Beyond Certification
By Jasmine Maringmei & Dr Tiameren Jamir
Across India, and increasingly in Meghalaya, National Quality Assurance Standards (NQAS) certification has become synonymous with “quality” in public health facilities. While certification creates measurable benchmarks and signals reform, an important policy question remains: does compliance with standards translate into better care for the mothers, children, and citizens who depend on the public system? Meghalaya’s commitment to strengthening its health system is evident. Significant administrative and financial investments are being made to ensure that public health facilities meet the National Quality Assurance Standards (NQAS). While the journey towards quality assurance continues, notable progress has been made under the NQAS framework.
In 2025, ten public health facilities, including several PHCs and a district hospital, secured NQAS certification. Moreover, a total of 91 Health and Wellness Centers (HWCs) across Meghalaya have achieved NQAS certification, marking a significant step in institutionalizing quality in primary care. This represents approximately 19.4% of the state’s HWCs, paving the way for broader system strengthening. These accomplishments are not limited to infrastructure upgrades but also reflect the sustained efforts of district teams, quality managers, frontline workers, and state-level leadership. Yet certification is only the beginning of the quality journey. NQAS requires facilities to meet standards across eight domains — service provision, patient rights, inputs, support services, clinical care, infection control, quality management, and outcomes.
While meeting such standards is necessary for providing good-quality care, they do not automatically translate into better care, higher utilization, or greater patient trust. A facility can meet every checklist requirement and still fail the community it serves. This matters because a large share of Meghalaya’s population depends on the public system. Nearly half of all institutional births occur in government facilities, and over 93% of children receive vaccinations there (NFHS-5, 2019–20). In rural areas, the dependence is even higher: 93% of hospitalizations and more than half of outpatient visits are managed by the public system (NSSO, 2019). When such a significant proportion of maternal and child health services flows through PHCs and HWCs, certification cannot remain a symbolic exercise. It must translate into better care on the ground.
This gap is particularly visible at the HWC level in Meghalaya. Many centres continue to face shortages of medicines, limited diagnostics, unreliable power supply, and chronic human resource gaps. Vacancies in Mid-Level Health Provider (MLHP) posts, frequent transfers, and resignations disrupt continuity of care. These challenges are not unique to Meghalaya, but geography and remoteness amplify their impact.
Quality Is Also About People, Not Just Processes
Health care is delivered by health workers, which makes them central to any quality improvement program. District teams have observed that many MLHPs and ANMs, despite knowing protocols and standards, struggle during external NQAS assessments. Hesitation and limited communication during assessments often mask their competence. This is not a technical failure. It is a human one. Even the most rigorous quality frameworks rarely account for the emotional and professional pressures frontline workers face. When quality is reduced to checklists and documentation, it does not capture all the contextual constraints that affect quality care.
Encouragingly, some districts in Meghalaya are already finding ways around this. Facilities that have achieved NQAS certification are informally mentoring those still in the process. Peer-to-peer hand-holding, shared mock assessments, and exposure visits are building confidence more effectively than formal training alone. Tools and handbooks exist, developed by technical partners, but uptake remains uneven, highlighting the need for facilitation, not just availability.
Sustaining Quality: A Policy Imperative
The real policy challenge, then, is not how many facilities get certified, but how many continue to improve after certification. Without sustained mentoring, supportive supervision, and investment in soft skills, facilities risk stagnation. Documentation is maintained for audits, while patient experience remains unchanged. If Meghalaya is serious about quality, it must do at least five things differently:
* Treat NQAS as a continuous improvement process, not a one-time achievement.
* Institutionalize mentorship between certified and non-certified facilities.
* Invest in communication, confidence, and leadership for frontline providers.
* Align infrastructure upgrades with workforce stability, especially in remote districts.
* Measure success not only through scores, but also through service utilization, patient experience, and staff retention.
The next phase must move beyond celebrating certificates to asking harder questions about sustainability, patient centeredness, and trust. Quality is not a plaque on the wall; it is a continuous conversation between the health system and the people it serves. If Meghalaya can keep that conversation alive, NQAS can move from a compliance badge to a catalyst for lasting health system reform.
(Jasmine Maringmei is a Consultant- Senior Project Officer, Indian Institute of Public Health Shillong; Dr Tiameren Jamir is Faculty, Indian Institute of Public Health Shillong, Contact: [email protected])
