Bridging the gap in India’s healthcare quality ecosystem

India has made remarkable strides in building a robust healthcare quality infrastructure. The National Accreditation Board for Hospitals and Healthcare Providers (NABH), the National Accreditation Board for Testing and Calibration Laboratories (NABL), and aligned bodies have established internationally recognised accreditation frameworks that have elevated standards across the hospital and laboratory sectors. More recently, the landscape has been supplemented by ISO 7101, the globally adopted international standard on healthcare organisation management, further reinforcing India’s credibility as a destination for high-quality medical care.

Yet, despite this impressive architecture, a significant gap persists. Two rapidly growing segments of the healthcare economy, wellness facilities and Medical Value Travel (MVT), remain entirely uncovered by any credible accreditation or certification regime anchored to global standards. This is not merely an administrative oversight; it is a structural vulnerability that undermines India’s standing as a premier healthcare destination and exposes patients and travellers to unverified, potentially substandard services.

“Even as India has developed a world-class healthcare accreditation ecosystem, supplemented now by the newly launched ISO 7101, a critical gap is observed in the wellness and medical value travel domain where no accreditation or certification to global standards is currently available.”

Diagnostic centres: A parallel crisis of quality enforcement
Diagnostic centres occupy a particularly critical position in the healthcare delivery chain. From pathology and radiology to molecular diagnostics and imaging, the accuracy and reliability of diagnostic outputs directly determine patient safety, treatment appropriateness, and clinical outcomes. NABL accreditation provides a credible quality benchmark for laboratories, yet accreditation remains voluntary, and the vast majority of diagnostic facilities in India, particularly in Tier-II and Tier-III cities, operate outside any formal quality assurance framework.

The Clinical Establishments (Registration and Regulation) Act, 2010 (CEA) prescribes minimum standards for clinical establishments, including diagnostic centres. These minimum standards are not aspirational; they are a regulatory floor. However, the implementation of the CEA is the constitutional prerogative of state governments, as health is a state subject under India’s federal structure. Herein lies the central failure: many states have either not adopted the CEA or have failed to enforce it with any rigour.

The consequence is a two-speed system, a tier of accredited, globally competitive facilities operating alongside a much larger tier of unregulated establishments where quality is untested, and patient safety is compromised. This is not a gap that voluntary accreditation alone can bridge. It requires political will at the state level to enforce minimum standards as a non-negotiable baseline.

It bears emphasis that accreditation should, and must, remain voluntary. It is neither realistic nor appropriate to expect every diagnostic laboratory across India to attain world-class accreditation status. The imperative is different: minimum statutory standards, already legislated under the CEA, must be enforced. State governments are failing in this duty.

Wellness centres and medical value travel facilitators: A vacuum in certification
The wellness sector, encompassing wellness spas, Ayush wellness centres, naturopathy facilities, and allied services, and the Medical Value Travel (MVT) ecosystem, is among the fastest-growing segments of India’s healthcare export economy. Yet they operate in a certification vacuum. There are no structured, globally benchmarked certification schemes applicable to these sectors, despite the ready availability of relevant international standards.

ISO standards specific to wellness spas and medical spas have existed for some time. ISO 21426 and related frameworks provide an internationally recognised basis for the certification of such facilities. Similarly, international standards applicable to Medical Value Travel Facilitators (MVTFs), the agencies and intermediaries who arrange medical travel packages for international patients, are well established. The paradox is stark: the standards exist; the institutional will to operationalise them in India has, until recently, been absent.

The SEPC–AHPI initiative: A constructive first step
Recognising this gap, the Services Export Promotion Council (SEPC), in partnership with the Association of Healthcare Providers (India) (AHPI), has convened an Expert Group to develop structured certification schemes for Wellness Centres and MVTFs. This initiative, which draws on available ISO standards and engages independent, accredited third-party certification bodies (CBs), represents a constructive and overdue intervention.

The Expert Group has finalised three certification schemes for launch:

• Certification of Wellness Spas (based on applicable ISO standards)
• Certification of Ayush Wellness Centres (linked to the Ayush Quality Mark managed by the Ayush Export Promotion Council on behalf of the Ministry of Ayush)
• Certification of Medical Value Travel Facilitators (MVTFs)

A fourth scheme, certification of Medical Spas under ISO 21426, is under finalisation and applies to non-Ayush wellness facilities. The draft frameworks have been made publicly available on the SEPC website, inviting stakeholder engagement.

The Ayush Quality Mark program, managed under the Ministry of Ayush, already covers wellness centres and MVTFs within the Ayush ecosystem and has identified applicable international standards. The SEPC–AHPI initiative extends this logic beyond Ayush, recognising that wellness and medical value travel are sectors that transcend any single therapeutic tradition.

The governance architecture: What needs to change
Enforce minimum standards under the CEA. The immediate priority must be the enforcement of minimum standards under the Clinical Establishments Act across all states. Accreditation incentivises excellence; enforcement ensures safety. These are complementary, not competing, imperatives. State health departments must be held accountable for operationalising the CEA framework, particularly for diagnostic centres and clinical laboratories that serve large patient populations with limited ability to assess quality independently.

Scale voluntary certification for wellness and MVT. Voluntary certification schemes, if well-designed and credibly administered, can drive market differentiation and consumer trust. The SEPC–AHPI certification framework offers a promising template. For this to achieve meaningful scale, the schemes must be administered through genuinely independent, internationally accredited certification bodies, not industry-captured or government-run bodies. The scheme’s credibility depends entirely on the certifying body’s credibility.

Integrate certification with export promotion. India’s ambition to become a global hub for medical value travel must be backed by credible quality signals. International patients and healthcare purchasers demand verifiable assurance of quality. Certification of MVTFs and wellness facilities to global standards is not a bureaucratic exercise; it is a competitive necessity. SEPC’s role in championing this initiative, alongside its broader mandate of services export promotion, is entirely appropriate.

Completing the quality architecture
India’s healthcare quality ecosystem is genuinely impressive at its upper tiers, but it remains incomplete. The absence of certification frameworks for wellness facilities and MVTFs, and the chronic under-enforcement of minimum standards for diagnostic centres, are gaps that carry real costs to patient safety, to international competitiveness, and to the credibility of India’s healthcare brand.

The SEPC–AHPI Expert Group’s initiative to finalise and launch certification schemes is a welcome and necessary development. It should be accompanied by renewed commitment from state governments to enforce the CEAt and by sustained investment in making voluntary accreditation accessible and financially viable for smaller providers.

The architecture of India’s healthcare quality ecosystem will only be complete when it is both aspirationally excellent, as NABH and NABL attest, and universally safe. Achieving the latter demands political will, regulatory diligence, and institutional partnership of the kind exemplified by the SEPC–AHPI collaboration. The moment to act is now.
MB Bureau