9. Joint Director (IEC) :  Member
10. Joint Director, DME :  Member
11. State Consultant (Quality Assurance)
12. State Consultant (Public Health)
13. State Consultant (Quality Monitoring)
14. Administrative-cum-Programme Assistant.

The SQAU is headed by the SQAC’s member secretary, who along with the state programme
officers provide support to the SQAC for implementation of QA activities in the state. All the positions of this unit should preferably be regular from the state cadre, however in case of non- availability from the State cadre the posts can at Sl.No. 11 to 14 can be hired under NHM till the posts are filled-in from the state cadre.
The number of full time technical persons (consultants) may be increased once the state decides to expand QA for the Disease Control and other programmes as part of the mandate of the State QAC.
Terms of reference of the committee are as per the national guidelines for quality assurance.

B. District Level

B.1 District level Quality Assurance Committee (DQAC) :

In order to implement the Programme in a comprehensive manner and in accordance with the national guidelines, District level Quality Assurance Committee is hereby reconstituted. The broad responsibility of this committee will be to oversee the quality assurance activities across the District in accordance with the national & state guidelines, and also ensure regular and accurate reporting of the various key indicators. Terms of Reference of the committee are as per the national and state guidelines for Quality Assurance. The DQAC is hereby reconstituted as follows:

B.2 Composition:
1. District Collector : Chairperson.
2. District Co-ordinator of Hospital Services : Convener and Member Secretary
3. District Medical & Health Officer : Co-Convener
4. Medical Superintendent of Teaching / : Member District / Area Hospital
5. Additional DM & HO (FW) : Member
6. Medical Superintendent of the Area Hospital : Member (one each, by rotation)
7. In-charge Medical Officer of CHC & PHC : Member (one each, by rotation)
8. One empanelled Gynacologist from (Public Institutions)
9. One empanelled Surgeon from (Public Institutions)
10. One Medical Super Specialist (From Public Institutions)
11. One Anesthetist (From Public Institutions)
12. One Pediatrician (From Public Institutions)
13. All Programme Officers of the District : Members
14. Executive / Deputy Executive Engineer from TSMSIDC / TVVP : Member
15. Principal, Regional / District Training Centre / PO-DTT : Members
16. District Public Health Nursing Officer (DPHNO) : Member
17. District Programme Management Officer / Member District Programme Officer, NHM 
18. District Manager, National Ambulance Service  : Member
19. District Extension and Mass Media Officer (DEMO) : Member
20. One Representative from the District Legal Cell : Member
21. One Member from an Accredited Private Sector Hospital / NGO (health care sector)
22. One representative from Medical professional bodies
eg. FOGSI / IMA / IAP / IAPSM / Association of Public Health : Member
B.2. District Family Planning Indemnity Sub committe:
Committee Consisting of 5 members from within the DQAC would process claims received from the clients and complaints / claims lodged against the surgeons and accredited facilities, as per procedure and time frame laid down in the manual on “Family Planning Indemnity Scheme 2013”.
The subcommittee would comprise of the following:
1. District Collector :  Chairperson
2. District Medical & Health Officer :  Convener
3. District Programme Officer (Family Welfare) / equivalent :  Member Secretary
4. Empanelled Gynaecologist (from public institutions) :  Member
5. Empanelled Surgeon (from public institutions)  :  Member
B.3. District Quality Assurance Unit:
DQAU is the working arm under DQAC that will be responsible for undertaking various activities as per the Terms of Reference of the committee and also entrusted to them from time to time by the DQA Committee. The DQAU is hereby reconstituted as follows:
Composition:
1. Additional District Medical and Health Officer (FW) / DCHS / Equivalent - Head of DQAU
2. Medical Superintendent / CSRMO of the District Hospital / Equivalent-Convener
3. District Consultant (Quality Assurance).
4. District Consultant (PH)
5. District consultant (Quality Monitoring)
6. Administrative cum Programme Assistant.
The DQAU is headed by the Member Secretary DQAC, who along with the District Programme officers provide the support to the DQAC for implementation of QA activities in the district. All the positions of this unit should preferably be regular staff from the government. However, in case of non- availability of the regular cadre staff, District Consultant (Quality Assurance and Monitoring) and Administrative cum Programme Assistant can be hired under NHM till the regular cadre become available. Terms of Reference of the committee are as per the national and state guidelines for Quality
Assurance

B.4. District Quality Team (DQT) at District Hospital:
The DQT will be functioning exclusively at District hospitals. Terms of Reference of the
committee are as per the national and state guidelines for Quality Assurance. The DQT is hereby reconstituted as follows:
Composition
The composition of the Quality Team at the District Hospital is as follows:
1. Medical Superintendent  : Chairperson
2. Civil Surgeon,RMO : Convener
3. Civil Surgeon Specialist, Anaesthesia at DH : Member
4. Civil Surgeon Specialist, General Surgery at DH : Member
5. Civil Surgeon Specialist, Obstetrics and Gynaecology at DH : Member
6. Civil Surgeon Specialist, General Medicine at DH : Member
7. Specialist from Laboratory services / Blood Bank  : Member
(Microbiologist/ Pathologist)- for enforcing IMEP & BMW Protocols
8. Nursing Superintendent at DH : Member
9. Pharmacy Supervisor : Member
10. District Manager, National Ambulance Service : Member
11. Executive / Deputy Executive Engineer from : Member TSMSIDC / TVVP
12. Assistant Finance Officer / Assistant Director / : Member
Administrative Officer at the District Hospital
13. Dietician, District Hospital : Member
14. Health Inspector / In-charge Sanitation  : Member
15. (Hospital Manager) District Hospital Quality Manager.

6.  The Mission Director, National Health Mission / Commissioner, Family Welfare / Director, Family Welfare is hereby directed to take necessary action to initiate Setting up of Organizational Framework, Prepare Road Map for implementation of Quality Assurance Process in all the Health facilities in Phases, Empanel quality assessors and extend the programme for bringing all the Health Care Delivery Services and other National Programmes under its umbrella in the State as per the Operational Guidelines issued
by the Ministry of Health and Family Welfare, Government of India.

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF TELANGANA)
SURESH CHANDA
PRINCIPAL SECRETARTY TO GOVERNMENT