Foreword

This standard originates from a deliberate policy choice made in Georgia in 2014: to advocate for international healthcare accreditation rather than attempt to replace it. Working through the Public Health Institute of Georgia (PHIG, established 2011), its founders organized the country's first structured accreditation initiative — including expert missions by Joint Commission International — and carried this advocacy directly to Georgia's Ministry of Health over the following years.

That advocacy produced, in 2018, the first draft of a Georgian-adapted accreditation standard, and in 2020, the formal establishment of Accréditation Sans Frontières (ASF) as an international legal entity in Paris, alongside the ASF International Standards Council — the standing body responsible for developing and revising ASF's standards. The Council's methodology is directly informed by the World Health Organization's guideline development process, including WHO's use of the GRADE framework for weighing evidence certainty, adapted to the practical work of accreditation. ASF's founder has served since 2016 as a founding member of the UN Secretary-General's Independent Accountability Panel for Every Woman, Every Child, Every Adolescent, and ASF has been a member of the International Society for Quality in Health Care (ISQua) since 2023.

This advocacy also found regulatory validation in Georgian government policy requiring independent international accreditation of hospitals, formally implemented through Order №4/ნ (26 January 2023).

Consistent with the structure recognized across major international standards bodies, ASF's work spans four pillars: accreditation of organizations against its published standards, accreditation of the standards themselves through the International Standards Council's ongoing review, accreditation of the surveyors who conduct ASF's own assessments, and accreditation of the training that equips facilities and professionals to meet them, delivered through GMJ Academy. This standard has been developed and refined through consultation with practitioners across multiple continents, and every edition includes a Health & Migration endorsement grounded in WHO's Global Competency Standards for health workers serving refugees and migrants — a commitment ASF treats as non-negotiable. Consistent with ASF's founding principle of accreditation without borders, this standard is published in full and made freely available to any organization seeking to build accreditation capacity in its own country.

This, the third edition, is published in 2026. The ASF International Standards Council reviews and revises each standard on a three-year cycle.

About This Document

This is the complete ASF Hospital Standards reference — nine standards in total. Standards 1 through 7 are mandatory, organised around the patient's actual journey rather than institutional departments: Access & Arrival, Reception & Information, Environment & Shared Spaces, Care & Treatment, Safety & Emergency Preparedness, Aftercare & Follow-up, and Governance & Management. A facility completes all seven before accreditation is possible.

Standards 8 and 9 are optional endorsements — Medical Tourism and Refugee & Migrant Health — layered onto the base standards for facilities that specifically serve those patient populations. Neither is ever issued alone; both assume Standards 1 through 7 are already genuinely met, and add depth on top.

Every criterion in this document follows the same two-page structure: an assessment page (a hospital self-assessment table, and exactly what an ASF assessor will independently check, shown to you in advance) and a guidance page (why the standard exists, what good and failure look like, the most common reasons hospitals score partial, how to implement from zero, and what surveyors specifically look for).

Every criterion carries at least one reference. Numbered references are formal, individually verified Vancouver-style citations; where a criterion instead reflects genuine professional consensus without one attributable paper, that is stated honestly rather than assigned an invented citation. A complete reference list appears at the end of this document, followed by an index.

Radical transparency is the design, not a courtesy: every self-assessment question and every assessor method is published here, in advance, before any visit. This is what makes ASF's model different — everything up to the actual visit is open, and the visit itself is only one day.

Immediately after this page is the Facility Classification chapter — a short questionnaire every facility completes first, sorting itself into one of four types: Crisis, Transitional, Small, or Standard. Every criterion in the standards that follow carries a four-cell strip showing whether it applies in full, in an adapted form, or not at all, for each of these four types.

On the standard-level scoring threshold: the rule that a standard scores Red if more than 10% of its CORE criteria score Red is a considered working threshold set during this document's development, not an empirically validated figure. It should be treated as provisional and revisited once real assessment data exists to test it.

Chapters