Today, health is a human right in India, and the government is working hard for universalization of health services provision till the grassroots. Health without accountability is a challenging task in hand, and recently, state governments drafted a bill toward public health system to move in the strengthened direction of accountability mechanism. Accountability is the quality or state of being accountable, and it is an important component of the health-care reforms in India. This article provides more nuanced understanding of accountability which includes the specification of accountability, conceptual framework of accountability, and its potential approaches for how accountability is viewed today in India with reference to the Central, State, District, and other stakeholders. It examines the role of accountability in making accountable health plans, and its relationship governance/ownership structures as a key component of health-care reforms as improved accountability is a major element in improving the health system performance. The article elaborates on the definition of accountability in terms of answerability and sanctions and distinguishes the three types of accountability, namely financial, performance, and political/democratic. The article describes three accountability-enhancing strategies, namely reducing the pilferage, assuring acquiescence with procedures and standards, and improved learning from the past experience. The recent events in Indian health care put forward a serious issue on how accountability can be fixed if health mishaps happened and how we can make our health plans accountable to the needs and aspiration for the people of India. Overall, the accountability is discouraging and more needs to be done to enhance the accountability compliance in India.

Background:Ministry of Health and Family Welfare has developed National Quality Framework to assess the quality of services for improvement and helps in certification of facilities, while Kayakalp was launched to promote cleanliness and hygiene in public health facilities.Objective:The objective of the study is to assess if Kayakalp implementation within the public health facilities supports quality certification of health facilities.Methods:A retrospective study was designed to gather data for 32 quality-certified district hospitals under National Quality Assurance Standards (NQAS) between May 2015 and April 2018 by reviewing records. Certification criteria and their external assessment checklist under NQAS and Kayakalp program for district hospitals were extracted from their respective states. External assessment score of all district hospitals under study was entered and analyzed using Statistical Package for the Social Sciences version 22 for Pearson's correlation analysis and MS Excel 2016 for statistical analysis.Results:Pearson's correlation coefficient was 0.217, which means that Kayakalp implementation has less significance on the quality certification of public health facilities to NQAS. A scatter chart was plotted which depicts nonlinear relationship between dependent and independent variable.Conclusion:Overall impact of implementation of Kayakalp initiative on quality certification of public health facilities to NQAS was significantly low; however, this could be due to less weightage given to the checkpoints in NQAS as compared to in NQAS.

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