COHSASA is the Council for Health Service Accreditation of Southern Africa, a not-for-profit body founded in 1995 that runs quality improvement and accreditation programmes for hospitals and clinics in Africa. For Botswana, it helped the Ministry of Health write the National Health Quality Standards for hospitals, published in 2013, which score every hospital department criterion by criterion.
This guide is for hospital managers, matrons, quality coordinators and ministry programme staff preparing a facility in Botswana for COHSASA assessment.
What is COHSASA and who recognises it?
COHSASA is based in South Africa. Its website says it works in 12 countries and assesses hospitals, clinics, day clinics, palliative care services and consulting rooms.
It writes its own standards. The current set is the second edition of its Healthcare Facility Standards, with separate versions for inpatient and ambulatory care. The inpatient version has 25 service elements, from management and human resources to theatre, laboratory, pharmacy and food services.
COHSASA is itself assessed by the ISQua External Evaluation Association (ISQua EEA), the international body that evaluates accrediting organisations and their standards. The ISQua EEA awards register lists three COHSASA awards valid from December 2023 to December 2027: the organisation, its Healthcare Facility Standards and its Surveyor Training Programme. COHSASA's Palliative Healthcare Standards are listed separately, valid from February 2025 to February 2029.
Note what the register does not show. It lists no Botswana-specific standards. ISQua EEA recognition belongs to COHSASA and its own standards, not to the national standards it helped Botswana write.
Accreditation is also different from a licence. The Botswana standards define accreditation as a finding by an accrediting body that an organisation meets set standards. Licensing sets the minimum required to protect public health and safety. If your group is weighing other frameworks, our guides to JCI hospital accreditation and ISO 7101:2023 for healthcare quality cover two of them.
How did COHSASA's work in Botswana begin?
Botswana facilities enrolled in a COHSASA pilot programme in 2009. COHSASA's history page says it developed national health quality standards for Botswana in 2012 and supported the Ministry of Health in building its quality improvement and accreditation framework.
The ministry published the result in 2013 as the National Health Quality Standards, Standards and Guidelines for Hospitals. The acknowledgements credit COHSASA's support. In December 2016, two hospitals and three clinics celebrated their first two-year accreditation awards, according to a COHSASA press release. By then 18 Botswana hospitals and clinics were in the programme.
Awards have continued. COHSASA reports that Selebi-Phikwe Government Hospital in the Central District earned a second full two-year award after its first, which ran from 2019 to 2021.
A note on editions. The 2013 manuals label their patient questionnaire as belonging to the first edition of the hospital standards. Copies titled "Botswana Hospital Standards Version 2" also circulate, but in October 2026 we could not find a second version on the Ministry of Health guidelines page or on COHSASA's website. Ask the ministry or COHSASA which version your survey will use before you build your evidence.
What do the Botswana hospital standards cover?
The standards are grouped into service elements. Each service element contains standards, and each standard is broken into criteria, the measurable items surveyors score. An intent statement explains each standard, and a guideline under each criterion explains what compliance looks like.
The ministry publishes two volumes. Service elements 1 to 9 are generic and apply across the whole hospital. Volume 1 says elements 28 to 31 are also generic, but they are not in either published volume.
The table summarises the two volumes. The evidence column is AGS's interpretation, not the ministry's wording.
| Volume | Service elements | Areas covered | Typical evidence a hospital keeps |
|---|---|---|---|
| Volume 1 (generic) | SE 1 to SE 9 | Management and leadership, human resources, administrative support, access to care, patient and family rights, management of information, risk management, quality management and improvement, prevention and control of infection | Governance documents, staff files with credentials and orientation records, health record procedures, consent and complaints records, risk and incident registers, fire and emergency drills, quality indicators, infection surveillance data |
| Volume 2 (clinical services) | SE 10 to SE 24 | General medical, surgical, paediatric and obstetric wards, critical care, maternity, psychiatric care, theatre and anaesthesia, nuclear medicine, laboratory, radiology, pharmacy, emergency, outpatient and combined outpatient and emergency services | Clinical practice guidelines in use, patient assessments within set time frames, partograms, medication records, theatre safety checks, laboratory and radiology quality records, continuity of care notes |
Laboratory services are one service element among many here. A hospital laboratory that also wants ISO accreditation can read our ISO 15189 guide.
How is each criterion scored?
Surveyors rate every criterion as compliant, partially compliant, non-compliant or not applicable. Criteria that do not apply to the hospital are left out of the score. Partial compliance requires definite progress of more than half the way to meeting the criterion.
Partial and non-compliance are each graded by severity, from mild to very serious. Each rating converts to points. A compliant criterion earns 80 points, and the scale falls to 5 points for a very serious non-compliance. Criteria are also weighted by their importance for legality, patient and staff safety, the physical structure and efficiency.
Two rules matter most. Some criteria are marked critical because a failure endangers patients or staff or breaks the law. A failed critical criterion pulls down the whole standard.
Other criteria are root criteria for a whole system, such as the quality programme. A root criterion cannot be scored compliant while most of its linked criteria fail.
What will surveyors check in a Botswana hospital?
The manual tells surveyors to study documents, interview staff and patients, audit patient records and observe care, facilities and equipment. Three of its rules shape how you should prepare.
- Written beats verbal. A policy that exists only by word of mouth scores as non-compliant. A written policy with no proof of use, or one still in draft, scores as partially compliant.
- Audits use thresholds. Where compliance is measured by audit, a result in fewer than 80% of staff or records is scored as partial compliance.
- Records are judged on the day. Surveyors audit discharged patients' folders chosen from admission registers, looking for cases with transfers, blood transfusions, resuscitation, consent, refusal of treatment and deaths. They share the results with clinical staff, and the results cannot be changed later.
Surveyors also interview a sample of patients with a set questionnaire covering their rights and what they were told. In practice, run your own folder audit on the same case types a few months ahead, and fix the gaps before the survey.
How long does a COHSASA accreditation award last?
COHSASA's programme starts with training on its standards and a self-evaluation by hospital staff. A baseline survey follows. The team uses the results to set priorities and an action plan, then tracks progress department by department before the external survey.
COHSASA says facilities that meet its standards on first entering the programme receive a two-year award. Longer awards, including four-year awards, follow as a facility sustains its standards. Every accredited facility has an interim survey halfway through its award period.
How AGS can help
The COHSASA Botswana Hospital Standards (QMS) kit contains 44 editable Microsoft Word documents. It is written for an organisation that runs assessments against the standards. A quality manual, a scheme document and 14 procedures cover application, assessment planning, decisions, surveillance, impartiality, complaints and appeals. It also includes a master assessment checklist organised by service element, guidance for applicant hospitals and for assessors, and a training plan.
Frequently asked questions
What does COHSASA stand for?
Council for Health Service Accreditation of Southern Africa. It was founded in 1995 and operates as a not-for-profit company.
Are the Botswana hospital standards the same as COHSASA's own standards?
No. The Botswana standards were published by the Ministry of Health in 2013 with COHSASA's support. COHSASA's own Healthcare Facility Standards, second edition, are a separate set and are the ones ISQua EEA has accredited.
Can a clinic use these hospital standards?
The hospital manuals are written for hospital services. COHSASA also has ambulatory care standards for outpatient settings, so ask COHSASA which set fits your facility.
Does buying documentation mean the hospital will be accredited?
No. Documents are a starting point. Accreditation depends on how the system is implemented and on the surveyors' findings.
AGS provides independent documentation toolkits. This guide and the referenced kit are prepared to support COHSASA and Botswana Ministry of Health requirements. They are not affiliated with, endorsed by or approved by COHSASA, the Ministry of Health or ISQua EEA, and they do not guarantee any survey or accreditation outcome.
Reviewed October 2026. Facts checked against the sources current at publication.