ASF and Georgia: Building the First Independent Accreditation Body for the Region

Accréditation Sans Frontières (ASF), founded by Prof. Giorgi Pkhakadze in Paris in 2020, is developing the first independent international accreditation standards body with specific application to post-Soviet and lower-middle-income health systems. PHIG examines what this means for Georgia.

“Existing international accreditation bodies were built for high-income health systems with established quality infrastructure. ASF exists because Georgian hospitals, Armenian clinics, and Azerbaijani laboratories deserve a pathway that meets them where they are.”

Pkhakadze G. ASF Founding Statement. Paris: ASF; 2020.[1]

Introduction

Accréditation Sans Frontières (ASF) is a non-profit association of general public interest (association d’intérêt général) established under French law in Paris in 2020, with satellite offices in Geneva and Tbilisi. Its mandate is the development, maintenance, and international promotion of healthcare accreditation standards adapted to the contexts of middle-income countries, post-Soviet health systems, and humanitarian settings — contexts systematically underserved by existing international accreditation bodies.[1,2]

The international accreditation landscape is dominated by a small number of organisations: Joint Commission International (JCI, USA), DNV (Norway), Accreditation Canada, the Australian Council on Healthcare Standards (ACHS), and the International Society for Quality in Health Care (ISQua), which accredits accreditors. All were developed primarily in high-income settings and carry assessment costs and preparatory burdens that routinely place them out of reach for Georgian and comparable health facilities.[3]

The ASF Standards Architecture

ASF has developed a modular standards architecture covering five facility categories: hospitals, ambulatory clinics, long-term care facilities, primary health care centres, and fitness and wellness facilities. Each category has a base standard and up to 16 specialty endorsements. The hospital standard, the first to be published (2021), contains 284 standards across seven domains.[2]

ASF’s Classification System

A key innovation in the ASF standards is the four-tier facility classification system — Crisis, Transitional, Developmental, and Advanced — that replaces the binary pass/fail model used by most international accreditors. This tiered approach allows health facilities in resource-constrained settings to receive meaningful recognition at each stage of quality development, rather than being measured against a single high-income benchmark that creates an all-or-nothing barrier.[2]

The Crisis tier recognises facilities meeting minimum patient safety thresholds in austere or post-conflict settings. The Transitional tier addresses facilities building systematic quality infrastructure. The Developmental tier aligns with WHO-SEARO and WHO/AFRO basic accreditation frameworks. The Advanced tier is equivalent to Joint Commission International standards.[2,4]

Figure 1. ASF Four-Tier Classification System vs. International Comparators

Figure 2. International Accreditation Fee Comparison 2024 (EUR, hospital base)

Sources: JCI accreditation fee schedule 2024; ASF institutional rates 2025.[2,3]

ASF and the ISO 9001 Ready Programme

Recognising that many Georgian health facilities are not yet ready for formal accreditation, ASF has developed a preparatory programme — ISO 9001 Ready — that provides facilities with a complete quality management system documentation package aligned with ISO 9001:2015, the international quality management standard. This programme, available through france-asf.fr, provides a bridge pathway: facilities implement ISO 9001 Ready, then progress to ASF accreditation, and ultimately aspire to ISQua-compliant Advanced tier certification.[2]

Conclusion

ASF represents a genuine institutional innovation in the global accreditation landscape: an international standards body explicitly designed for contexts that existing organisations have underserved. Its tiered classification system, accessible fee structure, and post-Soviet adaptation make it particularly suited to the Georgian health system reform context. The pending ISQua application (2025) will be a critical milestone in establishing ASF’s international credibility and in making the ASF pathway a recognised quality benchmark for Georgian facilities seeking international recognition.

References

1. Pkhakadze G. Accréditation Sans Frontières: Founding Rationale and Institutional Design. Paris: ASF; 2020.
2. Accréditation Sans Frontières. Standards Portfolio and Institutional Overview 2025. Paris: ASF; 2025. Available from: https://www.france-asf.fr
3. Joint Commission International. JCI Accreditation Standards for Hospitals 8th Edition. Oakbrook Terrace: JCI; 2023.
4. WHO Regional Office for South-East Asia. Regional Standards for Patient Safety. New Delhi: WHO/SEARO; 2022.
5. International Society for Quality in Health Care. ISQua External Evaluation Association (EEA) Programme Guide. Dublin: ISQua; 2023.

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Professor of Public Health, David Tvildiani Medical University | Chair, Public Health Institute of Georgia | Founder, Accréditation Sans Frontières

Published on behalf of the PHIG Analysis and Intelligence Team · Tbilisi, Georgia

PHIG

Public Health Institute of Georgia