COHSASA Healthcare Standards


COHSASA has been involved in the development of standards for a range of healthcare facilities for over two decades. Standards have been developed to meet specific requirements of clients and COHSASA has developed country-specific sets of standards on the African continent for both private and public sectors. Standards have been developed, piloted, used and refined for hospitals, clinics, hospices, sub-acute facilities and rehabilitation centres.  

Definition of standards for healthcare facilities

Healthcare facilities standards are statements that define the key functions, activities, processes and structures and systems required for organisations to be in a position to provide safe, quality services and as they are determined by professional and regulatory bodies, healthcare professionals, staff, patients and citizens. If standards are substantially met, facilities can achieve accreditation.

COHSASA standards are accredited by the International Society for Quality in Health Care (ISQua). This means they have met the principles and requirements set forth by the global body.

The COHSASA standards currently accredited:

  • COHSASA Healthcare Facility Standards – Inpatient Care (First Edition) Accredited until December 2023
  • COHSASA Healthcare Facility Standards – Ambulatory Care (First Edition) Accredited until December 2023
  • COHSASA/HPCA Palliative Care Standards – (Fourth Edition) Accredited until 2024

Origin of healthcare facility standards

The current standards have been developed according to a set of principles over many years and with the collaboration of the international quality improvement community (over 40 countries) under the auspices of ISQua- EEA. These principles are indispensable in guiding the content and structure of accreditation standards for healthcare facilities.

While COHSASA recognises the importance of the international acceptance of our standards, such standards need to be relevant and adjusted to suit an array of settings in Africa, including rural and urban environments.

Because medical, nursing and health management science is in a constant state of flux, COHSASA routinely assesses to what extent its standards remain feasible and applicable. Over the past 20 years, major professional bodies have assisted with the development and refinement of the standards. COHSASA continuously gauges the responses and comments of clients (including facility management), healthcare professionals in the field, surveyors and the public regarding its standards. When further refinements are made to standards, COHSASA takes into account feedback from all facilities in its programmes and there is a formal policy to review and update standards at regular, prescribed intervals with input from professionals and their representative organisations.

COHSASA’s Healthcare Facility Standards have been accredited by ISQua until 2022.  This universal and comprehensive set of standards incorporates the latest important global developments and best practice.

The unique phases of standards developments

Standards are developed in three phases: In the first (normative) phase current international literature is researched/reviewed and speciality expert advisors from professional bodies such as the Society of Anaesthesiologists of South Africa, the South African Association of Surgeons and other professional bodies are consulted for suggested revisions of existing standards or for input into new standards.

During the second (empirical) phase, the new or revised standards and criteria are tested in healthcare facilities to ensure they are applicable and to assess their suitability for low- and middle-income countries.

In the third (consensus) phase, the standards are presented to a Standards Development Committee and speciality expert advisors. The Committee and advisors evaluate the standards in terms of patient and personnel safety, legality and efficiency. If satisfied, the Standards Development Committee submits the standards to a Technical Committee for review. If satisfied, the Technical Committee will make a recommendation to the Board that the standards should be approved. Selected standards, such as the COHSASA Healthcare Facility Standards for Inpatient and Ambulatory Care, are then submitted to ISQua for review and accreditation.

COHSASA standards

To ensure that integrated, coordinated care  is provided, COHSASA develops and measures standards in all areas and departments of a healthcare facility. COHSASA’s Inpatient Care (First Edition) Standards comprises 36 Service Elements and the Ambulatory Care (First Edition) Standards cover 19 Service Elements in which criteria and associated guidelines define and describe systems required to enable the facility to provide quality care.

COHSASA’s standards are grouped into both departments and the functions they serve across the various units in facilities. For example, there is a Service Element dedicated to Infection Prevention and Control (IPC) systems within facilities and the standards required for IPC are built into all of the other Service Elements and sections of a healthcare facility where it is appropriate to measure them. The following diagram shows how the standards are grouped:



The contents of the standards fit into the two general categories: patient care and management of the facility. Standards that focus on patient care address patient rights, access to care, continuum of care, patient assessment, care planning and the delivery of care and, when appropriate, education of the patient and his or her family.

Standards that relate to management of the organisation cover leadership of the organisation, roles and responsibilities of staff, management of information, creation and maintenance of a safe environment for patients, infection prevention and control, quality management and human resource management.

The programme sets common standards for all service areas that are based on essential functions:

  • staff should be trained so that they can meet standards,
  • policies and procedures should guide staff to achieve the objectives of the facility,
  • monitoring systems and protocols must be in place to measure the extent to which the organisation meets its objectives,
  • a formally structured reaction (or Quality Improvement) system must be in place to allow the facility to reach its full potential.

In addition to these common and essential standards, there are service-specific standards that define the specific requirements of individual services, e.g. infection control in laundries, radiation protection in radiology departments, etc. Each standard has intention statements to guide and educate staff regarding the requirements of criteria compliance with the standards.

Standard Scoring System

The compliance of facilities with the full range of standards and criteria is established via a digitised information system CoQIS (COHSASA Quality Information System).

The output is in the form of text and graphical reports that show strengths and weaknesses of the facility as a whole, as well as those of individual departments and services.

The data and information generated in these processes are of fundamental value, not only in the standard assessment process, but also to the management of a facility. The reports can be used to identify deficiencies and monitor interventions that address problem areas.

Criteria are the measurable elements that define the specific requirements needed to ensure that the intentions of the standards are met. Each criterion is evaluated separately and assigned a score during the survey process in order to assess compliance. The following designations are allocated to each criterion to indicate the level of compliance:

Compliant (C) – if the condition is met

Partially compliant (PC) – if partially met

Non compliant (NC) – if there is no observable progress towards complying with the required condition

A standard may have one or more criteria that are marked “critical”. The critical criteria form the basis of a risk management programme and priority setting. Non- or partial compliance with these requirements will compromise patient or personnel safety or represent legal transgressions. Critical criteria that are non- or partially compliant are incompatible with accreditation. COHSASA’s information system can exclude criteria that are scored as Not Applicable (NA) in a particular facility (for example, not all hospitals have a nuclear medicine capability).

Weighted values are also allocated to each criterion according to its importance in relation to medicolegal requirements and the impact of non- or partial compliance with safe patient care. This is the “severity rating” and, for the scoring system linked to this document, criteria are rated from 1 (mild) to 4 (very serious).

These weighted scores are aggregated to give standard compliance scores. Standard scores are aggregated to score key systems and processes specific to each department/service essential for its safe, effective and efficient operation. The same scoring range is used for performance indicators, which, in turn, are aggregated to give service/department scores. Aggregated departmental/service scores provide a global score used to assess the overall compliance of the facility.

There are more than 3800 measurable criteria in a comprehensive set of COHSASA hospital standards. Criteria that are partially compliant or non-compliant are known as deficiencies. The level of improvement can be indicated by the number or deficiencies at the baseline survey which have achieved compliance at the time of the external survey.