1

National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a

constituent board of Quality Council of India, set up to establish and operate

accreditation programme for healthcare organizations. The board is structured to

cater to much desired needs of the consumers and to set benchmarks for

progress of health industry. It is a member of ISQua. NABH has already set

accreditation standards for Ayurveda hospitals. Information regarding this is

available in the publications Accreditation Standards for Ayurveda Hospitals

(2009) and Structural Standards for Ayurveda Hospitals (2009). However, the

suitability of this accreditation system for Ayurveda hospitals in Kerala is a subject

of debate. To discuss the merits and demerits of the present NABH accreditation

guidelines, a Consultative Seminar on NABH Guidelines for Ayurveda Hospitals

was organized at CARe Keralam Ltd on 3 November, 2013.

Shri. BalachadraDas delivering presidential address.

The seminar began at 11 A.M. with a one-minute silent prayer. Thereafter, Sri

Karimpuzha Raman, Managing Director of CARe Keralam Ltd welcomed the

delegates and spoke about the relevance of the seminar. Sri M.C. Balachandradas,

Managing Director of Sree Sankara Community for Ayurveda Consciousness Ltd,

2

Changanassery delivered the presidential address. He said that CARe Keralam Ltd

is taking this initiative in the larger interests of the industry and requested

participants to express their views sincerely.

Sri Karimpuzha Raman, Managing Director of CARe Keralam Ltd welcoming the gathering

Dr. Induchoodan, presenting QA presentation

Dr. Induchoodan, Assistant General Manager-Vaidyaratnam Oushadhasala,

Trichur, Treatment Standardization Committee Convener-AHMA & NABH (AYUSH)

Assessor presented an informative PowerPoint presentation entitled Quality

Assurance, Standardization & Accreditation of Ayurveda Hospitals & Wellness

3

Centres- Scope and Limitations. The basic question posed by the presentation as

whether the present guidelines are suitable to Ayurvedic Hospitals in Kerala and

whether can appropriate based on the quality concepts from Ayurvedic texts.

The major recommendations of the seminar are as follows:

The present NABH accreditation standards for Ayurveda hospitals depend

heavily on the guidelines set for allopathic hospitals. It is confusing and

requires more finances to comply with the present standards. There are

nearly 2000 Ayurveda hospitals in Kerala. Majority of them are 10-bedded

hospitals which cannot be accredited in NABH due to lack of category.

Hospitals with more than 200 beds are found only in Arya Vaidya Sala,

Kottakkal and the Government Ayurveda colleges.

The present guidelines do not put emphasis on treatment. They

concentrate on Documentation, personnel and structure only. Similarly

there is no clarity in many points. An example is infection control. Similarly,

the present NABH guidelines are not practical on qualification of nurses and

therapists.

What is Bio-Medical Waste (BMW) in Ayurveda (disposal of which is

mandatory as per NABH Norms)? Ayurveda does not create wastes with

blood or body parts, except in the case of rakthamoksham, where blood-

filled leech may be considered as a BMW. The major waste material coming

out of an Ayurveda hospital is the used kizhi and medicated oil discarded

after use. Large quantities of this oil are available and many unscrupulous

4

elements misuse this spent oil. An ecofriendly way should be found out to

make use of or to destroy this waste oil.

When GMP was introduced in Kerala there was uproar. It was rumoured

that the system was intended to favour large manufacturers. But over the

years GMP has become very popular and now all Ayurveda companies and

GMP- certified. Same is the case with NABH accreditation. We should not

oppose NABH accreditation system vehemently. There are many good

aspects in NABH accreditation system. An example is SOPs. Sooner or later

the accreditation system is going to be implemented everywhere and those

who cannot comply with the norms will have to disappear from the scene.

Therefore, instead of just opposing NABH accreditation we should evolve a

new accreditation system that is suitable for even small scale hospitals of

Kerala. For those who can afford the expenses can go for NABH

accreditation if interested. Similarly assessment of compliance with

standards also needs to be carried out more effectively.

Efforts should be made to prevent the appearance of massage parlours.

Their activities are detrimental to the interest of Ayurveda.

Documentation of treatments is beneficial. There is certainly a need for

standards in the sphere of Ayurveda. It can be a mix of useful parts of

present NABH guidelines and scientific aspects considering the Kerala

tradition of treatment.

5

NABH accreditation should not become statutory. Only those who can

afford should opt for NABH accreditation.

The present NABH system needs modifications.

There is no standardized protocol for treatment as per NABH. Eventhough a

standardized treatment protocol was developed by AHMA and approved by

Dept. of AYUSH for Insurance coverage; it is not implemented widely since

it is not mandatory. There are lack of proper case sheets and discharge

summaries in several Hospitals. This system should change at first before

focusing international standards. As done in allopathic hospitals, the entire

process of treatment needs to be documented.

An accreditation system suitable for small Ayurveda hospitals of Kerala

should be developed. For example, can we agree with the stipulation that

the pharmacy of all Ayurveda hospitals should have same area as that of big

Hospitals?

We should draft a minimum standard for hospitals. Then we should

categorize and grade hospitals.