Accreditation is not a stand-alone solution.

The politics and purpose of health care accreditation programmes around the world have changed radically from the original models of North America 50 years ago. Then they were hospitalfocused, profession-driven, voluntary, self-financing and essentially non-governmental. The 1990s saw a rapid growth of programmes with an increasing emphasis on primary care, networks, health systems and regulation – driven largely by national governments and international donor agencies (1). The traditional collegial model of accreditation is moving towards a semi-regulatory model of external assessment; many newer programmes, for political, economic or technical reasons, have failed to meet initial expectations but others have flourished. Most recently, in many countries, the ambition of achieving universal health coverage (UHC) has generated a demand (and market) for defining and monitoring “good services” and for the development of accreditation as an independent assessment of the competence and capacity of provider organizations. In practice, UHC tends to focus on one dimension of quality – access to care – and give less attention to providing safe, effective, patient-centered care, or to integrating health care financing to performance and to existing systems such as for patient safety, clinical effectiveness and accreditation. Whatever is the trigger for embarking on an accreditation system, global experience is clear that effective programmes must be integrated with national strategies for change management, not be regarded as a stand-alone injectable solution. International developments in health care accreditation