Frequently Asked Questions

What is COHSASA?

COHSASA (non-profit company) has been operating throughout Africa (but principally in South Africa) since 1995. It was conceived in 1994 to support efforts to provide equity in healthcare provision. In the past 28 years the Council has worked in healthcare facilities in both the private and public sectors, conferring accreditation on those facilities that comply with standards ratified by representative professional bodies and the International Society for Quality in Health Care External Evaluation Association (IEEA).

How does the scoring process work?

All areas of a healthcare facility need to reach compliance with standards (at least 80 out of 100) before accreditation can be awarded. The scores are weighted according to their importance in terms of legal requirements and how they impact on patient safety. If a standard contains criteria which have repercussions for patient safety and medico-legal implications, these so-called  critical criteria have to be compliant before an institution can be accredited.  


Can accreditation make a difference to patient safety and care?

If an organisation is working according to standards that require excellent managerial and clinical policies, procedures and operations, risks to patients will be reduced and the quality of healthcare provided will be improved. Accreditation is a snapshot in time – that at a certain point in an organisation’s history, it has met published standards. The onus is on that organisation to maintain standards and to continue to improve. Strictly applied quality improvement methods can improve patient safety and quality of care by guiding interventions, monitoring progress and identifying improvements. COHSASA identifies impediments or blocks in the improvement process and assists hospital staff to overcome these in a process that eventually leads to a facility being accredited. The goal is accreditation, the means is quality improvement on a continuous basis.

Does accreditation prevent adverse events in healthcare facilities?

No, it does not but because the organisation is meeting standards and because an external accreditation body like COHSASA is monitoring deficiencies, which can then be acted upon, risks to patients are reduced.

What gives COHSASA its authority?

COHSASA has been accredited by the International Society for Quality in Health Care (ISQua) External Evaluation Association (IEEA) from 2002 to 2006, from 2006 to 2010,  from 2010 to 2014, from 2014 to 2018, and from 2018 to 2023. Being internationally accredited by ISQua means that COHSASA has been given formal worldwide recognition as an organisation that meets agreed international standards that have been specifically developed and tested for healthcare external evaluation bodies. An IEEA accreditation provides reassurance to governments, funders, clients and the organisation itself that its performance, standards, training or education programmes meet the highest international standards and are continuously improved. In addition to its status as an accredited organisation, COHSASA healthcare facility standards are also accredited by IEEA.

COHSASA works closely with representatives of professional associations to develop standards, refine them and ensure that these standards are up to date.

Who funds COHSASA?

COHSASA provides a service for fees paid by hospitals, hospital groups, governing authorities and provincial departments of health. In some cases research is donor-funded.

How many hospitals does COHSASA work in?

COHSASA has worked in over 600 healthcare institutions including hospitals, clinics, sub-acute care facilities and hospices in both the private and public sector. We work in Africa. There are currently 67 health facilities that hold full accreditation from COHSASA.

Does COHSASA work in the private sector?

Yes, it does. It accredits hospitals and clinics as well as hospices and community centres.

What additional services or training does COHSASA provide?

COHSASA provides training for hospital and clinic managers in understanding the theory of quality improvement and standards, as well as practical training in how to implement the COHSASA programme and meet the standards. Surveyors and quality advisors also receive training from COHSASA. 

How do I approach COHSASA to do research?

Send an email to Jacqui Stewart at with a brief  summary of your research proposal and your contact details.

Who serves on COHSASA’s board?

Board Members are appointed for their knowledge, skills and experience in a particular field of endeavour and they include doctors, nurses, administrators and entrepreneurs drawn from both public and private sectors who are considered leaders in their field.

What is accreditation?

In the healthcare field, according to the International Society for Quality in Healthcare External Evaluation Association (IEEA) it is:

  • awarded based on achievement of quality standards and the independent external survey by peers of an organisation’s level of performance in relation to the standards;
  • the longest established and most widely known process for the external evaluation of healthcare services;
  • a formal process to ensure delivery of safe, high quality health care;
  • based on standards and processes devised and developed by health care professionals for healthcare services;
  • a developmental process using the skills of external peers trained and appointed as a team of assessors;
  • public recognition of achievement by a healthcare organisation of requirements of national healthcare standards;
  • generally available to public and private sectors;
  • the coverage of a range of healthcare environments from local community-based care through to tertiary level providers and healthcare systems.
What areas of hospitals and clinics become accredited?

In the COHSASA programme, all areas of hospital and clinics have to meet standards. We help to improve systems that operate in clinical areas, clinical support areas (radiology, pharmacy and laboratory), technology, health and safety, infection control, administration and management and hotel areas.

How much does it cost to accredit a healthcare facility?

These fees vary according to client needs, the size of the institution, the number of standards that need to be assessed and the location of the facility. For further information, email

How long does it take to become accredited?

This depends on the type of healthcare facility involved and how much compliance it has already achieved with professional standards. Where hospitals have continuously improved their quality and maintained standards, accreditation can be immediate. However, hospitals with poor resources and systems in place may take longer than those that are well managed and using resources optimally. The average time-frame for accrediting a public hospital is about 18 to 24 months. Once accreditation is achieved, quality needs to continue to improve and this is an ongoing, never-ending process. In our experience, once the quality improvement processes become embedded in normal hospital routine, accreditation surveys are less daunting.

What happens if you "fail" or don’t meet the standards?

To assist the many South African hospitals from disadvantaged backgrounds with poor resource bases that do not initially achieve accreditation but have made significant strides since their entry into the programme, COHSASA has developed two strategies to keep facilities focused on the long and winding road to quality service provision. These strategies are the Facilitated Accreditation Programme and the Graded Recognition Programme. The latter programme encourages a facility’s momentum towards accreditation by certifying specific, progressive levels of compliance with essential performance indicators calculated according to an algorithm. Criteria define the requirements of each of the three levels of Graded Recognition, “Progress”, “Entry Level” and “Intermediate Level”. Facilities achieving these levels are awarded certificates for a defined period and are encouraged and motivated to continue to higher levels and finally achieve accreditation. There are also individual certificates for services that achieve substantial compliance with standards.

What are the benefits of becoming accredited?

It confers a certain amount of peace of mind to patients that the facility where they are receiving treatment is engaged in the process of continually improving the quality of service it provides. It assists doctors and nurses in that they feel safer working to streamlined systems; it helps administrative staff by providing checks and balances, by providing a system for accountability and the optimal use of resources. If a medical facility has passed through the stringent requirements of a COHSASA programme, it should become a preferred provider and should guide medical funders in their choice of facilities for their members. Accreditation helps to improve the image and delivery in public sector services: that they are endeavouring to provide quality service to their customers. According to IEEA, external evaluation is in demand in many countries by governments, healthcare managers, patients and communities wanting to know more about how scarce resources are being used to deliver safe, quality health care and with what results for external, independent assessment of the performance of services against formally established standards. COHSASA, as an African accreditor of health facilities, offers unique assets. Our home page has a paper on the benefits of accreditation.

What support is required from management?

COHSASA’s experience is that without management commitment to quality improvement and the accreditation programme, progress at any institution is – at best – limited and at worst severely impaired. Effective leaders – Quality Champions – at all levels of the organisation are required to emerge and commit to the concept of improving the quality of care provided to patients. Governing authorities responsible for healthcare facilities’ performance (at a provincial or at the private medical group HQ level) need to pay close attention to the information supplied by COHSASA, which identifies deficiencies and evaluates progress of compliance with standards.

How do managers know their hospitals are improving?

Hospital managers receive a “dashboard” from the COHSASA Quality Information System (CoQIS) which provides a birds-eye view of the status quo of compliance in each department in their facility and where deficiencies are located. Using CoQIS, managers can deep-dive for more information to find out precisely what is wrong in each department. In this way, managers can use data provided by CoQIS to help manage their facilities and monitor progress.