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Improving the quality
of health services -
tools and resources
Improving the quality of health services: tools and resources
ISBN 978-92-4-151508-5
© World Health Organization 2018
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Printed in Switzerland
Improving the
quality of
health services -
tools and resources
compiled by the
WHO Service Delivery and Safety Department DECEMBER 2018
This document has been developed by an Improvement cross-cut team within the Department of Service Delivery and Safety (SDS) at WHO headquarters. The document aims to support implementation of quality improvement approaches to make health services more effective, safe and people-centred. The document brings together the main tools and resources focused on quality improvement currently in use within the SDS department.
Contents
8 Introduction
10 Service delivery and quality
improvement
12 Tools and resources for improving
the quality of health services
45 Quality improvement resources in
development
52 Annex 1: Rapid mapping of quality
improvement definitions
57 Annex 2: Further information
58 Annex 3: Process note – WHO SDS
improvement cross-cut
THE COMPENDIUM AT A GLANCE
What is the compendium?
The tools and resources described in this document (hereafter referred to as “the compendium”) are a resource for WHO Member States aiming to improve the quality of service delivery. The compendium collates current tools and resources on quality improvement (QI) developed by the WHO Service Delivery and Safety Department (SDS) and provides examples of how the tools and resources have been applied in country settings.
Who is the compendium for?
• Ministries of health, quality improvement teams, researchers and development agencies.
• WHO technical programmes, regional and country offices in their technical cooperation work with country counterparts and donors.
• Those working to improve the quality of health service delivery.
Why is it needed?
• The compendium has been developed to collate existing resources that facilitate quality improvement in service delivery.
• As a technical resource for countries in support of quality improvement efforts within health service delivery.
• Highlight adaptable tools and resources that can support local quality improvement efforts.
SDS technical areas and type of tools
Technical AreasTraditional complementary and integrative medicine
Emergency and essential surgery
Primary care
Blood safety
Palliative care
Hospital management
People-centred care
Infection prevention and control
Emergency
Policies, strategies and plans
Community engagement
Institutional health partnerships
Patient safety
Types of tools and resources
Guidance
Implementation
Advocacy
Manuals
Capacity-building
Guidelines
Frameworks
Research
Assessment
Training resources
How could I use the compendium?
• As a reference list of helpful tools and resources aimed at improving the quality of health services.
• As an overview of available tools and resources for quality improvement that have been developed by WHO.
• As a starting point for further technical collaboration with partners and WHO expertise in these respective subject areas.
• The current compendium is not an exhaustive list of QI interventions. It should be used in conjunction with other existing evidence-based guidance. The compendium is grouped into two sections: the first part of the compendium provides an overview of finalized tools and resources. The second part of the compendium collates tools and resources currently under development. Where applicable, case studies have been provided.
7
Improving the quality of
health services: tools and resources8
Introduction
The adoption of the sustainable development goals (SDGs) placed additional emphasis
on improving overall human development by 2030. Improving health outcomes is at the forefront of this global commitment, with Goal 3 calling on all stakeholders to “ensure healthy lives and promote well-being for all at all ages”. The SDGs also reaffirm a global commitment to advancing universal health coverage (UHC). Its focus is to ensure that all people and communities have access to the quality health services they need, without facing financial hardship. The momentum towards UHC is rooted in the principles of the Alma-Ata Declaration (1) which identified health as a human right. To realize the goal of health for all and achieve universal access to quality health services, the
1 Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12: World Health Organization (http://www.who.int/publications/almaata_declaration_en.pdf?ua=1 accessed 20 August 2018)
WHO Framework for Integrated People-Centred Health Services (IPCHS) calls for a fundamental shift from health systems designed around diseases and health institutions towards health systems designed for people (2). Globally, there is a need to look beyond service coverage and financial protection and emphasize improvements in quality service delivery at the core of country action. This is because quality of health services, coupled with service coverage will play a critical role in strengthening national health systems and improving health outcomes.
Global consensus on quality is emerging. Three major publications on quality have been published in 2018: first, the joint WHO-World Bank-OECD publication on the delivery of quality health services as a global imperative for UHC; then, the Lancet Global
2 Framework on integrated people-centred health services. Report by the secretariat: World Health Organization ( http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1 accessed 20 August 2018)
9INTRODUCTION
high quality health systems in the SDG era; and third, the US National Academies of Science Report on Improving the Quality of Health Care Globally. Each call for action on quality improvement. This document is developed in anticipation of and in support of this collective call and will be refined further over time.
There is an increasing collective recognition that quality health services should be:
• effective: providing evidence-based health care services to those who need them;
• safe: avoiding harm to people for whom the care is intended and reducing the risk of unnecessary harm associated with health care to an acceptable minimum;
• people-centred: adopting the perspectives of individuals, carers, families and communities as participants in, and beneficiaries of, trusted health systems that are organized around the comprehensive needs of people, rather than individual diseases, and that respect social preferences.
In addition, in order to achieve the benefits of quality health care, health services should also be:
• timely: reducing waiting times and sometimes harmful delays for both those who receive and those who give care;
• equitable: providing care that does not vary in quality on account of age, sex, gender, race, ethnicity, geographical location, religion, socioeconomic status, linguistic or political affiliation;
• integrated: providing care that is coordinated across the entire spectrum of health care services and providers and makes available the full range of health services throughout the life course;
• efficient: maximizing the benefit of available resources and avoiding waste.
Improving the quality of
health services: tools and resources10
Service delivery and quality
improvement
Improvement in the quality of health care is a pivotal entry point for health systems strengthening. Quality
improvement (QI) approaches play a role in improving the quality of health services delivered across the various levels of the health system – primary, secondary and tertiary. QI approaches support the identification of various service delivery gaps, produce solutions to address identified gaps and mitigate potential service delivery bottlenecks. The experience surrounding QI approaches in improving care in specific areas such as maternal, neonatal and child health, HIV/AIDS, TB/Malaria programmes is well documented. Technical programmes and development agencies have adhered to various definitions of quality improvement.
Findings from a rapid mapping of these quality improvement definitions can be found in Annex 1.
The collation of these definitions points to a consensus on certain essential principles for quality improvement to be effective and sustainable.
Principles:
• commitment from senior leadership
• ownership by people and teams
• developing locally identified solutions
• improvement of input structures
• clearly identified roles and responsibility of team members
• continuous monitoring and learning for improvement
• feedback and incentive mechanisms.
11Service delivery and quality improvement
Building on this rapid scanning and the grounding principles, a quality improvement intervention can be defined across various levels of the health system.
Focusing on change processes, a quality improvement intervention can be defined as “a change process in health care systems, services, or suppliers for the purpose of increasing the likelihood of optimal clinical quality of care measured by positive health outcomes for individuals and populations” (3).
At the organizational level, a quality improvement intervention can be defined as “an organizational strategy that formally involves the analysis of process and outcomes data and the application of systematic efforts to improve performance” (3).
Building further, a working definition of quality improvement definition co-developed by the WHO headquarters SDS Improvement cross-cut team reads as follows:
3 Evidence-based Practice Center systematic review protocol: closing the quality gap 2010:quality improvement interventions to address health disparities. Rockville, MD: Agency for Healthcare Research and Quality; 2012 (https://effectivehealthcare.ahrq.gov/topics/ disparities-quality-improvement/research-protocol, accessed 19 February 2018)
Quality improvement is the action of every person working to implement iterative, measurable changes, to make health services more effective, safe and people-centred.
Improving the quality of
health services: tools and resources12
Tools and resources for
improving the quality
of health services
Goal and objectives
The overall goal of this document is to provide a resource for countries seeking to improve the
quality of their health service delivery.
The document:
• collates existing WHO tools and resources on quality improvement; and
• outlines the use of the tool or resource as applied in service delivery.
The primary inclusion criteria for the tools and resources included in this document is that they must be applicable for country support. Thereby, the document provides practical examples of how the tool was applied in-country, including relevant links with other areas, such as measurement.
The document focuses on tools and resources developed within the WHO Service Delivery and Safety Department. It is not, therefore, an exhaustive list of service delivery and safety tools and resources across WHO or
beyond. Of particular note, the document is not designed as a standards setting tool.
The categorization of the tools and resources in this document has been informed by the WHO publications categorization system. Types of tools include training and capacity-building tools, along with text books and guidance documents. Resources include advocacy documents, country reports, meeting reports and technical reports. Documents listed as guidelines have all gone through the WHO Guideline Review Committee process.
Target audience
The target audience for this document are ministries of health, facility quality improvement teams, researchers and development agencies.
WHO technical programmes, regional and country offices can also use the document in their technical cooperation work with the identified audience. Those working to improve the quality of health service delivery can also make good use of this resource.
13Tools and resources for improving the
quality of health services
Gaps
Development of the document allowed gaps to be identified in the quality improvement tools and resources that exist. Of particular note is that:
• improvement and measurement are inter-related; however, a number of the identified QI tools and resources made little or no mention of measurement considerations;
• there is currently no mechanism to track the application of SDS tools and resources in-country, once finalized, such an approach would contribute to the refinement of the tools, informed by implementation experience.
These gaps will allow a set of recommendations to be developed that will inform future development of quality improvement resources.
A feedback loop mechanism is currently under development to prospectively track the application of the resource at the country level. This feedback mechanism will allow for input into the adoption and usage of tools at the country level. It could also help to shed light on the adaptation of emerging global tools and to identify promising case studies at the country level. This mechanism will be linked strongly with the WHO SDS corporate web page, once activated.
Implications for countries and WHO
The document has clear implications for the work on service delivery for country level engagement and internally within WHO. The document can:
• provide framing and catalyse action on quality improvement activities and facilitate WHO’s support to ministries of health on quality of care;
• support the implementation of WHO normative standards on quality of care by highlighting available tools and resources in service delivery;
• serve as a facilitator and bring about convergence of the work on quality improvement within WHO, working closely with the WHO Taskforce for Quality UHC.
Structure of the document
Each section addresses a technical area. The structure is standardized with detailed information on finalized WHO SDS documents. The first level of the document provides an overview of WHO SDS tools and resources. Where applicable, case studies and key lessons learnt have been provided. A second section of the document outlines tools and resources that are currently in development within SDS.
Improving the quality of
health services: tools and resources14
Part I. structure Tools and resources finalized
Name of tool (Year)
Type of tool Audience Summary description
Key lessons learnt Interlinkages with other areas
1. Quality improvement in emergency settings
Name of tool (year)
Type of tool
Audience Summary description Key lessons learnt Interlinkages with other areas
Recovery Toolkit (2015)
Training / capacity-building
Policy-makers, front-line staff, civil society, academic researchers
The Recovery Toolkit is a library of guidance resources in a single place which can be quickly and easily accessed, to guide action. A key purpose of the Recovery Toolkit is to support countries in the reactivation of health services which may have suffered as a result of a public health emergency. These services include ongoing programmes such as maternal and child health services, and noncommunicable diseases. But in addition, and because the Toolkit contains core information needed to achieve functioning national and sub-national health systems, it also supports countries to implement their national health plans during the recovery phase of a public health emergency.
Use of the early Recovery Toolkit addresses a key challenge – how to identify and access the best and most up-to-date technical resources to support action planning and action. Bringing together the resources of vertical programmes in one place has the potential to enhance efficiency.
The “resource supplement” of the WHO, World Bank and OCED report “Delivering quality health services: a global imperative for UHC” provides a compendium of resources that measure and report quality of care at the international level, according to pre-determined measurement tools.
Building back from the Ebola outbreak in Liberia: spotlight on country voices
Liberia: I’m confident that the early recovery toolkit will increase awareness and access among partners and countries of the products/resources available. This awareness can help to achieve high standards, prevent inefficient duplication of effort and wheel reinvention and encourage communication and coordination when it is most needed.
- Alex Gasasira, WHO Representative, Liberia
15Tools and resources for improving the
quality of health services
2. P
olicies, s
tra
teg
ies
and
plans
Nam
e of
tool
(y
ear)
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt
Inte
rlink
ages
with
oth
er
area
s
Deliv
erin
g qu
ality
hea
lth
serv
ices
: a
glob
al
impe
rativ
e fo
r uni
vers
al
heal
th
cove
rage
(2
018)
Guid
ance
Polic
y-m
aker
sTh
is jo
int W
HO-W
orld
Ban
k-OE
CD p
ublic
atio
n pr
ovid
es
a gl
obal
pic
ture
of q
ualit
y of c
are
and
its im
porta
nce
to a
chie
ving
pub
lic h
ealth
goa
ls w
ithin
the
cont
ext o
f un
ivers
al h
ealth
cov
erag
e. It
des
crib
es h
ow q
ualit
y im
prov
emen
t sho
uld
be b
uilt
into
the
foun
datio
ns
of h
ealth
syst
ems,
and
addr
esse
s key
issu
es th
at
requ
ire a
ttent
ion
in o
rder
to im
prov
e qu
ality
of h
ealth
ca
re in
cou
ntrie
s. It
als
o pr
esen
ts a
rang
e of
leve
rs
to im
prov
e qu
ality
and
hig
hlig
hts t
he im
porta
nce
of
driv
ing
qual
ity im
prov
emen
t thr
ough
nat
iona
l pol
icy
and
stra
tegy
. A q
ualit
y cal
l for
act
ion
is p
ut fo
rwar
d to
he
alth
pol
icy-
mak
ers s
eeki
ng to
ach
ieve
the
goal
of
acce
ss to
hig
h qu
ality
, peo
ple-
cent
red
heal
th se
rvic
es
for a
ll. F
or m
ore
info
rmat
ion
visi
t http
://ww
w.wh
o.in
t/se
rvic
edel
ivery
safe
ty/q
ualit
y-re
port/
en/
No le
sson
s lea
rnt a
s yet
. A
com
pend
ium
of
reso
urce
s, “G
loba
l effo
rts
mea
surin
g qu
ality
of
care
” is p
rovi
ded,
that
su
mm
arize
s glo
bal
effo
rts in
mea
surin
g an
d re
porti
ng q
ualit
y of
care
at t
he in
tern
atio
nal
leve
l, acc
ordi
ng to
pre
-de
term
ined
mea
sure
men
t to
ols:
http
://ww
w.wh
o.in
t/ser
vice
deliv
erys
afet
y/m
easu
rem
ent/e
n
WHO
Ha
ndbo
ok
for N
atio
nal
Qual
ity P
olic
y an
d St
rate
gy
(201
8)
Capa
city
-bu
ildin
g,
advo
cacy
Polic
y-m
aker
s, te
chni
cal
partn
ers
The
WHO
Han
dboo
k fo
r nat
iona
l qua
lity p
olic
y an
d st
rate
gy (N
QPS)
out
lines
an
appr
oach
for t
he
deve
lopm
ent o
f nat
iona
l pol
icie
s and
stra
tegi
es
to im
prov
e qu
ality
of c
are.
The
NQP
S Ha
ndbo
ok is
no
t a p
resc
riptiv
e pr
oces
s gui
de, b
ut is
des
igne
d to
supp
ort t
eam
s dev
elop
ing
such
pol
icie
s and
st
rate
gies
, rec
ogni
zing
the
varie
d ex
perti
se, e
xper
ienc
e an
d re
sour
ces a
vaila
ble
to c
ount
ries a
t diff
eren
t st
ages
in th
is p
roce
ss. T
he H
andb
ook
is d
esig
ned
to su
ppor
t cou
ntrie
s to
impr
ove
qual
ity o
f car
e an
d in
stitu
tiona
lize
a cu
lture
of q
ualit
y acr
oss t
he h
ealth
sy
stem
. An
acco
mpa
nyin
g co
mpe
ndiu
m o
f too
ls a
nd
reso
urce
s has
bee
n co
llate
d to
supp
ort d
evel
opm
ent
and
impl
emen
tatio
n of
nat
iona
l qua
lity p
olic
ies a
nd
stra
tegi
es.
1. C
o-de
velo
pmen
t of t
he H
andb
ook
with
nat
iona
l qu
ality
lead
s and
thos
e wi
th e
xper
t kno
wled
ge
on q
ualit
y of c
are
secu
red
early
stak
ehol
der
buy-
in a
nd e
nsur
ed c
onte
nt w
as re
leva
nt to
the
end
user
. 2.
Cou
ntry
eng
agem
ent d
urin
g th
e de
velo
pmen
t of
the
Hand
book
reve
aled
sign
ifica
nt d
eman
d fo
r nat
iona
l qua
lity e
fforts
to b
e st
ruct
ured
and
gu
ided
by a
n ov
erar
chin
g po
licy a
nd st
rate
gy.
3. T
he a
ppro
ach
outli
ned
in th
e ha
ndbo
ok c
an
be a
tim
e-co
nsum
ing
proc
ess,
and
coun
tries
ar
e lik
ely t
o ne
ed fu
rther
tool
s, re
sour
ces a
nd
supp
ort b
eyon
d th
at p
rovi
ded
in th
e Ha
ndbo
ok if
th
e po
licy a
nd st
rate
gy a
re to
be
effe
ctive
. Thi
s m
ay in
clud
e su
ppor
t fro
m d
onor
s and
tech
nica
l ag
enci
es, d
irect
tech
nica
l sup
port
from
WHO
, an
d ac
cess
to fu
rther
tool
s and
reso
urce
s.
The
WHO
Glo
bal L
earn
ing
Labo
rato
ry fo
r Qua
lity
UHC
host
s too
ls a
nd
reso
urce
s to
supp
ort
impl
emen
tatio
n of
na
tiona
l qua
lity p
olic
ies
and
stra
tegi
es a
long
side
a
mec
hani
sm fo
r ac
tive
lear
ning
thro
ugh
disc
ussi
on.
Improving the quality of
health services: tools and resources16
Case
stud
y 1: N
atio
nal q
ualit
y pol
icy a
nd st
rate
gy in
Sud
an
In S
udan
, the
app
roac
h ou
tline
d in
the
NQPS
Han
dboo
k ha
s bee
n us
ed to
gui
de th
e pr
oces
s of d
evel
opin
g a
natio
nal q
ualit
y pol
icy a
nd st
rate
gy. W
orki
ng in
col
labo
ratio
n wi
th th
e W
HO
Suda
n Co
untry
Offi
ce, W
HO E
aste
rn M
edite
rrane
an R
egio
nal O
ffice
, and
WHO
hea
dqua
rters
Ser
vice
Del
ivery
and
Saf
ety d
epar
tmen
t, th
e Su
dan
Fede
ral M
inis
try o
f Hea
lth le
d a
mul
ti-st
akeh
olde
r pro
cess
to d
evel
op a
nd im
plem
ent a
nat
iona
l qua
lity p
olic
y and
stra
tegy
. Sud
an h
as a
rela
tivel
y lon
g hi
stor
y of e
fforts
to im
prov
e qu
ality
of c
are,
with
a q
ualit
y dire
ctor
ate
havi
ng b
een
esta
blis
hed
in th
e Fe
dera
l Min
istry
of H
ealth
in 2
001.
Fol
lowi
ng so
me
succ
ess w
ith se
tting
stan
dard
s and
rolli
ng o
ut in
itiat
ives o
n pa
tient
safe
ty a
nd in
fect
ion
prev
entio
n an
d co
ntro
l, the
re w
as in
crea
sing
mom
entu
m b
ehin
d a
new
push
for q
ualit
y car
e dr
iven
by p
ublic
exp
ecta
tions
, res
ourc
e co
nstra
ints
, and
the
ongo
ing
thre
at o
f em
ergi
ng o
utbr
eaks
and
em
erge
ncie
s.
Deve
lopm
ent o
f the
nat
iona
l qua
lity p
olic
y and
stra
tegy
in S
udan
invo
lved
cons
ider
atio
n of
all
eigh
t ess
entia
l ele
men
ts o
utlin
ed in
the
Hand
book
: ide
ntifi
catio
n of
nat
iona
l hea
lth
goal
s and
prio
ritie
s; c
o-de
velo
pmen
t of a
loca
l def
initi
on o
f qua
lity;
stak
ehol
der m
appi
ng a
nd e
ngag
emen
t; co
mpr
ehen
sive
situ
atio
nal a
naly
sis;
sele
ctio
n of
impr
ovem
ent m
etho
ds
and
inte
rven
tions
; cla
rific
atio
n of
gov
erna
nce
and
orga
niza
tiona
l stru
ctur
es; a
sses
smen
t and
stre
ngth
enin
g of
hea
lth m
anag
emen
t inf
orm
atio
n sy
stem
s; a
nd id
entif
icat
ion
of q
ualit
y in
dica
tors
and
cor
e m
easu
res.
Eac
h st
age
of th
e pr
oces
s was
supp
orte
d by
WHO
wor
king
in c
lose
col
labo
ratio
n wi
th c
olle
ague
s lea
ding
eac
h el
emen
t in
the
Fede
ral M
inis
try o
f Hea
lth.
Tool
s and
reso
urce
s to
supp
ort t
he p
roce
ss, s
uch
as th
ose
for s
ituat
iona
l ana
lysi
s, we
re a
dapt
ed to
the
spec
ific
loca
l con
text
, and
dat
a co
llect
ion
tool
s wer
e co
-dev
elop
ed.
A ke
y obs
erva
tion
of a
pply
ing
the
Hand
book
pro
cess
in S
udan
is th
at th
e ei
ght e
lem
ents
are
not
to b
e se
en a
s sep
arat
e en
titie
s in
a lin
ear p
roce
ss, b
ut a
s int
erco
nnec
ted
cons
ider
atio
ns
in a
bro
ader
pro
cess
of p
olic
y and
stra
tegy
dev
elop
men
t. Fo
r exa
mpl
e, id
entif
icat
ion
of n
atio
nal g
oals
, dev
elop
men
t of t
he lo
cal q
ualit
y def
initi
on, a
nd e
lem
ents
of t
he si
tuat
iona
l an
alys
is w
ere
all i
ncor
pora
ted
in a
larg
e st
akeh
olde
r eng
agem
ent p
roce
ss.
Anot
her k
ey le
sson
from
the
Suda
n NQ
PS e
xper
ienc
e is
the
impo
rtanc
e of
ear
ly e
ngag
emen
t of k
ey st
akeh
olde
rs. F
or e
xam
ple,
it wa
s ide
ntifi
ed e
arly
on,
that
whi
le th
e Fe
dera
l Min
istry
of
Hea
lth w
as re
spon
sibl
e fo
r pol
icy a
nd st
rate
gy d
evel
opm
ent,
othe
r sta
te m
inis
tries
wou
ld b
e re
spon
sibl
e fo
r im
plem
entin
g. T
hus,
thei
r ear
ly a
nd m
eani
ngfu
l eng
agem
ent w
as c
ritic
al
to su
cces
s.
The
Suda
n ex
perie
nce
also
em
phas
ized
the
impo
rtanc
e of
ens
urin
g th
at th
e pr
oces
s out
lined
in th
e Ha
ndbo
ok is
supp
orte
d by
det
aile
d op
erat
iona
l pla
nnin
g an
d m
onito
ring
of th
e im
plem
enta
tion
effo
rt. S
ituat
iona
l ana
lysi
s rev
eale
d th
at, w
here
this
had
not
occ
urre
d, p
revi
ous n
atio
nal e
fforts
had
bee
n le
ss su
cces
sful
.
In g
ener
al, t
he n
atio
nal t
eam
dev
elop
ing
the
polic
y and
stra
tegy
felt
that
the
NQPS
pro
cess
was
rele
vant
to th
eir s
ettin
g an
d us
eful
as a
foun
datio
n fo
r the
ir in
itiat
ive. H
owev
er, s
ome
tool
s, re
sour
ces a
nd a
spec
ts o
f the
app
roac
h di
d ha
ve to
be
adap
ted
to th
e lo
cal c
onte
xt, a
nd fu
rther
tech
nica
l sup
port
was r
equi
red
to b
uild
the
capa
city
of t
he lo
cal t
eam
to c
ompl
ete
the
NQPS
pro
cess
. Pop
ulat
ion
leve
l im
pact
is n
ot ye
t kno
wn, b
ut th
e NQ
PS p
roce
ss it
self
prom
otes
bui
ldin
g of
syst
ems o
f mea
sure
men
t to
asse
ss th
e im
pact
of n
atio
nal q
ualit
y effo
rts.
17Tools and resources for improving the
quality of health services
3. C
ommun
ity e
nga
gemen
t
Nam
e of
tool
(yea
r)Ty
pe o
f to
olAu
dien
ce
Sum
mar
y des
crip
tion
Key l
esso
ns le
arnt
In
terli
nkag
es w
ith o
ther
are
as
Enha
nced
Cap
acity
Bu
ildin
g Tr
aini
ng fo
r Fr
ont-l
ine
Staf
f on
Build
ing
Trus
t and
Co
mm
unic
atio
n:
Faci
litat
or’s
Guid
e (2
016)
Trai
ning
/
Capa
city
-bu
ildin
g
Tech
nica
l st
aff
work
ing
in su
rvei
llanc
e an
d em
erge
ncy
This
trai
ning
gui
de c
ontri
bute
s to
impr
ovin
g th
e qu
ality
of e
mer
genc
y re
spon
ses.
It w
as d
esig
ned
to im
prov
e th
e qu
ality
of s
urve
illan
ce a
ctiv
ities
by
equi
ppin
g fro
nt-li
ne st
aff w
ith th
e sk
ills
and
tool
s to
enga
ge w
ith c
omm
uniti
es
in w
ays t
hat b
uild
trus
t, su
ppor
t the
up
take
of p
ublic
hea
lth in
terv
entio
ns
and
cont
ribut
e ov
eral
l to
achi
evin
g in
fect
ion
prev
entio
n an
d co
ntro
l ob
ject
ives,
such
as d
urin
g an
Ebo
la
outb
reak
.
1. T
rain
ed st
aff d
emon
stra
ted
grea
ter
know
ledg
e an
d m
ore
posi
tive
attit
udes
re
gard
ing
trust
bui
ldin
g an
d co
mm
unic
atio
n wi
th c
omm
uniti
es.
2. T
rain
ed st
aff r
epor
ted
high
er le
vels
of
conf
iden
ce in
thei
r abi
lity t
o bu
ild tr
ust a
nd
com
mun
icat
e ef
fect
ively.
3.
Fro
nt-li
ne st
aff b
oth
repo
rted
and
dem
onst
rate
d a
grea
ter a
bilit
y to
turn
fru
stra
tion
into
opp
ortu
nitie
s for
dia
logu
e.
4. F
ront
-line
staf
f wor
ked
to b
uild
trus
t by
work
ing
with
com
mun
ity m
embe
rs to
im
prov
e liv
ing
cond
ition
s eve
n th
ough
such
ta
sks a
re c
onsi
dere
d ou
tsid
e th
eir ‘
norm
al’
job
func
tions
.
Alth
ough
spec
ifica
lly d
evel
oped
for t
he
2014
Ebo
la re
spon
se in
Sie
rra L
eone
, co
nten
t of t
his f
acili
tato
r’s g
uide
can
be
ada
pted
and
use
d by
hea
lth st
aff
acro
ss va
rious
func
tions
that
dire
ctly
in
tera
ct w
ith c
omm
unity
mem
bers
.
Unde
rsta
ndin
g an
d M
anag
ing
Fear
- Tr
aini
ng fo
r Hu
man
itaria
n W
orke
rs
in E
mer
genc
ies
[vid
eo]
(201
6)
Capa
city
-bu
ildin
g
Fron
t-lin
e st
aff i
n em
erge
ncie
s
This
tech
nica
l vid
eo c
ontri
bute
s to
qual
ity im
prov
emen
t in
resp
onse
op
erat
ions
. It w
as sp
ecifi
cally
de
velo
ped
as p
art o
f a tr
aini
ng p
acka
ge
to h
elp
heal
th p
rofe
ssio
nals
and
re
spon
se st
aff p
repa
re to
eng
age
and
com
mun
icat
e wi
th E
bola
-affe
cted
co
mm
uniti
es. T
he vi
deo
desc
ribe
how
fear
influ
ence
s bio
logi
cal, p
hysi
olog
ical
, em
otio
nal, c
ogni
tive
and
beha
viou
ral
resp
onse
s and
the
impo
rtanc
e of
this
kn
owle
dge
for h
ealth
pro
fess
iona
ls to
be
abl
e to
pro
mot
e co
nnec
tivity
and
bu
ild tr
ust w
ith in
divi
dual
s, fa
mili
es a
nd
com
mun
ities
who
are
exp
erie
ncin
g fe
ar.
The
vide
o is
rele
vant
for e
mer
genc
y pr
epar
edne
ss, r
espo
nse
and
reco
very
. It
can
also
be
appl
ied
to lo
ng-te
rm
heal
th sy
stem
s stre
ngth
enin
g ef
forts
.
Improving the quality of
health services: tools and resources18
Nam
e of
tool
(yea
r)Ty
pe o
f to
olAu
dien
ce
Sum
mar
y des
crip
tion
Key l
esso
ns le
arnt
In
terli
nkag
es w
ith o
ther
are
as
Com
mun
ity
enga
gem
ent
fram
ewor
k fo
r qua
lity,
peop
le-c
entre
d an
d re
silie
nt h
ealth
se
rvic
es
(201
7)
Mee
ting
repo
rt Pr
ogra
mm
e, m
anag
ers,
polic
y-m
aker
s, re
sear
cher
s, an
d te
chni
cal
partn
ers
The
CEQ
mee
ting
repo
rt in
trodu
ces
a fra
mew
ork
that
inst
itutio
naliz
es
com
mun
ity e
ngag
emen
t as a
fu
ndam
enta
l com
pone
nt o
f hea
lth
serv
ice
desi
gn a
nd d
elive
ry. T
he C
EQ
fram
ewor
k de
scrib
es ke
y fea
ture
s th
at th
e he
alth
syst
em n
eeds
to h
ave
to b
e pr
epar
ed a
nd re
ady t
o en
gage
wi
th se
rvic
e us
ers,
thei
r fam
ilies
and
lo
cal c
omm
uniti
es. T
he p
roce
ss u
sed
to g
ener
ate
the
CEQ
fram
ewor
k is
als
o de
scrib
ed.
The
CEQ
fram
ewor
k wa
s gen
erat
ed b
y id
entif
ying
impo
rtant
inte
rface
poi
nts b
etwe
en
heal
th se
rvic
es, s
ervi
ce u
sers
and
loca
l co
mm
uniti
es th
at im
pact
serv
ice
qual
ity,
peop
le-c
entre
dnes
s and
resi
lienc
e. T
he C
EQ
fram
ewor
k wi
ll be
use
d to
gen
erat
e ev
iden
ce
arou
nd a
pac
kage
of e
ngag
emen
t int
erve
ntio
ns
that
supp
ort c
ontin
uous
qua
lity i
mpr
ovem
ent.
The
CEQ
was d
evel
oped
join
tly w
ith th
e He
alth
Pro
mot
ion
and
Soci
al D
eter
min
ants
Un
it in
the
WHO
Afri
can
Regi
onal
Offi
ce a
nd
will
be fi
eld-
test
ed w
ith th
e Gl
obal
Mal
aria
Pr
ogra
mm
e, M
ater
nal a
nd C
hild
Hea
lth, H
IV
and
Imm
uniza
tion
depa
rtmen
ts w
ithin
WHO
.
19Tools and resources for improving the
quality of health services
Case
stud
y 2: C
omm
unity
eng
agem
ent a
s a m
echa
nism
to im
prov
e th
e qu
ality
of s
urve
illan
ce a
nd b
uild
trus
t with
com
mun
ities
dur
ing
the
2013
-201
6 Eb
ola
viru
s dis
ease
res
pons
e in
Si
erra
Leo
ne
This
cap
acity
-bui
ldin
g pr
ojec
t (th
e in
terv
entio
n) re
spon
ded
to a
n id
entif
ied
need
in E
bola
-affe
cted
cou
ntrie
s to
addr
ess c
omm
unity
trus
t and
impr
ove
the
qual
ity o
f rel
atio
nshi
ps
betw
een
front
-line
staf
f and
com
mun
ities
, par
ticul
arly
surv
eilla
nce
staf
f who
wer
e co
nduc
ting
case
inve
stig
atio
n an
d co
ntac
t tra
cing
act
iviti
es –
crit
ical
to p
reve
ntin
g an
d co
ntro
lling
fu
rther
spre
ad o
f Ebo
la vi
rus d
isea
se.
Som
e of
the
outc
omes
soug
ht w
ere
grea
ter r
ecep
tivity
of f
ront
-line
staf
f to
com
mun
ities
, incr
ease
d tru
st b
etwe
en fr
ont-l
ine
staf
f and
qua
rant
ined
fa
mili
es a
nd im
prov
ed c
apac
ity o
f loc
al st
aff t
o de
sign
and
del
iver f
ollo
w-up
trai
ning
s.
A co
nsul
tativ
e an
d ite
rativ
e pr
oces
s of c
o-de
velo
pmen
t and
co-
lear
ning
bet
ween
mul
tiple
stak
ehol
ders
(dis
cipl
inar
y exp
erts
and
par
tner
s) a
t glo
bal, n
atio
nal a
nd lo
cal l
evel
s was
m
anag
ed b
y WHO
thro
ugho
ut d
esig
n an
d im
plem
enta
tion
of th
e pr
ojec
t. Th
e in
terv
entio
n wa
s rol
led
out i
n Si
erra
Leo
ne in
col
labo
ratio
n wi
th th
e He
alth
Edu
catio
n Un
it an
d th
e De
partm
ent o
f Dis
ease
Pre
vent
ion
and
Cont
rol.
Ove
r 600
hea
lth p
erso
nnel
acr
oss t
hree
dis
trict
s wer
e tra
ined
by a
mixe
d in
tern
atio
nal a
nd n
atio
nal t
eam
of t
rain
ers.
The
trai
ning
pr
ogra
mm
e ce
ntre
d on
faci
litat
ed a
nd e
xper
ient
ial a
dult-
cent
red
lear
ning
. Int
erlin
ked
mod
ules
incl
uded
: rea
ctive
and
rece
ptive
em
otio
nal s
tate
s; d
ialo
gic
tech
niqu
es to
man
age
conv
ersa
tion
chal
leng
es; t
rust
bui
ldin
g;, u
nder
stan
ding
cul
ture
, etc
.
Key l
esso
ns le
arnt
.
1.
The
desi
gn o
f int
erdi
scip
linar
y tra
inin
g to
impr
ove
serv
ice
deliv
ery h
as to
be
led
and
deliv
ered
by c
onte
nt sp
ecia
lists
abl
e to
des
ign
and
deliv
er tr
aini
ng a
nd w
ho a
re sk
illed
in
faci
litat
ion.
Thi
s ena
bled
trai
ners
to c
ontin
uous
ly a
dapt
and
resp
ond
to th
e ne
eds o
f par
ticip
ants
.
2.
Havi
ng m
ixed
coho
rts th
at in
clud
ed su
rvei
llanc
e of
ficer
s, vi
llage
and
relig
ious
lead
ers,
soci
al m
obili
zatio
n st
aff a
nd E
bola
surv
ivors
enh
ance
d th
e pr
oces
s of l
earn
ing
and
also
bui
lt im
porta
nt re
latio
nshi
ps b
etwe
en d
iffer
ent g
roup
s who
nee
ded
to w
ork
toge
ther
.
3.
It wa
s im
porta
nt to
ens
ure
that
the
train
ing
team
had
the
right
com
posi
tion
to e
nsur
e th
at re
leva
nt te
chni
cal c
onte
nt w
as a
vaila
ble
and
ques
tions
cou
ld b
e an
swer
ed. I
t als
o en
sure
d th
at e
ngag
emen
t cap
abili
ty w
as b
uilt
and
stay
ed w
ithin
loca
l sys
tem
s.
In-tr
aini
ng e
valu
atio
n sh
owed
that
mea
n pa
rtici
pant
com
fort
in e
ngag
ing
with
the
com
mun
ity in
crea
sed
and
post
-trai
ning
cas
e st
udy i
nter
view
s als
o sh
owed
that
fron
t-lin
e st
aff w
ere
bette
r abl
e to
turn
frus
tratio
ns in
to o
ppor
tuni
ties f
or d
ialo
gue,
bette
r de-
esca
late
tens
ions
and
nur
ture
gre
ater
trus
t. Th
is w
as a
lso
obse
rved
by W
HO st
aff o
n th
e gr
ound
who
saw
surv
eilla
nce
offic
ers q
uick
ly d
e-es
cala
ting
tens
e si
tuat
ions
.
Look
ing
ahea
d, th
is e
xper
ienc
e sh
ould
serv
e as
a c
all f
or fu
rther
wor
k to
inte
grat
e co
mm
unity
eng
agem
ent m
ore
syst
emat
ical
ly w
ithin
nat
iona
l sur
veill
ance
syst
ems,
as a
way
of
impr
ovin
g th
e qu
ality
, res
pons
ivene
ss a
nd p
eopl
e-ce
ntre
dnes
s of s
urve
illan
ce sy
stem
s.
Improving the quality of
health services: tools and resources20
4. Inst
itut
ional
healt
h pa
rtner
ships
Nam
e of
tool
(y
ear)
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt
Inte
rlink
ages
with
oth
er a
reas
Twin
ning
Pa
rtner
ship
s for
Im
prov
emen
t: St
eps 1
-6
(201
8)
Trai
ning
/Ca
paci
ty-
build
ing
Adm
inis
trato
rs,
front
-line
staf
f, po
licy-
mak
ers
The
mod
el is
bas
ed o
n a
6-st
ep c
ycle
wh
ich
begi
ns w
hen
two
partn
ers a
gree
to
esta
blis
h a
partn
ersh
ip. T
PI g
uide
s the
re
spec
tive
partn
ers t
hrou
gh a
syst
emat
ic
proc
ess,
in o
rder
to id
entif
y are
as fo
r im
prov
emen
t, de
velo
p an
act
ion
plan
to
impl
emen
t im
prov
emen
ts, a
nd th
en
eval
uate
the
prog
ress
ion
and
chan
ges
mad
e to
ward
s qua
lity i
mpr
ovem
ent.
The
6 st
eps r
elat
ed to
impr
ovem
ent i
nclu
de:
partn
ersh
ip d
evel
opm
ent,
need
s ass
essm
ent,
gap
anal
ysis
, act
ion
plan
ning
, act
ion
and
eval
uatio
n.
1. A
ckno
wled
ge th
at g
aps
exis
t, th
at im
prov
emen
ts
are
need
ed a
nd a
gree
/co
mm
it to
a p
artn
ersh
ip
appr
oach
as t
he m
eans
of
impr
ovem
ent.
2. J
oint
iden
tific
atio
n of
pro
blem
s and
co-
deve
lopm
ent o
f the
in
terv
entio
ns u
sing
a
syst
emat
ic a
ppro
ach
to
addr
ess t
he im
prov
emen
t ar
ea(s
).3.
Con
side
r spr
ead
and
sust
aina
bilit
y of h
ealth
se
rvic
e im
prov
emen
ts fr
om
onse
t of a
ctiv
ity(s
) at t
he
hosp
ital l
evel
(inc
ludi
ng
natio
nal a
nd su
b-na
tiona
l le
vel)
Step
6 o
f the
par
tner
ship
mod
el is
dire
ctly
re
late
d to
mea
sure
men
t. In
the
Libe
ria/J
apan
co
untry
exa
mpl
e, th
e pa
rtner
s wor
ked
toge
ther
to
colle
ctive
ly d
evel
op a
mon
itorin
g an
d ev
alua
tion
plan
. Thi
s will
be
plac
ed w
ithin
the
cont
ent o
f th
e co
mpe
ndiu
m. T
ools
and
reso
urce
s rel
atin
g to
ev
alua
tion
are
also
cap
ture
d in
this
doc
umen
t.
21Tools and resources for improving the
quality of health services
Case
stud
y 3: P
artn
ersh
ip d
evel
opm
ent a
nd co
ntin
ued
stre
ngth
enin
g –
Japa
n an
d Li
beria
The
Partn
ersh
ip b
etwe
en N
agas
aki U
nive
rsity
Hos
pita
l (NU
H) a
nd T
elle
wayo
n M
emor
ial H
ospi
tal (
TMH)
in L
ofa
Coun
ty, L
iber
ia, w
as fo
rmed
in A
ugus
t 201
6. A
t the
tim
e, TM
H wa
s re
cove
ring
from
the
Wes
t Afri
can
Ebol
a ou
tbre
ak o
f 201
4 an
d re
lyin
g on
inte
rnat
iona
l sup
port
to re
activ
ate
its e
ssen
tial h
ealth
serv
ices
and
mov
ing
forw
ard
with
reco
very
effo
rts in
al
ignm
ent w
ith n
atio
nal r
ecov
ery p
lans
. Dur
ing
the
reco
very
at T
MH,
it w
as q
uick
ly re
alize
d th
at im
pact
of t
he E
bola
resp
onse
had
dep
lete
d m
any r
esou
rces
and
that
ext
ensi
ve w
ork
was n
eede
d to
impr
ove
qual
ity. N
UH sa
w th
at th
e ne
eds a
t TM
H we
re e
xten
sive
and
agr
eed
to fo
rm a
par
tner
ship
with
TM
H. T
he M
inis
try o
f Hea
lth a
nd th
e Co
unty
aut
horit
ies i
n Li
beria
su
ppor
ted
this
par
tner
ship
at t
he o
nset
of t
he fo
rmal
TPI
agr
eem
ent.
Care
ful c
onsi
dera
tion
was g
iven
to th
e ar
chite
ctur
e of
the
partn
ersh
ip, r
ecog
nizin
g th
e di
ffere
nt c
ultu
re a
nd
cont
ext o
f the
resp
ectiv
e pa
rtner
s.
Mov
ing
forw
ard
from
this
initi
al p
artn
ersh
ip, a
situ
atio
nal a
sses
smen
t and
gap
ana
lysi
s wer
e co
mpl
eted
at T
MH
in O
ctob
er 2
016.
Fol
lowi
ng th
e ga
p an
alys
is, a
n of
ficia
l “ac
tion
plan
ning
” mee
ting
took
pla
ce in
Dec
embe
r 201
6 wh
ere
both
par
tner
s agr
eed
to ta
ckle
som
e ar
eas w
ithin
infe
ctio
n pr
even
tion
and
cont
rol (
IPC)
such
as h
and
hygi
ene
and
wast
e m
anag
emen
t. It
was n
oted
that
by i
mpr
ovin
g th
ese
two
serv
ices
, ove
rall
qual
ity c
ould
be
impr
oved
thro
ugho
ut th
e wh
ole
hosp
ital.
The
partn
ersh
ip u
nder
took
two
partn
ersh
ip e
xcha
nge
visi
ts in
Lib
eria
and
Jap
an re
spec
tivel
y. Th
e pr
inci
ples
of t
he p
artn
ersh
ip w
ere
rein
forc
ed th
roug
hout
whi
le th
e im
prov
emen
t wor
k pr
ocee
ded.
The
bi-d
irect
iona
lity o
f the
par
tner
ship
lear
ning
was
em
phas
ized.
For
exa
mpl
e, th
e TM
H te
am le
ader
gav
e a
talk
abo
ut th
eir e
xper
ienc
e in
the
Ebol
a re
spon
se, w
hich
NUH
st
ated
they
ben
efite
d gr
eatly
from
bec
ause
they
lear
nt a
bout
the
real
ities
of d
iagn
osis
and
trea
ting
Ebol
a-af
fect
ed p
atie
nts.
In L
iber
ia, t
he te
chni
cal i
mpr
ovem
ents
alig
ned
with
ove
rall
proc
ess a
nd m
anag
eria
l im
prov
emen
ts w
ithin
TM
H.
In li
ght o
f the
thre
e ob
ject
ives o
f TPI
(par
tner
ship
, impr
ovem
ent a
nd sp
read
), th
e 6-
step
mod
el g
uide
d th
e pa
rtner
ship
thro
ugh
the
thre
e cr
ossc
uttin
g ar
eas o
f im
prov
emen
t. In
add
ition
to
the
impr
ovem
ents
mad
e to
IPC
prac
tices
at T
MH,
mea
sure
men
t pro
cess
es w
ere
also
impl
emen
ted
by u
sing
such
tool
s as t
he W
HO h
and
hygi
ene
asse
ssm
ent s
trate
gy. E
ngag
emen
t of
the
com
mun
ity a
nd o
ther
hos
pita
ls in
the
regi
on w
as o
ne o
utco
me
of ‘s
prea
ding
’ the
impr
ovem
ents
. For
exa
mpl
e, th
e le
ader
ship
in L
ofa
Coun
ty h
oste
d a
lear
ning
even
t for
the
impr
ovem
ents
at T
MH
to b
e sh
ared
with
thre
e ot
her a
rea
hosp
itals
. In
sum
mar
y, TP
I is a
com
preh
ensi
ve, c
ross
-cut
ting
mod
el fo
cuse
d on
bui
ldin
g re
latio
nshi
ps, im
prov
emen
ts a
nd th
en
shar
ing
the
know
ledg
e ga
ined
.
The
activ
ities
und
erta
ken
were
in a
lignm
ent w
ith th
e na
tiona
l and
cou
nty h
ealth
pla
ns w
hich
con
tinue
d to
evo
lve a
s the
par
tner
ship
pro
gres
sed.
Improving the quality of
health services: tools and resources22
5. P
atient s
afe
ty
Nam
e of
tool
(y
ear)
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt
Inte
rlink
ages
with
oth
er
area
s
Safe
Chi
ldbi
rth
Chec
klis
t (2
015)
Guid
ance
Do
ctor
s, nu
rses
, m
idwi
ves,
paed
iatri
cian
s, ge
nera
l pr
actit
ione
rs,
and
othe
r birt
h at
tend
ants
in
mat
erni
ty
faci
litie
s
The
WHO
Saf
e Ch
ildbi
rth C
heck
list i
s a to
ol in
tend
ed
to im
prov
e th
e qu
ality
of c
are
for w
omen
and
bab
ies a
t th
e tim
e of
chi
ldbi
rth. T
he C
heck
list i
s an
orga
nize
d lis
t of
evi
denc
e-ba
sed
esse
ntia
l birt
h pr
actic
es ta
rget
ing
maj
or c
ause
s of m
ater
nal d
eath
s, in
trapa
rtum
-rela
ted
still
birth
s and
neo
nata
l dea
ths t
hat o
ccur
in fa
cilit
ies
arou
nd th
e wo
rld.
A co
llabo
rativ
e fie
ld-te
stin
g ex
erci
se w
as c
arrie
d ou
t fro
m 2
012
thro
ugh
2015
to e
xplo
re q
uest
ions
add
ress
ing
com
plia
nce
with
, bar
riers
to a
nd su
cces
s fac
tors
of
effe
ctive
and
sust
aine
d us
e of
the
Chec
klis
t in
a ra
nge
of
setti
ngs a
roun
d th
e wo
rld. T
he re
sults
are
pub
lishe
d at
ht
tp://
www.
who.
int/p
atie
ntsa
fety
/topi
cs/s
afe-
child
birth
/ch
ildbi
rth_c
olla
bora
tion_
enga
ging
/en/
.
The
Chec
klis
t is i
n lin
e wi
th th
e co
mpr
ehen
sive
WHO
Fr
amew
ork
for I
mpr
ovem
ent o
f the
Qua
lity o
f Mat
erna
l an
d Ne
wbor
n Ca
re th
at a
ims t
o ac
hiev
e co
vera
ge o
f ke
y pra
ctic
es, p
eopl
e-ce
ntre
d ou
tcom
es a
nd e
vent
ually
im
prov
ed h
ealth
out
com
es.
1. G
ain
buy-
in fr
om m
anag
ers/
adm
inis
trato
rs in
the
first
inst
ance
. 2.
Ens
ure
that
staf
f hav
e ad
equa
te
know
ledg
e an
d sk
ills t
o ha
ndle
co
mpl
icat
ions
. Men
torin
g an
d tra
inin
g is
one
exa
mpl
e of
bui
ldin
g sk
ills a
nd c
ompe
tenc
ies.
3.
Lac
k of
supp
lies a
nd e
quip
men
t is
a m
ajor
bar
rier t
o su
cces
sful
im
plem
enta
tion
of th
e Ch
eckl
ist.
4. L
ocal
ada
ptat
ion
and
cont
extu
aliza
tion
are
key.
5. In
tegr
ate
Chec
klis
t use
into
the
broa
der q
ualit
y of c
are
impr
ovem
ent
effo
rts fo
r mot
hers
and
new
born
s, in
clud
ing
mot
hers
’ cas
e no
tes.
This
tool
is c
lose
ly li
nked
with
th
e wo
rk o
n im
prov
ing
qual
ity
of m
ater
nal a
nd n
ewbo
rn
care
. For
mor
e in
form
atio
n,
plea
se se
e ht
tp://
www.
who.
int/m
ater
nal_c
hild
_ad
oles
cent
/topi
cs/q
ualit
y-of
-ca
re/e
n/.
Case
stud
y 4: B
ette
r Birt
h st
udy i
n In
dia
The
Bette
rBirt
h st
udy,
cond
ucte
d by
Aria
dne
Labs
(www
.aria
dnel
abs.
org)
from
201
4-20
16 w
as a
mul
ti-ce
ntre
d ra
ndom
ized
cont
rolle
d tri
al to
test
the
WHO
Saf
e Ch
ildbi
rth C
heck
list
(SCC
) in
Utta
r Pra
desh
, Ind
ia. A
t the
hea
rt of
this
stud
y wer
e th
e co
ncep
ts o
f ‘en
gage
’ (bu
y-in
at d
istri
ct a
nd fa
cilit
y lev
el, p
rom
otin
g sy
stem
atic
cha
nge)
, ‘lau
nch’
(impl
emen
tatio
n of
th
e SC
C), a
nd fi
nally
‘sup
port’
(coa
chin
g, m
ainl
y with
pee
r-to-
peer
mod
els f
or th
e up
take
of e
ssen
tial b
irth
prac
tices
). Th
is is
one
of t
he la
rges
t fac
ility
-bas
ed ra
ndom
ized
cont
rolle
d tri
als,
whic
h m
easu
red
the
impa
ct o
f a m
ulti-
pron
ged
appr
oach
(che
cklis
t + c
oach
ing
+ da
ta fe
edba
ck) o
n ea
rly (7
–day
) mat
erna
l and
per
inat
al m
orbi
dity
and
mor
talit
y in
inst
itutio
nal
child
birth
s in
reso
urce
-lim
ited
setti
ngs.
The
out
com
es a
cros
s 161
000
del
iverie
s wer
e ve
ry p
rom
isin
g, sh
owin
g a
dram
atic
impr
ovem
ent i
n ad
here
nce
to e
ssen
tial b
est p
ract
ices
in si
tes
wher
e th
e SC
C wa
s int
rodu
ced.
Whi
le th
ere
was n
o m
easu
rabl
e im
prov
emen
t in
mat
erna
l and
neo
nata
l mor
bidi
ty a
nd m
orta
lity i
n th
e in
terv
entio
n ar
m, it
was
reco
gnize
d th
at th
e SC
C ca
nnot
be
a st
anda
lone
tool
. Rat
her t
he W
HO S
CC e
mbo
dies
the
basi
c es
sent
ial b
est p
ract
ices
for o
ptim
al m
ater
nal a
nd n
eona
tal c
are.
The
Che
cklis
t is n
ow in
corp
orat
ed a
s par
t of t
he
qual
ity o
f car
e to
olki
t in
Indi
a.
23Tools and resources for improving the
quality of health services
Nam
e of
tool
(y
ear)
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt
Inte
rlink
ages
with
oth
er
area
s
Safe
Chi
ldbi
rth
Chec
klis
t im
plem
enta
tion
guid
e (2
015)
Guid
ance
He
alth
car
e pr
ofes
sion
als
A gu
ide
to h
elp
heal
th c
are
man
ager
s and
lead
ers,
and
birth
atte
ndan
ts in
trodu
ce, im
plem
ent,
and
use
the
Safe
Chi
ldbi
rth C
heck
list i
n fa
cilit
y-ba
sed
deliv
erie
s.
It co
vers
how
to in
trodu
ce a
nd e
nsur
e co
ntin
uous
use
of
the
Chec
klis
t, ho
w to
laun
ch it
form
ally,
and
how
to
prov
ide
supp
ort f
or im
plem
enta
tion
thro
ugh
coac
hing
an
d da
ta sh
arin
g. T
he Im
plem
enta
tion
guid
e pr
ovid
es
a st
ep-b
y-st
ep a
ppro
ach
for e
ffect
ive a
nd su
stai
nabl
e us
e of
the
Chec
klis
t in
heal
th c
are
faci
litie
s, wh
ich
will
in tu
rn im
prov
e ad
here
nce
to e
ssen
tial b
irth
prac
tices
. Th
e Gu
ide
prov
ides
furth
er d
etai
ls o
n th
e ke
y fac
ilita
ting
fact
ors i
dent
ified
, and
hig
hlig
hts i
mpo
rtant
fact
ors
for e
ngag
emen
t, la
unch
of t
he C
heck
list a
nd o
ngoi
ng
supp
ort.
Targ
eted
for f
acili
ty le
vel u
se b
ut in
clud
es
advi
ce fo
r a n
atio
nal l
evel
app
roac
h.
1.
Gain
buy
-in fr
om m
anag
ers/
adm
inis
trato
rs in
the
first
inst
ance
. 2.
En
sure
that
staf
f hav
e ad
equa
te
know
ledg
e an
d sk
ills t
o ha
ndle
co
mpl
icat
ions
. Men
torin
g an
d tra
inin
g is
one
exa
mpl
e of
bui
ldin
g sk
ills a
nd c
ompe
tenc
ies.
3.
La
ck o
f sup
plie
s and
equ
ipm
ent
is a
maj
or b
arrie
r to
succ
essf
ul
impl
emen
tatio
n of
the
Chec
klis
t. 4.
Lo
cal a
dapt
atio
n an
d co
ntex
tual
izatio
n ar
e ke
y.5.
In
tegr
ate
Chec
klis
t use
into
th
e br
oade
r qua
lity o
f car
e im
prov
emen
t effo
rts fo
r mot
hers
an
d ne
wbor
ns, in
clud
ing
mot
hers
’ ca
se n
otes
.
This
tool
is c
lose
ly li
nked
with
th
e wo
rk o
n im
prov
ing
qual
ity
of m
ater
nal a
nd n
ewbo
rn
care
. For
mor
e in
form
atio
n,
plea
se se
e ht
tp://
www.
who.
int/m
ater
nal_c
hild
_ad
oles
cent
/topi
cs/q
ualit
y-of
-ca
re/e
n/.
Case
stud
y 5: S
afe
Child
birth
Che
cklis
t use
in S
ri La
nka
The
WHO
Saf
e Ch
ildbi
rth w
as im
plem
ente
d in
a te
rtiar
y car
e ho
spita
l in
Sri L
anka
. Afte
r int
rodu
cing
the
Chec
klis
t, he
alth
car
e wo
rker
s wer
e tra
ined
to u
se it
. It w
as to
be
used
for
each
wom
an a
dmitt
ed to
the
labo
ur ro
om. A
regu
lato
ry re
quire
men
t was
put
in p
lace
for n
ursi
ng st
aff t
o ad
opt a
nd im
plem
ent t
he C
heck
list,
and
coac
hing
was
pro
vide
d fo
r the
birt
h at
tend
ants
.
The
aver
age
num
ber o
f chi
ldbi
rth p
ract
ices
che
cked
in th
e Ch
eckl
ist w
as 2
1 ou
t of 2
9. It
ems r
elat
ed to
edu
catin
g th
e m
othe
r to
seek
hel
p du
ring
labo
ur, a
fter d
elive
ry a
nd a
fter
disc
harg
e fro
m h
ospi
tal, s
eeki
ng a
n as
sist
ant d
urin
g la
bour
, ear
ly b
reas
t-fee
ding
, mat
erna
l HIV
infe
ctio
n an
d di
scus
sing
con
trace
ptive
opt
ions
wer
e ch
ecke
d le
ast o
ften.
The
mea
n le
vel
of k
nowl
edge
on
the
SCC
amon
g he
alth
wor
kers
was
60.
1%. A
ttitu
des t
o ac
cept
ance
of u
sing
the
Chec
klis
t wer
e sa
tisfa
ctor
y. Av
erag
e ad
here
nce
to C
heck
list p
ract
ices
was
71.
3%.
Incr
ease
d wo
rklo
ad, p
oor e
nthu
sias
m o
f hea
lth w
orke
rs to
ward
s new
add
ition
s to
thei
r rou
tine
sche
dule
and
leve
l of u
ser-f
riend
lines
s of t
he C
heck
list w
ere
limita
tions
to it
s wid
er u
se.
Amon
g us
ers,
attit
ude
towa
rds t
he C
heck
list w
as sa
tisfa
ctor
y. Ad
optio
n ra
te a
mon
g al
l hea
lth w
orke
rs w
as 4
5.8%
and
kno
wled
ge re
gard
ing
the
Chec
klis
t was
60.
1%. T
hese
two
fact
ors
are
prob
ably
link
ed. T
here
fore
prio
r to
intro
duci
ng it
to a
faci
lity,
awar
enes
s abo
ut th
e va
lue
and
corre
ct u
se o
f the
SCC
nee
ds to
be
incr
ease
d, w
hile
giv
ing
atte
ntio
n to
satis
fact
ory
staf
fing
leve
ls.
Less
ons l
earn
t: 1)
The
SCC
can
be
impl
emen
ted
as a
nat
iona
l app
roac
h; 2
) The
leve
l of k
nowl
edge
of s
taff
mus
t be
addr
esse
d pr
ior t
o im
plem
enta
tion;
3) C
ontin
uous
staf
f edu
catio
n an
d m
otiva
tion
is e
ssen
tial;
4) E
ncou
rage
men
t mus
t orig
inat
e fro
m th
e to
p do
wn, w
ith e
arly
eng
agem
ent o
f the
MOH
, and
pol
icy-
mak
ers;
5) T
he S
CC m
ust b
e ad
apte
d ac
cord
ing
to th
e co
untry
setti
ng a
nd fa
cilit
y it i
s im
plem
ente
d in
. [Re
fere
nce:
Impl
emen
tatio
n of
the
WHO
safe
chi
ldbi
rth c
heck
list p
rogr
amm
e at
a te
rtiar
y car
e se
tting
in S
ri La
nka.
BM
C Pr
egna
ncy a
nd
Child
birth
201
5.]
Improving the quality of
health services: tools and resources24
Nam
e of
tool
Type
of t
ool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt:
Inte
rlink
ages
with
oth
er a
reas
:
Min
imal
Info
rmat
ion
Mod
el U
ser G
uide
: M
inim
al In
form
atio
n M
odel
for P
atie
nt
Safe
ty (M
IM P
S)(2
017)
Guid
ance
He
alth
car
e pr
ofes
sion
als
A to
ol to
faci
litat
e co
llect
ion,
an
alys
is, c
ompa
rison
, sha
ring
and
glob
al le
arni
ng fr
om a
dver
se e
vent
s, wh
ich
can
be u
sed
by c
ount
ries
or in
stitu
tions
look
ing
to se
t up
or
impr
ove
thei
r cur
rent
pat
ient
safe
ty
repo
rting
and
lear
ning
syst
ems.
Seve
ral h
ospi
tals
and
co
untri
es a
dapt
ed M
IM
PS fo
r the
ir re
porti
ng a
nd
lear
ning
syst
ems.
The
tool
is a
lso
stro
ngly
link
ed w
ith
mea
sure
men
t effo
rts w
ith th
e in
clus
ion
of a
st
ruct
ured
tem
plat
e co
ntai
ning
the
defin
ition
an
d th
e ra
tiona
le fo
r eve
ry e
ntity
(cat
egor
y or
rela
tions
hip)
of a
min
imal
adv
erse
eve
nt
repo
rting
syst
em.
Patie
nt S
<afe
ty
Rese
arch
: A g
uide
fo
r dev
elop
ing
train
ing
prog
ram
mes
(2
012)
Guid
ance
Ac
adem
ic
inst
itutio
ns
This
gui
de is
des
igne
d to
aid
cu
rricu
lum
dev
elop
men
t and
the
orga
niza
tion
of tr
aini
ng p
rogr
amm
es
in th
e fie
ld o
f pat
ient
safe
ty re
sear
ch.
Clos
ely l
inke
d to
the
work
on
natio
nal q
ualit
y po
licy a
nd st
rate
gy, a
nd in
fect
ion
prev
entio
n an
d co
ntro
l
Sum
mar
y of t
he
evid
ence
on
patie
nt
safe
ty: I
mpl
icat
ions
fo
r res
earc
h (2
008)
Rese
arch
Po
licy-
mak
ers,
heal
th c
are
adm
inis
trato
rs a
nd
regu
lato
rs, a
cade
mic
in
stitu
tions
, re
sear
cher
s, qu
ality
m
anag
ers
This
doc
umen
t pro
vide
s gui
danc
e fo
r set
ting
WHO
’s pr
iorit
ies f
or
patie
nt sa
fety
rese
arch
on
unsa
fe
care
in c
linic
al c
onte
xts i
n va
rious
co
untri
es a
nd th
e un
derly
ing
caus
es
cont
ribut
ing
to u
nsaf
e ca
re.
The
docu
men
t has
rele
vanc
e to
a n
umbe
r of
serv
ice
deliv
ery r
elat
ed a
reas
: nat
iona
l qu
ality
pol
icy a
nd st
rate
gy, in
fect
ion
prev
entio
n an
d co
ntro
l, prim
ary h
ealth
car
e.
25Tools and resources for improving the
quality of health services
Nam
e of
tool
Type
of t
ool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt:
Inte
rlink
ages
with
oth
er a
reas
:
Patie
nt S
afet
y Cu
rricu
lum
Gui
de
(201
1)
Guid
ance
trai
ning
/Ca
paci
ty-b
uild
ing
Prof
essi
onal
as
soci
atio
ns,
acad
emic
in
stitu
tions
, ed
ucat
ion
coun
cils
This
doc
umen
t is a
com
preh
ensi
ve
guid
e to
ass
ist e
ffect
ive c
apac
ity-
build
ing
in p
atie
nt sa
fety
edu
catio
n by
hea
lth c
are
acad
emic
inst
itutio
ns
and
is ta
rget
ed a
t den
tistry
, med
ical
, m
idwi
fery
, nur
sing
and
pha
rmac
y sc
hool
s. It
con
tain
s inf
orm
atio
n fo
r all
leve
ls o
f fac
ulty
staf
f and
a
com
preh
ensi
ve c
urric
ulum
cov
erin
g th
e es
sent
ial p
atie
nt sa
fety
prin
cipl
es
and
conc
epts
. The
Gui
de c
an b
e ea
sily
inte
grat
ed in
to e
xist
ing
curri
cula
to m
eet i
ndiv
idua
l nee
ds
and
is a
pplic
able
to d
iffer
ent c
ultu
res
and
cont
exts
.
The
first
par
t of t
he G
uide
is a
imed
at
heal
th c
are
educ
ator
s and
pro
vide
s a
syst
emat
ic a
ppro
ach
to b
uild
ing
inst
itutio
nal
capa
city
and
hig
hlig
hts t
he e
duca
tiona
l pr
inci
ples
ess
entia
l to
teac
hing
pat
ient
sa
fety
to d
iffer
ent c
ateg
orie
s of h
ealth
ca
re p
rofe
ssio
nals
. The
seco
nd p
art o
f th
e Gu
ide
cont
ains
11
topi
cs, s
ome
of
them
cro
ss-c
uttin
g na
ture
, incl
udin
g IP
C,
inva
sive
pro
cedu
res,
med
icat
ion
safe
ty,
qual
ity im
prov
emen
t met
hods
, rep
ortin
g an
d le
arni
ng, e
ngag
ing
patie
nts.
Patie
nt S
afet
y Cu
rricu
lum
Gui
de fo
r M
edic
al S
choo
ls (2
009)
Guid
ance
Tra
inin
g/Ca
paci
ty-b
uild
ing
Acad
emic
in
stitu
tions
(m
edic
al sc
hool
s),
prof
essi
onal
or
gani
zatio
ns,
educ
atio
nal c
ounc
ils
This
Cur
ricul
um g
uide
pro
vide
s a
com
preh
ensi
ve p
rogr
amm
e fo
r im
plem
enta
tion
of p
atie
nt sa
fety
ed
ucat
ion
in m
edic
al sc
hool
s wo
rldwi
de.
The
first
par
t of t
he G
uide
is a
imed
at h
ealth
ca
re e
duca
tors
and
pro
vide
s a sy
stem
atic
ap
proa
ch to
bui
ldin
g in
stitu
tiona
l cap
acity
an
d hi
ghlig
hts t
he e
duca
tiona
l prin
cipl
es
esse
ntia
l to
teac
hing
pat
ient
safe
ty in
m
edic
al sc
hool
s. T
he se
cond
par
t of t
he
Guid
e co
ntai
ns 1
1 to
pics
, som
e of
them
cr
oss-
cutti
ng in
nat
ure,
incl
udin
g IP
C,
inva
sive
pro
cedu
res,
med
icat
ion
safe
ty,
qual
ity im
prov
emen
t met
hods
, rep
ortin
g an
d le
arni
ng, a
nd e
ngag
ing
patie
nts.
Improving the quality of
health services: tools and resources26
Nam
e of
tool
Type
of t
ool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
nt:
Inte
rlink
ages
with
oth
er a
reas
:
Conc
eptu
al
Fram
ewor
k fo
r th
e In
tern
atio
nal
Clas
sific
atio
n fo
r Pa
tient
Saf
ety (
ICPS
)(2
009)
Guid
ance
Po
licy-
mak
ers,
heal
th c
are
adm
inis
trato
rs a
nd
regu
lato
rs, q
ualit
y m
anag
ers
The
Fram
ewor
k pr
ovid
es a
met
hod
for o
rgan
izing
pat
ient
safe
ty d
ata
and
info
rmat
ion.
It p
rovi
des g
uida
nce
to c
ompa
re d
ata
acro
ss d
isci
plin
es/
orga
niza
tions
, exa
min
e th
e ro
le
of sy
stem
and
hum
an fa
ctor
s, id
entif
y pot
entia
l pat
ient
safe
ty
issu
es, d
evel
op p
riorit
ies a
nd sa
fety
so
lutio
ns.
ICPS
has
bee
n wi
dely
use
d to
dev
elop
the
repo
rting
an
d le
arni
ng sy
stem
s at
faci
lity a
nd n
atio
nal l
evel
s.
Inte
rnat
iona
l Cla
ssifi
catio
n of
Dis
ease
s (IC
D) -1
1’s
Safe
ty a
nd Q
ualit
y Top
ic
Advi
sory
Gro
up h
as b
een
work
ing
on m
appi
ng IC
PS to
IC
D-11
.
The
ICPS
is d
esig
ned
to b
e a
genu
ine
conv
erge
nce
of in
tern
atio
nal p
erce
ptio
ns
of th
e m
ain
issu
es re
late
d to
pat
ient
safe
ty
and
to fa
cilit
ate
the
desc
riptio
n, c
ompa
rison
, m
easu
rem
ent,
mon
itorin
g, a
naly
sis a
nd
inte
rpre
tatio
n of
info
rmat
ion
to im
prov
e pa
tient
car
e.
High
5’s:
Sta
ndar
d Op
erat
ing
Proc
edur
es
Guid
ance
Polic
y-m
aker
s, he
alth
car
e ad
min
istra
tors
and
re
gula
tors
, qua
lity
man
ager
s, cl
inic
ians
an
d ot
her h
ospi
tal
staf
f
This
pro
ject
aim
s to
faci
litat
e th
e de
velo
pmen
t, im
plem
enta
tion
and
eval
uatio
n of
thre
e SO
Ps. T
he
thre
e SO
Ps re
late
d to
med
icat
ion
reco
ncili
atio
n, c
orre
ct si
te su
rger
y, an
d co
ncen
trate
d in
ject
able
m
edic
ines
, hav
e be
en d
evel
oped
, im
plem
ente
d an
d ev
alua
ted.
The
tool
pre
sent
s the
exe
mpl
ary i
ndic
ator
s an
d th
e gu
idel
ines
to m
easu
re th
ree
area
s, na
mel
y med
icat
ion
reco
ncili
atio
n, th
e pe
rform
ance
of t
he c
orre
ct p
roce
dure
at t
he
corre
ct b
ody s
ite, a
nd th
e sa
fe m
anag
emen
t of
con
cent
rate
d in
ject
able
med
icin
es. I
n ad
ditio
n, m
etho
dolo
gica
l rec
omm
enda
tions
fo
r mea
surin
g pa
tient
safe
ty a
re p
rese
nted
.
Met
hodo
logi
cal
guid
e fo
r dat
a po
or
hosp
itals
(2
010)
Guid
ance
He
alth
car
e ad
min
istra
tors
and
re
gula
tors
, qua
lity
man
ager
s, cl
inic
ians
The
guid
ance
des
crib
es a
set o
f m
etho
dolo
gies
that
can
be
used
ei
ther
to e
stim
ate
the
exte
nt o
f har
m
caus
ed b
y the
del
ivery
of h
ealth
car
e in
a p
artic
ular
hea
lth c
are
faci
lity o
r to
est
ablis
h pr
iorit
y act
ions
aro
und
perc
eive
d pa
tient
safe
ty is
sues
.
The
docu
men
t is c
lose
ly li
nked
with
pat
ient
sa
fety
and
its i
mpl
emen
tatio
n in
hos
pita
ls.
27Tools and resources for improving the
quality of health services
6. T
raditional
Compl
emen
tary
and
Integ
rativ
e Med
icin
e
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ce
Sum
mar
y des
crip
tion
Key l
esso
ns le
arnt
In
terli
nkag
es w
ith o
ther
ar
eas
WHO
Ben
chm
arks
for
train
ing
in:
Ayur
veda
(201
0)
Unan
i Med
icin
e (2
010)
Natu
ropa
thy (
2010
)
Oste
opat
hy (2
010)
Nuad
Tha
i (20
10)
Trad
ition
al C
hine
se
Med
icin
e (2
010)
Tui n
a (2
010)
Trai
ning
/Cap
acity
-bu
ildin
g Ac
adem
ics/
rese
arch
ers,
deve
lopm
ent a
genc
ies,
heal
th w
orke
rs,
nong
over
nmen
tal
orga
niza
tions
, pol
icy-
mak
ers
The
serie
s of b
ench
mar
ks fo
r tra
inin
g re
flect
wh
at th
e co
mm
unity
of p
ract
ition
ers i
n tra
ditio
nal
and
com
plem
enta
ry m
edic
ine
cons
ider
to b
e re
ason
able
pra
ctic
es in
trai
ning
pro
fess
iona
ls
to p
ract
ice
the
disc
iplin
e, co
nsid
erin
g co
nsum
er
prot
ectio
n an
d pa
tient
safe
ty a
s bei
ng c
ore
to
prof
essi
onal
pra
ctic
e. T
he tr
aini
ng to
ols p
rovi
de
a re
fere
nce
poin
t to
whic
h ac
tual
pra
ctic
e ca
n be
com
pare
d an
d ev
alua
ted.
The
doc
umen
ts
desc
ribe
mod
els o
f tra
inin
g fo
r tra
inee
s with
di
ffere
nt p
rofe
ssio
nal b
ackg
roun
ds. T
he li
st,
deve
lope
d by
a c
omm
unity
of p
ract
ition
ers,
aim
s to
pro
mot
e sa
fe p
ract
ice
and
min
imize
the
risk
of
acci
dent
s.
Ther
e is
a n
eed
to u
pdat
e an
d al
ign
the
train
ing
benc
hmar
ks w
ith p
ract
ice
benc
hmar
ks. R
esou
rce
mob
iliza
tion
to su
ppor
t de
velo
pmen
t and
re
finem
ent o
f doc
umen
ts
is ke
y.
The
tool
s ser
ve a
s ref
eren
ce
poin
ts to
whi
ch a
ctua
l pr
actic
e ca
n be
com
pare
d an
d ev
alua
ted.
WHO
Gui
delin
es o
n Ba
sic
Trai
ning
and
Sa
fety
in C
hiro
prac
tic
(200
5)
Trai
ning
/Cap
acity
-bu
ildin
g Ac
adem
ics/
rese
arch
ers,
deve
lopm
ent a
genc
ies,
heal
th w
orke
rs,
nong
over
nmen
tal
orga
niza
tions
, pol
icy-
mak
ers
This
doc
umen
t com
pris
es g
uide
lines
on
basi
c tra
inin
g an
d sa
fety
in c
hiro
prac
tic. A
vaila
ble
in
Engl
ish,
Fre
nch
and
Span
ish.
Regu
lar a
nd ti
mel
y upd
ate
is n
eede
d to
mai
ntai
n th
e re
leva
nce
of th
is re
sour
ce.
A sy
stem
of e
xam
inat
ions
an
d lic
ensi
ng m
ay b
e es
tabl
ishe
d or
ada
pted
on
the
basi
s of t
his t
rain
ing
prog
ram
me,
to e
nsur
e th
e co
mpe
tenc
e of
the
train
ees
and
avoi
d th
e pr
actic
e of
ch
iropr
actic
by u
nqua
lifie
d pe
rson
s.
Improving the quality of
health services: tools and resources28
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ce
Sum
mar
y des
crip
tion
Key l
esso
ns le
arnt
In
terli
nkag
es w
ith o
ther
ar
eas
Guid
elin
es o
n Ba
sic
Trai
ning
and
Saf
ety i
n Ac
upun
ctur
e (1
999)
Trai
ning
/Cap
acity
-bu
ildin
g Ac
adem
ics/
rese
arch
ers,
deve
lopm
ent a
genc
ies,
heal
th w
orke
rs,
nong
over
nmen
tal
orga
niza
tions
, pol
icy-
mak
ers
The
guid
elin
es o
n ba
sic
train
ing
cove
r bas
ic
requ
irem
ents
for t
rain
ing
non-
phys
icia
n ac
upun
ctur
ists
and
phy
sici
ans w
ishi
ng to
use
ac
upun
ctur
e in
thei
r clin
ical
wor
k an
d in
clud
es
a co
re sy
llabu
s. T
he g
uide
lines
on
safe
ty in
ac
upun
ctur
e ar
e in
tend
ed fo
r hos
pita
ls, c
linic
s an
d pr
actit
ione
rs a
nd p
rovi
de st
anda
rds f
or
safe
ty in
the
clin
ical
pra
ctic
e of
acu
punc
ture
. Av
aila
ble
in E
nglis
h, F
renc
h an
d Sp
anis
h.
Ther
e is
nee
d to
upd
ate
and
alig
n th
e tra
inin
g be
nchm
arks
with
pra
ctic
e be
nchm
arks
. The
pra
ctic
e be
nchm
arks
are
und
er
deve
lopm
ent.
The
docu
men
t is i
nten
ded
to a
ssis
t nat
iona
l hea
lth
auth
oriti
es in
setti
ng
stan
dard
s and
est
ablis
hing
of
ficia
l exa
min
atio
ns, a
s we
ll as
med
ical
scho
ols
and
inst
itutio
ns w
ishi
ng
to a
rrang
e tra
inin
g pr
ogra
mm
es.
WHO
Gui
delin
es fo
r As
sess
ing
Qual
ity
of H
erba
l Med
icin
es
with
Ref
eren
ce to
Co
ntam
inan
ts a
nd
Resi
dues
(2
007)
Guid
ance
Na
tiona
l /in
tern
atio
nal
drug
regu
lato
ry
agen
cies
, res
earc
hers
, ph
arm
aceu
tical
con
trol
labo
rato
ries,
polic
y-m
aker
s
Thes
e W
HO g
uide
lines
pre
sent
gen
eral
co
nsid
erat
ions
on
pote
ntia
lly h
azar
dous
co
ntam
inan
ts a
nd re
sidu
es in
her
bal m
edic
ines
an
d in
clud
e gu
idin
g pr
inci
ples
for a
sses
sing
the
qual
ity o
f her
bal m
edic
ines
, in te
rms o
f maj
or
cont
amin
ants
and
resi
dues
. It a
lso
reco
mm
ends
an
alyt
ical
met
hods
for q
ualit
ative
and
qu
antit
ative
det
erm
inat
ion
of su
ch c
onta
min
ants
an
d re
sidu
es.
Regu
lar a
nd ti
mel
y upd
ate
is n
eede
d to
mai
ntai
n th
e re
leva
nce
of th
e re
sour
ce.
With
in th
e ov
eral
l con
text
of
qua
lity a
ssur
ance
, the
se
guid
elin
es in
tend
ed to
pr
ovid
e ge
nera
l tec
hnic
al
guid
ance
to M
embe
r Sta
tes
in a
sses
sing
qua
lity r
elat
ing
to th
e sa
fety
of h
erba
l m
ater
ials
and
pro
duct
s cl
assi
fied
as m
edic
ines
, in
rela
tion
to m
ajor
and
co
mm
on c
onta
min
ants
and
re
sidu
es.
Gene
ral G
uide
lines
fo
r Met
hodo
logi
es
on R
esea
rch
and
Eval
uatio
n of
Tr
aditi
onal
Med
icin
e (2
000)
Guid
ance
Ac
adem
ics/
rese
arch
ers,
deve
lopm
ent a
genc
ies,
heal
th w
orke
rs,
nong
over
nmen
tal
orga
niza
tions
, pol
icy-
mak
ers
The
spec
ific
obje
ctive
s of t
he g
uide
lines
are
to
: har
mon
ize th
e us
e of
cer
tain
acc
epte
d an
d im
porta
nt te
rms i
n tra
ditio
nal m
edic
ine;
to
sum
mar
ize ke
y iss
ues f
or d
evel
opin
g m
etho
dolo
gies
for r
esea
rch
and
eval
uatio
n of
tra
ditio
nal m
edic
ine;
and
to im
prov
e th
e qu
ality
an
d va
lue
of re
sear
ch in
trad
ition
al m
edic
ine.
Th
e gu
idel
ines
con
sist
of s
ectio
ns o
n he
rbal
m
edic
ines
, tra
ditio
nal p
roce
dure
-bas
ed th
erap
ies,
clin
ical
rese
arch
, and
rela
ted
issu
es, in
clud
ing
ethi
cs, e
duca
tion
and
train
ing,
as w
ell a
s su
rvei
llanc
e sy
stem
s. A
vaila
ble
in E
nglis
h, F
renc
h an
d Sp
anis
h.
Regu
lar a
nd ti
mel
y upd
ate
is n
eede
d to
mai
ntai
n th
e re
leva
nce
of th
is re
sour
ce.
Reso
urce
cur
rent
ly b
eing
up
date
d.
Prov
ide
appr
opria
te
eval
uatio
n m
etho
ds to
fa
cilit
ate
the
deve
lopm
ent o
f re
gula
tion
and
regi
stra
tion
of
tradi
tiona
l med
icin
e.
29Tools and resources for improving the
quality of health services
Case
stud
y 6: I
ndo-
Swis
s Ayu
rved
a Fo
unda
tion
In 2
009,
Swi
tzer
land
reco
gnize
d tra
ditio
nal a
nd c
ompl
emen
tary
med
icin
e (T
&CM
) in
its p
ublic
hea
lth sy
stem
thro
ugh
a ch
ange
in it
s con
stitu
tion.
Thr
ough
SAM
A’s (S
wiss
Ayu
rved
ic
Med
ical
Aca
dem
y) a
ctive
eng
agem
ent w
ith th
e Sw
iss a
nd In
dian
gov
ernm
ents
, the
Indo
-Swi
ss A
yurv
eda
Foun
datio
n (IS
A), a
non
-for-p
rofit
org
aniza
tion,
was
offi
cial
ly c
reat
ed in
201
3 un
der S
wiss
law.
As a
resu
lt of
the
work
of I
SA, S
witz
erla
nd h
as d
efin
ed th
ree
prof
essi
ons f
or T
&CM
in it
s pub
lic h
ealth
syst
em: (
i) th
e al
lopa
thic
doc
tor w
ith a
com
plem
enta
ry tr
aini
ng in
T&C
M a
nd (
ii)
two
T&CM
pro
fess
ions
with
out p
rior t
rain
ing
in m
edic
ine.
WHO
ben
chm
arks
for t
rain
ing
in A
yurv
eda
defin
e th
e sa
me
thre
e pr
ofes
sion
s as f
ores
een
by th
e Sw
iss r
egul
atio
ns fo
r T&C
M.
The
rele
ase
of W
HO’s
benc
hmar
ks fo
r tra
inin
g in
Ayu
rved
a va
lidat
ed IS
A’s vi
sion
of A
yurv
eda
as a
key p
art o
f the
med
ical
syst
em. S
wiss
aut
horit
ies f
orm
ally
reco
gnize
d Ay
urve
da a
s a
fund
amen
tal t
rain
ing
com
pone
nt fo
r all
thre
e T&
CM-re
late
d pr
ofes
sion
s.
To su
ppor
t im
plem
enta
tion
of A
yurv
eda
into
the
Swis
s hea
lth sy
stem
, a h
igh
stan
dard
trai
ning
pro
gram
me
in A
yurv
eda
med
icin
e, M
edVa
idya
(run
by S
AMA
and
supp
orte
d by
ISA)
was
de
velo
ped.
The
trai
ning
is in
spire
d by
WHO
ben
chm
arks
, Swi
ss re
gula
tions
and
BAM
S co
nten
t (Ba
chel
or o
f Ayu
rved
a M
edic
ine
and
Surg
ery,
Indi
a). T
he o
bjec
tive
of th
e tra
inin
g is
to
train
hig
h-le
vel p
rofe
ssio
nals
to p
ract
ice
Ayur
veda
and
ens
ure
safe
kno
wled
ge tr
ansf
er, a
s wel
l as p
atie
nt sa
fety
. The
WHO
ben
chm
arks
supp
orte
d IS
A in
the
desi
gn o
f the
trai
ning
pr
ogra
mm
e.
Thre
e ke
y les
sons
lear
nt fr
om th
is p
roce
ss in
clud
e:1.
Th
e W
HO b
ench
mar
ks fo
r tra
inin
g in
Ayu
rved
a ha
ve g
iven
the
Swis
s reg
ulat
ory m
odel
for A
yurv
eda
its g
loba
l rel
evan
ce, o
n th
e on
e ha
nd b
y def
inin
g th
e sa
me
thre
e pr
ofes
sion
s fo
r the
dis
cipl
ine
and
on th
e ot
her h
and
by su
ppor
ting
ISA
Foun
datio
n’s vi
sion
of r
espe
ctin
g Ay
urve
da’s
tradi
tiona
l sci
entif
ic re
quire
men
ts a
nd h
igh
prof
essi
onal
stan
dard
s in
the
glob
aliza
tion
proc
ess.
2.
Th
roug
h th
e pr
oces
s of e
ngag
ing
with
the
Swis
s Gov
ernm
ent i
n th
is p
roce
ss, t
he fo
llowi
ng a
reas
of i
mpr
ovem
ent w
ere
note
d fo
r the
Ayu
rved
a gu
idel
ines
:
Mod
ern
teac
hing
met
hodo
logi
es sh
ould
be
intro
duce
d, su
ch a
s int
erac
tive
teac
hing
, gro
up w
ork,
peer
lear
ning
, sup
ervi
sed
pers
onal
trai
ning
out
side
the
clas
sroo
m
E-le
arni
ng a
nd E
-teac
hing
shou
ld b
e co
nsid
ered
as o
ptio
ns fo
r fut
ure
teac
hing
met
hodo
logi
es.
Som
e tra
inin
g co
nten
t is n
o lo
nger
rele
vant
in m
oder
n tim
es fo
r stu
dent
s out
side
Indi
a. S
ome
train
ing
aspe
cts c
an b
e co
nsid
ered
as o
ptio
nal (
redu
ce th
e nu
mbe
r of s
ugge
sted
hou
rs)
like
agad
a ta
ntra
and
rasa
shas
tra.
Improving the quality of
health services: tools and resources30
7. Em
erge
ncy
and
esse
ntia
l su
rger
y
Nam
e of
tool
(yea
r)Ty
pe o
f to
olAu
dien
ce
Sum
mar
y des
crip
tion
Key l
esso
ns
lear
nt
Inte
rlink
ages
wi
th o
ther
are
as
Surg
ical
Car
e Sy
stem
St
reng
then
ing
(201
7)M
anua
l Po
licy-
mak
ers,
gove
rnm
ent
auth
oriti
es,
acad
emic
s and
re
sear
cher
s
This
man
ual p
rovi
des t
he b
asic
s for
dev
elop
ing
a na
tiona
l sur
gica
l, ob
stet
ric a
nd a
naes
thes
ia p
lan.
Incl
uded
are
eig
ht c
ase
stud
ies f
rom
co
untri
es. A
nat
iona
l pla
n wi
ll pr
ovid
e th
e ba
sis f
or b
uild
ing
serv
ice
deliv
ery
capa
city
, incl
udin
g es
tabl
ishi
ng in
form
atio
n m
anag
emen
t with
M&E
.
• Del
ivers
the
build
ing
bloc
ks
for d
evel
opin
g su
rgic
al se
rvic
e de
liver
y• I
mpl
emen
tatio
n is
the
mos
t di
fficu
lt st
ep• H
ealth
Min
istry
bu
y-in
and
le
ader
ship
are
cr
itica
l• A
ll st
akeh
olde
rs’
inpu
t is c
ritic
al
Surg
ical
sub-
spec
ialti
es:
anae
sthe
sia,
obst
etric
s, m
ater
nal a
nd
child
hea
lth,
repr
oduc
tive
heal
th
emer
genc
ies,
nonc
omm
unic
able
di
seas
es, H
IV,
negl
ecte
d tro
pica
l dis
ease
s, m
edic
ines
.
Surg
ical
Site
Infe
ctio
n Gu
idel
ines
(201
7)Gu
idan
cePr
actit
ione
rs,
faci
litie
s,Ch
eckl
ist f
or re
duci
ng su
rgic
al si
te in
fect
ions
to im
prov
e su
rgic
al
outc
omes
.
Patie
nt`s
Com
mun
icat
ion
Tool
fo
r Sur
gica
l Saf
ety (
2015
)Ad
voca
cyPa
tient
s, fa
mili
es
and
care
give
rsTh
is to
ol a
ids p
atie
nt`s
with
a li
st o
f ess
entia
l inf
orm
atio
n th
at th
ey n
eed
to k
now
and
disc
uss w
ith th
eir h
ealth
car
e pr
ovid
er to
ens
ure
safe
r sur
gica
l ca
re b
efor
e an
d af
ter t
he p
roce
dure
.
Surg
ical
Ass
essm
ent
Tool
: fac
ility
and
serv
ice
asse
ssm
ent t
ool, u
sed
for g
ap
anal
ysis
and
bui
ldin
g ca
paci
ty
Guid
ance
Polic
y-m
aker
s, go
vern
men
t au
thor
ities
, ac
adem
ics a
nd
rese
arch
ers
With
out c
ontin
ued
mon
itorin
g an
d ev
alua
tion,
usi
ng re
liabl
e su
rvey
tool
s, th
ere
will
not b
e qu
ality
impr
ovem
ent.
This
tool
pro
vide
s the
mea
ns to
ob
tain
relia
ble
data
from
a fa
cilit
y and
a se
rvic
e de
liver
y per
spec
tive.
Co
mpr
ehen
sive
faci
lity a
nd se
rvic
e de
liver
y ass
essm
ent t
ool o
n su
rgic
al
care
with
sub-
mod
ules
for p
aedi
atric
surg
ery a
nd a
naes
thes
ia c
are.
Re
liabl
e da
ta m
ust b
e av
aila
ble
and
used
to d
rive
stra
tegi
c he
alth
pol
icy.
31Tools and resources for improving the
quality of health services
Case
stud
y 7: S
urgi
cal C
are
Syst
em a
pplic
atio
n in
Zam
bia
In 2
014,
the
Zam
bian
Min
istry
of H
ealth
per
form
ed a
n au
dit r
evea
ling
that
des
pite
sign
ifica
nt im
prov
emen
ts in
man
y hea
lth in
dica
tors
, the
MDG
targ
ets f
or n
eona
tal a
nd m
ater
nal
mor
talit
y wer
e no
t bei
ng m
et. T
here
fore
, a ta
sk fo
rce
was c
reat
ed b
y the
MOH
to id
entif
y som
e of
the
root
cau
ses o
f thi
s gap
. The
prim
ary o
bsta
cle
to a
chie
ving
thes
e ta
rget
s was
a la
ck
of su
rgic
al se
rvic
es, e
spec
ially
the
prov
isio
n of
cae
sare
an se
ctio
ns. F
urth
erm
ore,
a co
untry
-wid
e st
udy r
evea
led
that
74%
of Z
ambi
ans d
id n
ot h
ave
acce
ss to
safe
, tim
ely a
nd a
fford
able
su
rgic
al c
are.
In 2
015,
the
Zam
bian
del
egat
ion
spea
rhea
ded
WHA
reso
lutio
n 68
.15
to d
raw
atte
ntio
n to
the
need
to p
riorit
ize e
mer
genc
y and
ess
entia
l sur
gica
l and
ana
esth
esia
car
e as
par
t of
unive
rsal
hea
lth c
over
age.
Rec
ogni
zing
curre
nt g
aps w
ithin
the
dom
ains
of i
nfra
stru
ctur
e, wo
rkfo
rce,
serv
ice
deliv
ery,
finan
ce, in
form
atio
n m
anag
emen
t, an
d le
ader
ship
and
gov
erna
nce,
the
Zam
bian
Min
istry
of H
ealth
beg
an th
e pr
oces
s of d
evel
opin
g a
Natio
nal S
urgi
cal, O
bste
tric
and
Anae
sthe
sia
Plan
(NSO
AP).
Zam
bia’s
nat
iona
l pla
nnin
g pr
oces
s em
phas
ized
a pr
ovid
er-d
riven
pro
cess
, with
ove
rsig
ht b
y the
Min
istry
of H
ealth
. Thi
s NSO
AP p
roce
ss w
as c
ompo
sed
of th
e fo
llowi
ng p
hase
s:
1.
Base
line
asse
ssm
ent a
nd g
ap a
naly
sis
2.
Stak
ehol
der m
eetin
gs3.
W
ritin
g wo
rksh
op4.
Na
tiona
l Sur
gica
l, Obs
tetri
c an
d An
aest
hesi
a Fo
rum
5.
Cost
ing
work
shop
.In
ear
ly 2
017,
the
NSOA
P wa
s sig
ned
by th
e Za
mbi
an P
erm
anen
t Sec
reta
ry fo
r inc
lusi
on w
ithin
Zam
bia’s
Nat
iona
l Hea
lth S
trate
gic
Plan
for 2
017-
2021
. The
NSO
ASP
incl
udes
a ro
adm
ap
with
con
cret
e m
ilest
ones
and
mon
itorin
g m
echa
nism
s for
surg
ical
scal
e-up
in a
ll cr
itica
l dom
ains
.
8. P
rimary
care
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y le
sson
s le
arnt
Inte
rlink
ages
with
oth
er a
reas
:
Tech
nica
l ser
ies o
n Sa
fer P
rimar
y Car
e (2
016)
Tech
nica
l re
port
Min
istri
es o
f he
alth
, hea
lth c
are
adm
inis
trato
rs
and
regu
lato
rs,
orga
niza
tions
/in
stitu
tions
Thes
e do
cum
ents
des
crib
e th
e sc
ope,
appr
oach
, pot
entia
l so
lutio
ns, p
ract
ical
nex
t ste
ps, a
nd th
en p
rovi
de li
nks t
o on
line
tool
kits
and
man
uals
to p
rovi
de p
ract
ical
sugg
estio
ns
for c
ount
ries a
nd o
rgan
izatio
ns th
at h
ave
com
mitt
ed to
m
akin
g pr
imar
y car
e sa
fer.
Tech
nica
l are
as c
over
ed in
clud
e:
patie
nt e
ngag
emen
t, ed
ucat
ion
and
train
ing,
hum
an fa
ctor
s, ad
min
istra
tive
erro
rs, d
iagn
ostic
erro
rs, m
edic
atio
n er
rors
, mul
ti-m
orbi
dity
, tra
nsiti
ons o
f car
e an
d el
ectro
nic
tool
s.
No le
sson
s le
arnt
as
yet.
Seen
thro
ugh
a PH
C le
ns, t
hese
mon
ogra
phs
addr
ess a
reas
whi
ch w
ould
be
rele
vant
for
vario
us te
chni
cal a
reas
. For
exa
mpl
e, th
e m
onog
raph
on
elec
troni
c to
ols w
ould
be
of in
tere
st to
the
eHea
lth u
nit w
ithin
WHO
he
adqu
arte
rs a
s wel
l as t
he G
uide
lines
Re
view
Com
mitt
ee.
Improving the quality of
health services: tools and resources32
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y le
sson
s le
arnt
Inte
rlink
ages
with
oth
er a
reas
:
Met
hods
and
m
easu
res u
sed
in
prim
ary c
are
patie
nt
safe
ty re
sear
ch:
resu
lts o
f a li
tera
ture
re
view
(200
8)
Rese
arch
Re
sear
cher
s, qu
ality
man
ager
s, cl
inic
ians
This
doc
umen
t loo
ks a
t the
met
hods
use
d to
rese
arch
pat
ient
sa
fety
in p
rimar
y car
e an
d th
e m
etric
s thi
s res
earc
h us
es a
nd
prod
uces
.
No le
sson
s le
arnt
as
yet.
Give
n th
e se
arch
crit
eria
incl
uded
rese
arch
ab
out c
omm
unity
-bas
ed c
ompl
emen
tary
or
alte
rnat
ive m
edic
ine,
it al
so in
form
s co
mm
unity
out
reac
h pr
ogra
mm
es, a
s wel
l as
tradi
tiona
l med
icin
e pr
ogra
mm
es.
9. B
lood
safe
ty
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lean
ed
Inte
rlink
ages
with
ot
her a
reas
:
Aide
-Mem
oire
: Qu
ality
Sys
tem
s for
Bl
ood
Safe
ty
(200
2)
Advo
cacy
Po
licy-
mak
ers,
natio
nal b
lood
pr
ogra
mm
e m
anag
er
An e
ffect
ive q
ualit
y sys
tem
pro
vide
s a fr
amew
ork
with
in w
hich
ac
tiviti
es a
re e
stab
lishe
d, p
erfo
rmed
in a
qua
lity-
focu
sed
way a
nd
cont
inuo
usly
mon
itore
d to
impr
ove
outc
omes
. A q
ualit
y sys
tem
sh
ould
cov
er a
ll as
pect
s of i
ts a
ctiv
ities
and
ens
ure
trace
abili
ty,
from
the
recr
uitm
ent a
nd se
lect
ion
of b
lood
don
ors t
o th
e tra
nsfu
sion
of b
lood
and
blo
od p
rodu
cts t
o pa
tient
s. It
shou
ld
also
refle
ct th
e st
ruct
ure,
need
s and
cap
abili
ties o
f the
blo
od
trans
fusi
on se
rvic
e, as
wel
l as t
he n
eeds
of t
he h
ospi
tals
and
pa
tient
s tha
t it s
erve
s.
1. T
he b
lood
tran
sfus
ion
serv
ice
is a
n im
porta
nt c
ompo
nent
of
a st
rong
hea
lth sy
stem
. A
syst
ems a
ppro
ach
is c
ruci
al
in d
evel
opin
g a
natio
nal b
lood
se
rvic
e to
ens
ure
unive
rsal
ac
cess
to sa
fe a
nd q
ualit
y bl
ood
trans
fusi
on.
Link
s with
nat
iona
l qu
ality
pol
icy a
nd
stra
tegy
, prim
ary
care
and
hos
pita
l m
anag
emen
t
33Tools and resources for improving the
quality of health services
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lean
ed
Inte
rlink
ages
with
ot
her a
reas
:
Qual
ity m
anag
emen
t tra
inin
g fo
r blo
od
trans
fusi
on se
rvic
esFa
cilit
ator
s’ to
olki
t
Trai
ning
m
anua
l and
to
olki
ts
Natio
nal b
lood
pr
ogra
mm
e m
anag
er,
qual
ity
man
ager
of
bloo
d se
rvic
e,
educ
atio
nal
and
train
ing
inst
itute
s, he
alth
wor
kers
Qual
ity M
anag
emen
t Tra
inin
g (Q
MT)
: thi
s fac
ilita
tor’s
tool
kit i
s a
com
preh
ensi
ve se
t of t
each
ing
mat
eria
ls to
supp
ort a
n 18
-day
tra
inin
g co
urse
for q
ualit
y man
ager
s in
bloo
d tra
nsfu
sion
serv
ices
. It
cont
ains
gui
danc
e fo
r QM
T fa
cilit
ator
s, a
cour
se c
urric
ulum
, Po
werP
oint
pre
sent
atio
ns, a
ctiv
ities
, pre
sent
atio
n no
tes,
reso
urce
m
ater
ials
and
glo
ssar
y. Fa
cilit
ator
s are
enc
oura
ged
to a
dd lo
cal
reso
urce
mat
eria
ls, s
uch
as n
atio
nal s
tand
ards
and
exa
mpl
es o
f do
cum
enta
tion.
Par
t 1 o
f the
cou
rse
intro
duce
s gen
eral
con
cept
s of
qua
lity a
nd P
art 2
focu
ses o
n qu
ality
in th
e sp
ecifi
c co
ntex
t of
bloo
d tra
nsfu
sion
, fro
m b
lood
don
or re
crui
tmen
t to
the
trans
fusi
on
of b
lood
and
blo
od p
rodu
cts t
o th
e pa
tient
. The
cou
rse
cons
ists
of
15 m
odul
es c
onta
inin
g 57
pre
sent
atio
ns a
nd 6
9 ac
tiviti
es.
2. A
pre
-requ
isite
to im
plem
ent
a qu
ality
syst
em in
all
the
aspe
cts o
f blo
od tr
ansf
usio
n ch
ain,
from
don
or re
crui
tmen
t to
pat
ient
tran
sfus
ion,
is th
e es
tabl
ishm
ent o
f nat
iona
lly
coor
dina
ted
bloo
d tra
nsfu
sion
se
rvic
es.
3. T
he e
stab
lishm
ent a
nd
mai
nten
ance
of a
n ef
fect
ive
and
sust
aina
ble
qual
ity
man
agem
ent s
yste
m in
blo
od
trans
fusi
on se
rvic
es re
quire
s le
ader
ship
com
mitm
ent,
a st
rong
qua
lity c
ultu
re
and
a su
stai
nabl
e ex
tern
al
asse
ssm
ent p
rogr
amm
e to
dr
ive th
e sy
stem
con
tinua
lly to
im
prov
e.
Link
s with
nat
iona
l qu
ality
pol
icy a
nd
stra
tegy
, prim
ary
care
and
hos
pita
l m
anag
emen
t
Esta
blis
hing
Ext
erna
l Qu
ality
Ass
essm
ent
Prog
ram
mes
fo
r Scr
eeni
ng o
f Do
nate
d Bl
ood
for T
rans
fusi
on-
Tran
smis
sibl
e In
fect
ions
Impl
emen
tatio
n Gu
ide
Guid
ance
Na
tiona
l blo
od
prog
ram
me
man
ager
, qu
ality
m
anag
er o
f bl
ood
serv
ice,
QC p
erso
nnel
An e
xter
nal q
ualit
y ass
essm
ent (
EQA)
is a
n im
porta
nt c
ompo
nent
of
qua
lity s
yste
ms f
or b
lood
tran
sfus
ion
serv
ices
. Est
ablis
hing
ex
tern
al q
ualit
y ass
essm
ent p
rogr
amm
es fo
r the
scre
enin
g of
do
nate
d bl
ood
for t
rans
fusi
on-tr
ansm
issi
ble
infe
ctio
ns (T
TI):
this
impl
emen
tatio
n gu
ide
aim
s to
supp
ort W
HO M
embe
r Sta
tes
in e
stab
lishi
ng a
nd o
pera
ting
EQA
prog
ram
mes
for s
cree
ning
do
nate
d bl
ood
for T
TI. T
he g
uide
has
bee
n de
sign
ed fo
r use
by
natio
nal h
ealth
aut
horit
ies a
nd E
QA o
rgan
izing
inst
itutio
ns in
the
deve
lopm
ent o
f EQA
pro
gram
mes
. It w
ill a
lso
give
par
ticip
atin
g la
bora
torie
s ins
ight
s int
o th
e or
gani
zatio
n of
EQA
pro
gram
mes
fo
r TTI
scre
enin
g an
d an
und
erst
andi
ng o
f the
ben
efits
of
parti
cipa
tion
in th
is.
Link
s with
in vi
tro
diag
nost
ics a
nd
labo
rato
ry te
chno
logy
: ht
tp://
www.
who.
int/
diag
nost
ics_
labo
rato
ry/
en/
Improving the quality of
health services: tools and resources34
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lean
ed
Inte
rlink
ages
with
ot
her a
reas
:
Aide
-Mém
oire
fo
r Min
istry
of
Heal
th: N
atio
nal
Haem
ovig
ilanc
e Sy
stem
Advo
cacy
Polic
y-m
aker
s, na
tiona
l blo
od
prog
ram
me
man
ager
The
orga
niza
tion
of a
hae
mov
igila
nce
syst
em is
larg
ely d
eter
min
ed
by th
e st
ruct
ure
of th
e ex
istin
g na
tiona
l blo
od sy
stem
and
wid
er
heal
th sy
stem
. A sy
stem
of h
aem
ovig
ilanc
e is
dep
ende
nt o
n th
e tra
ceab
ility
of b
lood
and
blo
od p
rodu
cts f
rom
don
ors t
o re
cipi
ents
an
d vi
ce ve
rsa,
and
on th
e m
onito
ring,
repo
rting
, inve
stig
atio
n an
d an
alys
is o
f adv
erse
eve
nts.
The
rigo
rous
man
agem
ent o
f in
form
atio
n ge
nera
ted
thro
ugh
this
syst
em is
key t
o in
trodu
cing
am
endm
ents
in b
lood
pol
icie
s and
gui
delin
es th
at le
ad to
cha
nges
in
pro
cess
es a
nd p
ract
ices
in d
onat
ion
and
trans
fusi
on.
Sam
e le
sson
lear
nt a
s bef
ore
Link
s with
nat
iona
l qu
ality
pol
icy a
nd
stra
tegy
, prim
ary
care
and
hos
pita
l m
anag
emen
t.
A gu
ide
to
esta
blis
hing
a
natio
nal
haem
ovig
ilanc
e sy
stem
Guid
ance
Polic
y-m
aker
s, na
tiona
l blo
od
prog
ram
me
man
ager
, cl
inic
ians
and
tra
nsfu
sion
m
edic
ine
spec
ialis
t
Haem
ovig
ilanc
e in
clud
es th
e m
onito
ring,
repo
rting
, inve
stig
atio
n an
d an
alys
is o
f adv
erse
eve
nts r
elat
ed to
the
dona
tion,
pro
cess
ing
and
trans
fusi
on o
f blo
od, a
nd ta
king
act
ion
to p
reve
nt th
eir
occu
rrenc
e or
recu
rrenc
e. T
his g
uida
nce
aim
s to
supp
ort c
ount
ries
in e
stab
lishi
ng e
ffect
ive n
atio
nal s
yste
ms f
or h
aem
ovig
ilanc
e th
roug
hout
the
trans
fusi
on c
hain
. It p
rovi
des p
olic
y gui
danc
e on
es
tabl
ishi
ng a
hae
mov
igila
nce
syst
em a
s par
t of n
atio
nal b
lood
an
d he
alth
syst
ems,
and
incl
udes
tech
nica
l inf
orm
atio
n an
d gu
idan
ce o
n th
e sp
ecifi
c m
easu
res a
nd a
ctio
ns w
hich
nee
d to
be
take
n to
impl
emen
t a su
cces
sful
hae
mov
igila
nce
syst
em.
Link
s with
repo
rting
fo
r pat
ient
safe
ty:
http
://ww
w.wh
o.in
t/pat
ient
safe
ty/
impl
emen
tatio
n/re
porti
ng_a
nd_le
arni
ng/
en/
35Tools and resources for improving the
quality of health services
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lean
ed
Inte
rlink
ages
with
ot
her a
reas
:
Clin
ical
tran
sfus
ion
proc
ess a
nd p
atie
nt
safe
ty (A
ide-
mém
oire
for N
atio
nal
Heal
th A
utho
ritie
s an
d Ho
spita
l M
anag
emen
t)
Advo
cacy
Polic
y-m
aker
s, na
tiona
l blo
od
prog
ram
me
man
ager
, cl
inic
ians
and
tra
nsfu
sion
m
edic
ine
An a
ppro
pria
te a
nd c
orre
ct c
linic
al tr
ansf
usio
n pr
oces
s ens
ures
pa
tient
safe
ty a
nd c
ontri
bute
s to
impr
oved
hea
lth a
nd su
rviva
l. Ho
weve
r, tra
nsfu
sion
car
ries t
he ri
sk o
f adv
erse
eve
nts i
nclu
ding
er
rors
, tra
nsfu
sion
reac
tions
and
tran
smis
sion
of i
nfec
tions
. Er
rors
dur
ing
the
clin
ical
tran
sfus
ion
proc
ess c
an b
e pr
even
ted
by
the
stre
ngth
enin
g of
hos
pita
l sys
tem
s and
pro
cess
es fo
r clin
ical
tra
nsfu
sion
, the
trai
ning
of h
ospi
tal s
taff
and
the
impl
emen
tatio
n of
stan
dard
ized
proc
edur
es th
roug
hout
the
clin
ical
tran
sfus
ion
proc
ess.
Link
s with
nat
iona
l qu
ality
pol
icy a
nd
stra
tegy
, prim
ary
care
and
hos
pita
l m
anag
emen
t
The
clin
ical
use
of
bloo
d in
obs
tetri
cs,
paed
iatri
cs, s
urge
ry
and
anae
sthe
sia,
traum
a an
d bu
rns
Trai
ning
M
anua
l Na
tiona
l blo
od
prog
ram
me
man
ager
, cl
inic
ians
and
tra
nsfu
sion
m
edic
ine
The
Clin
ical
use
of b
lood
aim
s to
show
how
blo
od a
nd b
lood
pr
oduc
ts c
an b
e us
ed a
ppro
pria
tely
at a
ll le
vels
of t
he h
ealth
ca
re sy
stem
in a
ny c
ount
ry, w
ithou
t com
prom
isin
g st
anda
rds o
f qu
ality
and
safe
ty. I
t pro
vide
s a c
ompr
ehen
sive
gui
de to
the
use
of b
lood
and
blo
od p
rodu
cts a
nd, in
par
ticul
ar, w
ays o
f min
imizi
ng
unne
cess
ary t
rans
fusi
on.
Prim
ary c
are,
hosp
ital
man
agem
ent,
infe
ctio
n pr
even
tion
and
cont
rol
Improving the quality of
health services: tools and resources36
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lean
ed
Inte
rlink
ages
with
ot
her a
reas
:
Glob
al S
tatu
s Rep
ort
on B
lood
Saf
ety a
nd
Avai
labi
lity 2
016
Repo
rtPo
licy-
mak
ers,
natio
nal b
lood
pr
ogra
mm
e m
anag
ers
The
Wor
ld H
ealth
Org
aniza
tion
Glob
al D
atab
ase
on B
lood
Saf
ety
(GDB
S) w
as e
stab
lishe
d in
199
8 to
add
ress
glo
bal c
once
rns a
bout
th
e av
aila
bilit
y, sa
fety
and
acc
essi
bilit
y of b
lood
for t
rans
fusi
on.
The
obje
ctive
of t
his a
ctiv
ity is
to c
olle
ct a
nd a
naly
se d
ata
from
al
l cou
ntrie
s on
bloo
d an
d bl
ood
prod
uct s
afet
y as t
he b
asis
for
effe
ctive
act
ion
to im
prov
e bl
ood
trans
fusi
on se
rvic
es g
loba
lly.
The
2016
repo
rt, w
hich
is b
ased
on
the
late
st G
DBS
data
, pro
vide
s in
form
atio
n on
the
curre
nt st
atus
of b
lood
tran
sfus
ion
serv
ices
.
Link
s with
nat
iona
l qu
ality
pol
icy a
nd
stra
tegy
, prim
ary
care
and
hos
pita
l m
anag
emen
t
Case
stud
y 8: S
treng
then
ing
the
Natio
nal B
lood
Sys
tem
in B
huta
n to
ens
ure
equi
tabl
e ac
cess
to sa
fe b
lood
tran
sfus
ion
In 2
010,
Bhu
tan
beca
me
a be
nefic
iary
of t
he W
HO/O
FID
join
t pro
ject
(pha
se I:
201
0-20
13 a
nd p
hase
II: 2
015-
2017
). Th
e ov
eral
l pro
ject
goa
l has
bee
n to
pre
vent
med
ical
tran
smis
sion
of
infe
ctio
us d
isea
ses s
uch
as H
IV, h
epat
itis B
and
C th
roug
h tra
nsfu
sion
of b
lood
and
its a
ssoc
iate
d pr
oduc
ts. T
hrou
gh th
e pr
ojec
t, su
ppor
t in
polic
y gui
danc
e, ad
voca
cy, t
echn
ical
and
ca
paci
ty-b
uild
ing
were
pro
vide
d by
WHO
. An
adap
ted
vers
ion
of th
e W
HO to
ol w
as u
sed
to id
entif
y exi
stin
g co
nstra
ints
and
gap
s in
natio
nal b
lood
ava
ilabi
lity a
nd sa
fety
. Pro
ject
act
ivity
pl
ans w
ere
deve
lope
d wi
th th
e ob
ject
ives t
o st
anda
rdize
the
bloo
d sc
reen
ing
proc
ess w
ith a
focu
s on
stre
ngth
enin
g la
bora
tory
faci
litie
s, im
plem
entin
g go
od la
bora
tory
pra
ctic
es a
s wel
l as
stre
ngth
enin
g th
e na
tiona
l blo
od sy
stem
to im
prov
e ac
cess
to sa
fe, q
ualit
y and
ade
quat
e bl
ood
supp
lies.
The
key e
lem
ents
are
out
lined
in th
e Ai
de-M
emoi
re o
n Qu
ality
syst
ems a
s bui
ldin
g bl
ocks
to in
itiat
e th
e pr
oces
s of q
ualit
y man
agem
ent.
In 2
013,
the
Natio
nal S
tand
ards
for B
TS
were
dev
elop
ed a
nd la
ter i
ncor
pora
ted
into
the
regu
lato
ry fr
amew
ork
for i
mpr
oved
com
plia
nce.
WHO
tool
s wer
e us
ed a
s ref
eren
ce m
ater
ials
dur
ing
the
cons
ulta
tive
and
draf
ting
stag
es fo
r the
dev
elop
men
t of n
atio
nal g
uide
lines
such
as b
lood
don
or m
otiva
tion
and
recr
uitm
ent s
trate
gies
, blo
od d
onor
ass
essm
ent a
nd se
lect
ion,
qua
lity a
ssur
ed sc
reen
ing
of
trans
fusi
on-tr
ansm
issi
ble
infe
ctio
ns, n
atio
nal e
xter
nal q
ualit
y ass
essm
ent s
chem
es (N
EQAS
) in
bloo
d gr
oup
sero
logy
and
tran
sfus
ion-
trans
mis
sibl
e in
fect
ions
. A
guid
ance
doc
umen
t on
hae
mov
igila
nce
in B
huta
n ha
s now
bee
n pu
blis
hed
and
is in
use
acr
oss t
he c
ount
ry. Q
ualit
y man
agem
ent t
rain
ings
bas
ed o
n W
HO Q
ualit
y Man
agem
ent T
rain
ing
(QM
T) m
odul
es
were
con
duct
ed a
s par
t of c
apac
ity-b
uild
ing
of B
TS p
erso
nnel
and
a c
ore
grou
p of
qua
lity m
anag
ers i
nvol
ved
in w
ritin
g th
e Qu
ality
Man
ual, s
tand
ard
oper
atin
g pr
oced
ures
and
wor
k in
stru
ctio
ns. D
ata
repo
rting
and
info
rmat
ion
man
agem
ent o
n bl
ood
safe
ty h
as b
een
stre
ngth
ened
and
rece
ntly
a st
atus
repo
rt on
blo
od sa
fety
and
ava
ilabi
lity i
n Bh
utan
was
rele
ased
us
ing
findi
ngs o
f the
GDB
S re
port
of 2
016.
The
imm
edia
te im
pact
has
bee
n on
the
gene
ral p
ublic
bei
ng m
ore
awar
e of
the
impo
rtanc
e of
blo
od d
onat
ion,
beh
avio
ur c
hang
e an
d po
sitiv
e re
spon
se o
bser
ved
when
ask
ed to
don
ate
bloo
d vo
lunt
arily
. The
tim
ely a
vaila
bilit
y of b
lood
at t
he g
rass
root
leve
l, has
save
d liv
es o
f man
y Bhu
tane
se, e
spec
ially
pre
vent
ing
mat
erna
l dea
ths d
ue to
blo
od lo
ss, w
ith n
ewbo
rns,
infa
nts a
nd o
ther
chr
onic
ally
ill i
ndiv
idua
ls b
eing
oth
er b
enef
icia
ries.
No
HIV
or h
epat
itis t
rans
mis
sion
thro
ugh
bloo
d ha
s bee
n re
porte
d by
resp
ectiv
e pr
ogra
mm
es. P
erfo
rman
ce o
f bl
ood
bank
s has
esc
alat
ed in
pas
t yea
rs a
nd b
ette
r com
plia
nce
amon
g nu
rses
to u
se S
OPs a
nd re
port
adve
rse
reac
tions
to b
lood
. Ke
y les
sons
lear
nt1.
Bl
ood
syst
em m
ust b
e in
corp
orat
ed in
any
nat
iona
l hea
lth sy
stem
WHO
doc
umen
ts (i
n pa
rticu
lar t
he o
ne-p
age
Aide
Mem
oire
) are
the
appr
opria
te a
dvoc
acy t
ools
for g
aini
ng
polit
ical
com
mitm
ent a
nd su
ppor
t. 2.
A
syst
em a
ppro
ach
and
the
impl
emen
tatio
n of
a c
ompr
ehen
sive
stra
tegi
c pl
an is
cru
cial
for a
chie
ving
pro
visi
on o
f tim
ely a
nd u
nive
rsal
acc
ess t
o sa
fe a
nd q
ualit
y blo
od
trans
fusi
on se
rvic
es a
nd p
rodu
cts.
3.
Perfo
rman
ce o
f nat
iona
l blo
od se
rvic
e ca
n be
ben
chm
arke
d an
d co
ntin
ually
impr
oved
thro
ugh
the
repo
rting
and
ana
lysi
s of g
loba
l/reg
iona
l KPI
s of d
ata.
4.
Futu
re su
ppor
t sho
uld
be o
n es
tabl
ishi
ng p
rogr
amm
e an
d ca
paci
ty fo
r the
sele
ctio
n of
in-v
itro
diag
nost
ic k
its fo
r blo
od sc
reen
ing,
pro
mot
ing
evi
denc
e-ba
sed
clin
ical
tran
sfus
ion
prac
tices
and
impl
emen
ting
patie
nt b
lood
man
agem
ent g
uide
lines
.
37Tools and resources for improving the
quality of health services
10. In
fect
ion p
reven
tion a
nd
contro
l
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
WHO
gui
delin
es o
n co
re c
ompo
nent
s fo
r IPC
(2
016)
Guid
elin
ePo
licy-
mak
ers
(nat
iona
l lev
el)
and
faci
lity l
evel
ad
min
istra
tors
(fa
cilit
y lev
el)
The
guid
elin
es su
mm
arize
eig
ht fa
cilit
y-le
vel
and
six n
atio
nal-l
evel
reco
mm
enda
tions
on
IPC,
add
ress
ing
prog
ram
mes
, gui
delin
es,
educ
atio
n an
d tra
inin
g, su
rvei
llanc
e, m
ultim
odal
stra
tegi
es, m
onito
ring,
aud
it an
d fe
edba
ck, a
n en
ablin
g en
viro
nmen
t in
clud
ing
work
load
, sta
ffing
and
bed
oc
cupa
ncy a
nd th
e bu
ilt e
nviro
nmen
t, m
ater
ials
and
equ
ipm
ent.
For m
ore
info
rmat
ion:
http
://ww
w.wh
o.in
t/inf
ectio
n-pr
even
tion/
publ
icat
ions
/cor
e-co
mpo
nent
s/en
/
The
guid
elin
es a
re b
eing
use
d in
a n
umbe
r of c
ount
ries t
o dr
ive n
atio
nal a
nd fa
cilit
y lev
el
impr
ovem
ent i
n IP
C, su
ppor
ted
by re
leva
nt a
sses
smen
t too
ls.
In so
me
regi
ons t
he g
uide
lines
an
d as
soci
ated
ass
essm
ent a
nd
impl
emen
tatio
n to
ols a
re se
rvin
g as
the
foun
datio
n fo
r nat
iona
l IPC
gu
idel
ines
and
/or b
eing
pos
ition
ed
as p
art o
f the
AM
R ag
enda
.
Wat
er, s
anita
tion
and
hygi
ene
(WAS
H), q
ualit
y, pa
tient
safe
ty, a
ntim
icro
bial
st
ewar
dshi
p ac
cred
itatio
n/re
gula
tion,
pub
lic h
ealth
/di
seas
e co
ntro
l, occ
upat
iona
l he
alth
WHO
Cor
e co
mpo
nent
s nat
iona
l im
plem
enta
tion
m
anua
l (2
017)
Impl
emen
tatio
n m
anua
lPo
licy-
mak
ers
and
impl
emen
ters
re
spon
sibl
e fo
r IPC
(in
clud
ing
IHR)
and
AM
R
This
pra
ctic
al m
anua
l is d
esig
ned
to su
ppor
t im
plem
enta
tion
of th
e W
HO G
uide
lines
on
core
com
pone
nts o
f inf
ectio
n pr
even
tion
and
cont
rol p
rogr
amm
es a
t the
nat
iona
l le
vel, w
ith sp
ecia
l foc
us o
n co
untri
es w
ith
limite
d re
sour
ces.
Thi
s pra
ctic
al m
anua
l ou
tline
s how
to d
o th
is, t
hat i
s, ho
w to
im
plem
ent t
he G
uide
lines
. It f
ocus
es o
n th
e de
velo
pmen
t of a
sust
aina
ble
actio
n pl
an
info
rmed
by t
he lo
cal c
onte
xt to
put
into
op
erat
ion
the
Guid
elin
e re
com
men
datio
ns.
For m
ore
info
rmat
ion:
ht
tp://
www.
who.
int/i
nfec
tion-
prev
entio
n/to
ols/
core
-com
pone
nts/
en/
Thi
s man
ual o
utlin
es fi
ve st
eps
for i
mpl
emen
ting
IPC
prog
ram
mes
to
max
imize
the
likel
ihoo
d of
su
cces
s and
ove
rcom
e so
me
of
the
com
plex
ity in
the
proc
ess.
Th
e em
phas
is w
ithin
eac
h st
ep
is o
n lo
cal a
dapt
atio
n. H
owev
er,
depe
ndin
g on
the
loca
l situ
atio
n,
som
e st
eps m
ay a
lread
y hav
e be
en a
chie
ved,
whi
le o
ther
s may
ne
ed g
radu
al d
evel
opm
ent o
r to
be re
visi
ted
as n
ew c
halle
nges
or
chan
ges w
ithin
the
heal
th c
are
syst
em a
rise.
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
Improving the quality of
health services: tools and resources38
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
WHO
Cor
e co
mpo
nent
s nat
iona
l as
sess
men
t too
l (IP
CAT2
) (2
017)
Asse
ssm
ent t
ool
Polic
y-m
aker
s an
d im
plem
ente
rs
resp
onsi
ble
for I
PC
(incl
udin
g IH
R) a
nd
AMR
IPCA
T2 w
ill a
ssis
t cou
ntrie
s to
dete
rmin
e th
e co
re c
ompo
nent
s alre
ady i
n pl
ace,
that
is, n
atio
nal e
xist
ing
stre
ngth
s, an
d to
iden
tify g
aps o
r wea
knes
ses t
o gu
ide
actio
n pl
anni
ng. I
PCAT
2 co
rresp
onds
to
the
six c
ore
com
pone
nt re
com
men
datio
ns
of th
e gu
idel
ines
targ
eted
at t
he n
atio
nal
leve
l. Fo
r mor
e in
form
atio
n: h
ttp://
www.
who.
int/i
nfec
tion-
prev
entio
n/to
ols/
core
-co
mpo
nent
s/en
/
It is
very
impo
rtant
to u
nder
stan
d th
at IP
CAT2
is n
ot in
tend
ed to
be
used
as a
n au
dit t
ool.
Its p
urpo
se
is to
hel
p as
sess
, pla
n, o
rgan
ize
and
impl
emen
t a n
atio
nal I
PC
prog
ram
me.
The
tool
pro
vide
s a
gene
ral o
verv
iew
of th
e st
atus
of
IPC
activ
ities
acc
ordi
ng to
the
guid
elin
e re
com
men
datio
ns, r
athe
r th
an fo
cusi
ng o
n sp
ecifi
c IP
C pr
actic
es/ri
sk fa
ctor
s rel
ated
to
indi
vidu
al p
atie
nts.
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
WHO
Cor
e co
mpo
nent
s he
alth
car
e fa
cilit
y im
plem
enta
tion
man
ual (
2018
)
Impl
emen
tatio
n m
anua
lIP
C le
ads/
foca
l pe
rson
s and
team
s in
acu
te h
ealth
car
e fa
cilit
ies r
espo
nsib
le
for i
mpl
emen
ting
IPC,
incl
udin
g he
alth
car
e fa
cilit
y m
anag
ers
This
man
ual o
ffers
pra
ctic
al g
uida
nce,
tips,
reso
urce
s and
exa
mpl
es fr
om a
roun
d th
e wo
rld to
supp
ort g
uide
line
impl
emen
tatio
n. It
als
o fo
cuse
s on
the
deve
lopm
ent o
f a su
stai
nabl
e ac
tion
plan
that
shou
ld b
e in
form
ed b
y the
loca
l co
ntex
t to
put i
nto
oper
atio
n th
e gu
idel
ine
reco
mm
enda
tions
. Fin
ally,
the
man
ual
focu
ses o
n in
tegr
atin
g an
d em
bedd
ing
IPC
with
in th
e da
y-to
-day
stru
ctur
e an
d ac
tiviti
es o
f a h
ealth
car
e fa
cilit
y. Fo
r mor
e in
form
atio
n: h
ttp://
www.
who.
int/i
nfec
tion-
prev
entio
n/to
ols/
core
-com
pone
nts/
en/
Only
rece
ntly
laun
ched
. No
less
ons
lear
nt a
s yet
. W
ASH,
qua
lity,
patie
nt sa
fety
, an
timic
robi
al st
ewar
dshi
p ac
cred
itatio
n/re
gula
tion,
pu
blic
hea
lth/d
isea
se c
ontro
l, oc
cupa
tiona
l hea
lth.
WHO
Cor
e co
mpo
nent
s he
alth
car
e fa
cilit
y as
sess
men
t fra
mew
ork
(IPCA
F)
(201
8)
Asse
ssm
ent t
ool
IPC
lead
s/fo
cal
pers
ons a
nd te
ams
in a
cute
hea
lth c
are
faci
litie
s res
pons
ible
fo
r im
plem
entin
g IP
C, in
clud
ing
heal
th c
are
faci
lity
man
ager
s
The
IPCA
F is
a st
ruct
ured
, clo
sed-
form
atte
d qu
estio
nnai
re w
ith a
n as
soci
ated
scor
ing
syst
em. I
t is p
rimar
ily in
tend
ed to
be
self-
adm
inis
tere
d bu
t it c
an a
lso
be u
sed
for
join
t ass
essm
ents
with
ext
erna
l ass
esso
rs
(for e
xam
ple,
from
the
min
istry
of h
ealth
, W
HO o
r oth
er st
akeh
olde
rs) a
nd fa
cilit
y st
aff.
For m
ore
info
rmat
ion:
http
://ww
w.wh
o.in
t/inf
ectio
n-pr
even
tion/
tool
s/co
re-
com
pone
nts/
en/
Only
rece
ntly
laun
ched
. No
less
ons
lear
nt a
s yet
.W
ASH,
qua
lity,
patie
nt sa
fety
, an
timic
robi
al st
ewar
dshi
p ac
cred
itatio
n/re
gula
tion,
pu
blic
hea
lth/d
isea
se c
ontro
l, oc
cupa
tiona
l hea
lth.
39Tools and resources for improving the
quality of health services
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
WHO
gui
delin
es o
n th
e pr
even
tion
of
surg
ical
site
infe
ctio
n (2
016)
Guid
elin
eSu
rgic
al te
ams,
(sur
geon
s, nu
rses
, te
chni
cal s
uppo
rt st
aff,
anae
sthe
tists
) an
d an
y pr
ofes
sion
als d
irect
ly
prov
idin
g su
rgic
al
care
The
aim
of t
hese
gui
delin
es is
to p
rovi
de
a co
mpr
ehen
sive
rang
e of
evi
denc
e-ba
sed
reco
mm
enda
tions
for i
nter
vent
ions
to
be a
pplie
d du
ring
the
pre-
, intra
- and
po
stop
erat
ive p
erio
ds, f
or th
e pr
even
tion
of S
SI, w
hile
als
o co
nsid
erin
g, a
spec
ts
rela
ted
to re
sour
ce a
vaila
bilit
y and
valu
es
and
pref
eren
ces.
For
mor
e in
form
atio
n:
http
://ww
w.wh
o.in
t/inf
ectio
n-pr
even
tion/
publ
icat
ions
/ssi
-gui
delin
es/e
n/
Thes
e gu
idel
ines
hav
e ga
ined
at
tent
ion
in a
rang
e of
setti
ngs
sinc
e th
eir l
aunc
h, in
clud
ing
thro
ugh
lette
rs a
nd re
spon
ses
with
in sc
ient
ific
jour
nals
, and
are
al
read
y inf
orm
ing
an im
prov
emen
t to
ol k
it.
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
WHO
gui
delin
es
on h
and
hygi
ene
in
heal
th c
are
(200
9)
Guid
elin
ePo
licy-
mak
ers
and
impl
emen
ters
re
spon
sibl
e fo
r IP
C (in
clud
ing
Inte
rnat
iona
l Hea
lth
Regu
latio
ns (I
HR))
and
Antim
icro
bial
Re
sist
ance
(AM
R),
IPC
lead
s/fo
cal
pers
ons a
nd te
ams
in a
cute
hea
lth c
are
faci
litie
s res
pons
ible
fo
r im
plem
entin
g IP
C, in
clud
ing
heal
th c
are
faci
lity
man
ager
s
Guid
elin
es o
n ha
nd h
ygie
ne in
hea
lth
care
with
a re
view
of t
he e
vide
nce
on
hand
hyg
iene
in h
ealth
car
e an
d sp
ecifi
c re
com
men
datio
ns to
impr
ove
prac
tices
an
d re
duce
tran
smis
sion
of p
atho
geni
c m
icro
orga
nism
s to
patie
nts a
nd H
CWs.
The
gu
idel
ines
are
to b
e im
plem
ente
d in
any
si
tuat
ion
in w
hich
hea
lth c
are
is d
elive
red
eith
er to
a p
atie
nt o
r to
a sp
ecifi
c gr
oup
in a
pop
ulat
ion.
For
mor
e in
form
atio
n,
http
://ww
w.wh
o.in
t/inf
ectio
n-pr
even
tion/
publ
icat
ions
/han
d-hy
gien
e-20
09/e
n/
The
guid
elin
es h
ave
drive
n aw
aren
ess a
nd a
ctio
n si
nce
thei
r la
unch
in 2
009
and
have
bee
n th
e im
petu
s for
com
mitm
ent b
y co
untri
es (i
nclu
ding
num
erou
s m
inis
teria
l ple
dges
) and
hea
lth
faci
litie
s (in
clud
ing
regi
stra
tion
for
WHO
’s ha
nd h
ygie
ne c
ampa
ign)
, le
adin
g to
use
of t
he W
HO
impr
ovem
ent s
trate
gy/to
olki
t.
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
Improving the quality of
health services: tools and resources40
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
WHO
han
d hy
gien
e se
lf-as
sess
men
t fra
mew
ork
(HHS
AF)
(201
0)
Asse
ssm
ent t
ool
Polic
y-m
aker
s an
d im
plem
ente
rs
resp
onsi
ble
for I
PC
(incl
udin
g IH
R) a
nd
AMR,
IPC
lead
s/fo
cal
pers
ons a
nd te
ams
in a
cute
hea
lth c
are
faci
litie
s res
pons
ible
fo
r im
plem
entin
g IP
C, in
clud
ing
heal
th c
are
faci
lity
man
ager
s
A sy
stem
atic
tool
with
whi
ch to
obt
ain
a si
tuat
ion
anal
ysis
of h
and
hygi
ene
prom
otio
n an
d pr
actic
es w
ithin
an
indi
vidu
al
heal
th c
are
faci
lity.
For m
ore
info
rmat
ion:
ht
tp://
www.
who.
int/g
psc/
coun
try_w
ork/
hhsa
_fra
mew
ork_
Octo
ber_
2010
?ua=
1
This
tool
is u
sed
wide
ly in
man
y co
untri
es a
s dem
onst
rate
d th
roug
h tw
o W
HO g
loba
l sur
vey r
epor
ts
and
form
s par
t of a
hos
pita
l ex
celle
nce
awar
d in
four
WHO
re
gion
s. It
has
bee
n ad
opte
d by
m
any o
rgan
izatio
ns in
clud
ing
thos
e fo
cuse
d on
qua
lity a
nd sa
fety
, to
prom
ote
impr
ovem
ent i
n he
alth
fa
cilit
ies.
For
mor
e in
form
atio
n on
the
surv
ey re
port,
visi
t: ht
tp://
www.
who.
int/i
nfec
tion-
prev
entio
n/pu
blic
atio
ns/re
late
d-do
cum
ents
/en
/),
Addi
tiona
l les
sons
lear
nt a
re
capt
ured
in:
Alle
gran
zi B,
Con
way
L, La
rson
E e
t al.
Stat
us o
f the
im
plem
enta
tion
of th
e W
orld
Hea
lth
Orga
niza
tion
mul
timod
al h
and
hygi
ene
stra
tegy
in U
nite
d St
ates
of
Am
eric
a he
alth
car
e fa
cilit
ies.
Am
eric
an J
ourn
al o
f Inf
ectio
n Co
ntro
l 201
4; 4
2(3)
: 224
-230
ht
tps:
//www
.ncb
i.nlm
.nih
.gov
/pu
bmed
/245
8101
1?do
pt=A
bstra
ct
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
41
Nam
e of
tool
(yea
r)Ty
pe o
f too
lAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
WHO
han
d hy
gien
e gu
ide
to
impl
emen
tatio
n an
d as
soci
ated
reso
urce
s
Impl
emen
tatio
n m
anua
l and
as
soci
ated
re
sour
ces
Polic
y-m
aker
s an
d im
plem
ente
rs
resp
onsi
ble
for I
PC
(incl
udin
g IH
R) a
nd
AMR,
IPC
lead
s/fo
cal
pers
ons a
nd te
ams
in a
cute
hea
lth c
are
faci
litie
s res
pons
ible
fo
r im
plem
entin
g IP
C, in
clud
ing
heal
th c
are
faci
lity
man
ager
s
A su
ite o
f too
ls fo
r im
plem
entin
g W
HO
guid
ance
on
hand
hyg
iene
. For
mor
e in
form
atio
n: h
ttp://
www.
who.
int/i
nfec
tion-
prev
entio
n/to
ols/
hand
-hyg
iene
/en/
The
focu
s of a
num
ber o
f sci
entif
ic
publ
icat
ions
, the
mul
timod
al
impr
ovem
ent t
oolk
it is
wid
ely u
sed
in m
ost c
ount
ries a
roun
d th
e wo
rld.
WHO
web
stat
istic
s als
o co
nfirm
th
e po
pula
rity o
f man
y of t
he to
ols,
espe
cial
ly a
s the
y are
targ
eted
at
both
hig
h- a
nd lo
w-m
iddl
e in
com
e co
untri
es. A
key p
ublic
atio
n su
mm
arize
s the
impr
ovem
ent
stra
tegy
’s su
cces
s whi
ch th
eref
ore
refle
cts t
he u
sefu
lnes
s of t
he
tool
kit.
http
s://w
ww.b
mj.c
om/
cont
ent/3
51/b
mj.h
3728
/
WAS
H, q
ualit
y, pa
tient
safe
ty,
antim
icro
bial
stew
ards
hip
accr
edita
tion/
regu
latio
n,
publ
ic h
ealth
/dis
ease
con
trol,
occu
patio
nal h
ealth
.
WHO
gui
delin
es
for t
he p
reve
ntio
n an
d co
ntro
l of
carb
apen
em-re
sist
ant
Ente
roba
cter
iace
ae,
Acin
etob
acte
r ba
uman
nii a
nd
Pseu
dom
onas
ae
rugi
nosa
in h
ealth
ca
re fa
cilit
ies
(201
7)
Guid
elin
eIP
C le
ads/
foca
l pe
rson
s and
team
sPr
ovid
es e
vide
nce-
base
d re
com
men
datio
ns
on th
e ea
rly re
cogn
ition
and
spec
ific
requ
ired
IPC
prac
tices
and
pro
cedu
res t
o ef
fect
ively
pre
vent
the
occu
rrenc
e an
d co
ntro
l the
spre
ad o
f CRE
-CRA
B-CR
PsA
colo
niza
tion
and/
or in
fect
ion
in a
cute
he
alth
car
e fa
cilit
ies.
An
evid
ence
-bas
ed
fram
ewor
k to
hel
p in
form
the
deve
lopm
ent
and/
or st
reng
then
ing
of n
atio
nal a
nd
faci
lity I
PC p
olic
ies a
nd p
rogr
amm
es to
co
ntro
l the
tran
smis
sion
of C
RE-C
RAB-
CRPs
A in
a va
riety
of h
ealth
car
e se
tting
s is
als
o pr
esen
ted.
For
mor
e in
form
atio
n:
http
://ww
w.wh
o.in
t/inf
ectio
n-pr
even
tion/
publ
icat
ions
/gui
delin
es-c
re/e
n/
Man
y cou
ntrie
s hav
e de
velo
ped
natio
nal i
mpl
emen
tatio
n st
rate
gies
or
faci
lity l
evel
impl
emen
tatio
n to
ols b
ut th
ere
is a
nee
d fo
r WHO
to
crea
te a
n in
vent
ory o
f the
se to
ols
(on
prog
ress
as o
f Jun
e 20
18) a
nd
then
to id
entif
y and
dev
elop
whi
ch
WHO
tool
s are
nec
essa
ry to
supp
ort
impl
emen
tatio
n.
Antim
icro
bial
resi
stan
ce,
WAS
H.
Tools and resources for improving the
quality of health services
Improving the quality of
health services: tools and resources42
Case
stud
y 9: N
atio
nal I
PC p
rogr
amm
e im
plem
enta
tion
in Q
atar
The
natio
nal I
PC p
rogr
amm
e in
Qat
ar w
ent t
hrou
gh a
n ex
tern
al c
onsu
ltatio
n us
ing
the
WHO
cor
e co
mpo
nent
s nat
iona
l im
plem
enta
tion
man
ual a
nd a
ssoc
iate
d na
tiona
l ass
essm
ent
tool
(IPC
AT2)
. Thi
s was
don
e as
par
t of t
he J
oint
Pro
gram
Pla
nnin
g/Re
view
Mis
sion
(JPR
M) a
nd th
e Co
untry
Coo
pera
tion
Stra
tegy
for E
MRO
and
the
Stat
e of
Qat
ar. T
he m
ain
aim
of
this
mis
sion
was
to a
sses
s the
nat
iona
l IPC
pro
gram
me
agai
nst t
he W
HO st
anda
rd a
nd in
doi
ng so
, to
prov
ide
evid
ence
-bas
ed g
uida
nce
(incl
udin
g pr
iorit
izatio
n an
d to
ols)
for s
tepw
ise
impl
emen
tatio
n of
the
core
com
pone
nts o
f IPC
pro
gram
mes
that
are
requ
ired
to b
e in
pla
ce a
t the
nat
iona
l lev
el.
The
Min
istry
of P
ublic
Hea
lth (M
OPH)
of Q
atar
use
d th
e IP
CAT2
to se
lf-as
sess
the
stat
us o
f the
ir na
tiona
l IPC
pro
gram
me
agai
nst t
he si
x cor
e co
mpo
nent
s to
iden
tifyi
ng th
e le
vel o
f pr
ogre
ss a
nd st
reng
ths a
nd w
eakn
esse
s. T
hese
resu
lts w
ere
then
use
d in
con
junc
tion
with
the
man
ual (
whic
h ou
tline
s the
‘how
’ of i
mpl
emen
tatio
n) to
dev
elop
a st
epwi
se, s
usta
inab
le
actio
n pl
an a
imed
at a
chie
ving
ove
rall
com
plia
nce
with
the
requ
irem
ents
out
lined
in th
e W
HO c
ore
com
pone
nts g
uide
lines
. Det
aile
d te
chni
cal f
indi
ngs a
re n
ot re
porte
d he
re b
ut th
e ov
eral
l lev
el o
f com
plia
nce
varie
d wi
dely
acr
oss t
he si
x cor
e co
mpo
nent
s and
the
resu
lts w
ere
usef
ul in
hel
ping
to p
riorit
ize in
whi
ch a
reas
(cor
e co
mpo
nent
) act
ion
was m
ost n
eede
d.
This
wor
k al
so h
ighl
ight
ed th
e ne
cess
ity o
f im
prov
ing
both
inte
rlink
ages
bet
ween
the
IPC
prog
ram
me
and
othe
r pro
gram
mes
, and
com
mun
icat
ion/
colla
bora
tion
betw
een
the
MoH
and
ot
her k
ey st
akeh
olde
rs. T
he e
xerc
ise
resu
lted
in a
n im
prov
ed c
larif
icat
ion
of ro
les a
nd re
spon
sibi
litie
s acr
oss d
epar
tmen
ts a
s the
y rel
ate
to sp
ecifi
c ac
tiviti
es su
ch a
s out
brea
ks a
nd
data
repo
rting
.
Mai
n le
sson
s lea
rnt
• Th
e co
mbi
natio
n of
an
inte
r-rel
ated
ass
essm
ent t
ool (
IPCA
T2),
“how
to d
o” m
anua
l (na
tiona
l lev
el IP
C m
anua
l) an
d no
rmat
ive g
uida
nce
(IPC
core
com
pone
nts)
pro
vide
s a st
rong
ba
sis f
or a
sses
sing
the
stat
us o
f nat
iona
l IPC
pro
gram
mes
and
mak
ing
deta
iled
and
real
istic
pla
ns.
• Th
e to
ols a
re st
rong
eno
ugh
to g
ener
ate
impr
ovem
ent p
lans
eve
n wi
th se
lf-as
sess
men
t is u
sed.
• It
is n
eces
sary
to in
ter-r
elat
e na
tiona
l IPC
pro
gram
mes
with
oth
er h
ealth
inte
rven
tion
prog
ram
mes
, and
acr
oss s
take
hold
ers,
to e
nsur
e su
cces
s. H
ow th
is is
ach
ieve
d wi
ll va
ry
acro
ss c
ount
ries,
but i
t alw
ays r
equi
res d
ialo
gue
acro
ss st
akeh
olde
rs.
43
11. Pe
ople
-cen
tre
d ca
re
Nam
e of
tool
(yea
r)Ty
pe o
f to
olAu
dien
ceSu
mm
ary d
escr
iptio
nKe
y le
sson
s le
arnt
Inte
rlink
ages
wi
th o
ther
ar
eas
Cont
inui
ty a
nd c
oord
inat
ion
of c
are.
A p
ract
ice
brie
f to
supp
ort i
mpl
emen
tatio
n of
the
WHO
Fra
mew
ork
on in
tegr
ated
pe
ople
-cen
tred
heal
th se
rvic
es
(201
8)
Prac
tice
brie
fHe
alth
m
anag
ers a
nd
prac
titio
ners
This
pra
ctic
e br
ief o
n th
e co
ntin
uity
and
coo
rdin
atio
n of
car
e ad
dres
ses t
he c
ondi
tions
an
d on
goin
g re
latio
nshi
ps n
eede
d to
supp
ort s
eam
less
inte
ract
ions
am
ong
mul
tiple
pr
ovid
ers w
ithin
inte
rdis
cipl
inar
y tea
ms a
nd/o
r acr
oss c
are
setti
ngs a
nd/o
r sec
tors
. It
is p
art o
f a su
ite o
f WHO
reso
urce
s to
supp
ort i
mpl
emen
tatio
n of
the
Fram
ewor
k on
in
tegr
ated
peo
ple-
cent
red
heal
th se
rvic
es (I
PCHS
). It
high
light
s the
bro
ad a
nd o
verla
ppin
g na
ture
of t
he tw
o in
terre
late
d co
ncep
ts, c
ontin
uity
and
coo
rdin
atio
n, th
at c
an im
prov
e th
e ex
perie
nce
of p
eopl
e wi
th c
hron
ic c
are
and
supp
ort n
eeds
, enh
ance
the
prov
ider
ex
perie
nce,
impr
ove
heal
th o
utco
mes
and
incr
ease
hea
lth sy
stem
per
form
ance
. It p
rovi
des
a ta
xono
my a
nd p
riorit
y pra
ctic
e in
terv
entio
ns fo
r hea
lth m
anag
ers a
nd p
ract
ition
ers,
with
a fo
cus o
n pr
actic
al a
ctio
ns th
at c
an su
ppor
t im
plem
enta
tion
of th
ese
prac
tices
. M
oreo
ver,
it in
clud
es th
irty g
loba
l pra
ctic
e ex
ampl
es th
at h
ave
show
n im
pact
at t
he m
icro
, m
eso
and/
or m
acro
leve
l. Fo
r mor
e in
form
atio
n: h
ttp://
apps
.who
.int/i
ris/b
itstre
am/h
and
le/1
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lear
nt a
s ye
t.
Parti
cipa
tory
As
sess
men
t an
d Pl
anni
ng
(PAP
) Too
lkit.
12. Pa
llia
tiv
e Ca
re
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
Man
uals
/pub
licat
ion
on
palli
ative
car
e (p
aedi
atric
, hu
man
itaria
n cr
isis
and
prim
ary
heal
th c
are)
(2
018)
Guid
ance
Pa
lliat
ive c
are
acto
rs a
t nat
iona
l le
vel
Thre
e to
ols t
o fa
cilit
ate
the
impl
emen
tatio
n of
pa
edia
tric
palli
ative
car
e, pa
lliat
ive c
are
in th
e co
ntex
t of
hum
anita
rian
cris
is a
nd in
prim
ary h
ealth
car
e.
No le
sson
s lea
rnt a
s yet
.Th
e do
cum
ents
are
rela
ted
to
a nu
mbe
r of a
reas
incl
udin
g em
erge
ncy s
ettin
gs a
nd
prim
ary h
ealth
car
e.
Tools and resources for improving the
quality of health services
Improving the quality of
health services: tools and resources44
Nam
e of
tool
Type
of
tool
Audi
ence
Su
mm
ary d
escr
iptio
nKe
y les
sons
lear
ntIn
terli
nkag
es w
ith o
ther
ar
eas
Man
ual o
n pl
anni
ng a
nd
impl
emen
ting
palli
ative
car
e se
rvic
es: a
gui
de fo
r pro
gram
me
man
ager
s (2
018)
Guid
ance
Palli
ative
car
e ac
tors
at n
atio
nal
leve
l
A to
ol to
faci
litat
e th
e im
plem
enta
tion
of p
allia
tive
care
. Fo
r mor
e in
form
atio
n, vi
sit:
http
://ap
ps.w
ho.in
t/iris
/bit-
stre
am/h
andl
e/10
665/
2505
84/9
7892
4156
5417
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;-js
essi
onid
=B03
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297C
6?se
-qu
ence
=1
Cont
ribut
e to
hea
lth sy
stem
st
reng
then
ing
stra
tegi
es a
nd
to U
HC
Polic
y brie
fs o
n pa
lliat
ive c
are
(201
8)Ad
voca
cy
Polic
y-m
aker
s Th
e po
licy b
riefs
hig
hlig
ht p
ract
ical
exa
mpl
es o
f cou
ntry
st
rate
gies
on
palli
ative
, as w
ell a
s the
ir re
sulti
ng im
pact
.In
clus
ion
of c
ivil
soci
ety
from
low-
and-
mid
dle
inco
me
coun
tries
to
empo
wer p
eopl
e in
ad
voca
cy a
nd p
olic
y-m
akin
g fo
r pal
liativ
e ca
re.
Natio
nal q
ualit
y pol
icy a
nd
stra
tegy
45Quality improvement resources in development
Part II. Technical area Tools and resources in development: structure
Name of tool Type of tool Audience Summary description Interlinkages with other areas
1. Cross-cutting tools and resources
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
Global Efforts Measuring Quality of Care(GEMQoC) (2018)
Technical report
Policy-makers and academic researchers
The report provides a compendium of resources for countries working to improve the quality of health services, based on evidence and objective analysis. This report classified 29 efforts according to the types of resources, domains of health care performance, foundation of quality and health care needs.
The technical report presents 29 existing global efforts to measure quality of care or quality related health systems components. http://www.who.int/servicedeliverysafety/measurement/en
Towards a common mapping tool for measurement in health service delivery (2018)
Conceptual framework
Policy-makers, academic/researchers and technical partners
This conceptual framework has been developed to meet the global gap that currently exists on service delivery measurement and associated quality. The concept note presents a mapping tool for health service delivery measurement, lists pre-existing monitoring and evaluation, and a plan for analysing the gap and capacity-building in measurement.
The document links with various aspects of service delivery and safety.http://www.who.int/servicedeliverysafety/measurement/en
Quality improvement
resources in development
Improving the quality of
health services: tools and resources46
Name of tool Type of tool Audience Summary description Interlinkages with other areas
Evidence brief for policy on innovation in healthcare
Technical report
Policy-makers The current situation regarding technological and social innovations in health care. Formulation of policy options to have an integrated, people-centred approach to innovation in health care. For more information visit: http://www.who.int/servicedeliverysafety/en/
Innovation is a cross-cutting endeavour within service delivery. Innovative approaches need to be assessed to understand the drivers or barriers for successful uptake in multiple contexts.
Evidence brief for policy on engagement (2019)
Technical report
Policy-makers A look at the current situation of engagement from citizens, patients, families to the wider community. Documents different models and drivers of engagement. Formulation of policy options to have a systematic way of build better engagement.
Engagement is a cross-cutting endeavour within service delivery and key driver of UHC. Engagement strategies and practices need to be assessed to understand the drivers or barriers for successful uptake in multiple contexts.
2. Community engagement
Name of tool Type of tool Audience Summary description Interlinkages with other areas:
A suite of programme-specific and generic tools and resources are being developed to adapt and apply the CEQ framework.
Implementation package
Administrators, front-line staff, programme and health facility managers, policy-makers, researchers
The CEQ implementation package will help countries, researchers and partners wishing to improve the quality of engagement between health service providers and service users. It will contain a.) programme-specific and generic assessment tools and interventions to ready and prepare services and programmes to engage; b.) a menu of engagement interventions with evidence to enable countries to select appropriate and relevant interventions; c.) a selection of indicators and measurement tools; and d.) case studies showing where they have been applied and their impact.
For more information visit: http://www.who.int/servicedeliverysafety/areas/qhc/community-engagement/en/
The document will be co-developed with countries. This is an important and emerging area in QI that has the potential to significantly impact country level quality improvement efforts across entire health systems.
47
3. Patient safety
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
WHO mother-baby 7 day mCheck tool
Guidance Mothers and children
This tool instructs the user to recognize the danger signs in mother and baby during the first week after birth so appropriate health care can be sought.
Clear links with all technical programmes. For example ,maternal and child health and water, sanitation and hygiene.
Technical reports on Medication safety (polypharmacy, high-risk situations, transitions of care)
Technical reports
Policy-makers, health care administrators and regulators, organizations/institutions
These three technical reports outline the problem, current situation and recommended future approach to reducing medication-associated harm in polypharmacy, high-risk situations and transitions in care.
Closely related to all aspects of service delivery.
Framework on patient and family engagement
Guidance Policy-makers, health care providers
This document is an action framework that aims to support WHO Member States to nurture an enabling environment where patients, families and communities partner with providers and leaders at all system levels to improve patient safety, quality and health outcomes.
Linked to the WHO global strategy on people-centred and integrated health services.
Also to health promotion and health literacy.
4. Traditional, complementary and integrative medicine
Name of tool (year)
Type of tool Audience Summary description Interlinkages with other areas
WHO Benchmarks for training in:
• Yoga
• Anthroposophic Medicine
Training/
Capacity-building
Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers
The series of benchmarks for training reflect what the community of practitioners in traditional and complementary medicine (TCM) consider to be reasonable practice in training professionals to practice the discipline, considering consumer protection and patient safety as core to professional practice. The training tool provides a reference point to which actual practice can be compared and evaluated. The document describes models of training for trainees with different professional backgrounds. The list, developed by a community of practitioners, aims to promote safe practice and minimize the risk of accidents.
The tool serves as a reference point to which actual practice can be compared and evaluated.
Quality improvement resources in development
Improving the quality of
health services: tools and resources48
Name of tool (year)
Type of tool Audience Summary description Interlinkages with other areas
Technical document on clinical research in traditional and complementary medicine (tentative title)
Guidance Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers
The specific objectives of this guideline are to review the major challenges of clinical research in TCM and to clarify the aspects of clinical research that are unique to TCM. This document will present important and relevant guiding principles and key recommendations on research methods.
This document aims to provide appropriate methodologies and approaches to guide and conduct clinical research and evaluation of TCM; to promote and enhance the quality of clinical research addressing TCM; to facilitate the establishment of national regulations around TCM products and practices and enhance the quality of TCM practice in order to benefit patients.
WHO benchmarks for practice in:
• Ayurveda
• Panchakarma
• Unani medicine
Guidance Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers
Benchmarks can help assist in the development of approaches and frameworks and evaluate how existing systems can be improved.
These benchmarks for practice could be used in evaluating individual therapies, identifying trends in utilization, developing payment structures for service models, establishing regulatory frameworks for traditional and complementary medicine products and practice, providing oversight of providers, including accreditation and remuneration and determining how a service is delivered within a national health care system.
WHO benchmarks for training in Tibetan medicine
Guidance Government authorities and regulatory agencies, health care providers including traditional and complementary practitioners, academics and researchers, communities and the general public, NGOs and other related stakeholders.
The document intends to present what professional experts and health regulators consider to be adequate training levels and appropriate learning modules for trainees with different backgrounds. It will not only serve as a reference tool of quality evaluation and improvement for relevant stakeholders, but also contribute to the formulation of a traditional and complementary medicine service mode in the context of integrated, people-centred health care.
Will serves as a reference tool of quality evaluation and improvement for relevant stakeholders.
49
Name of tool (year)
Type of tool Audience Summary description Interlinkages with other areas
WHO benchmarks for practice in:
• Acupuncture
• Tui na
• Cupping
Guidance Government authorities and regulatory agencies, health care providers including traditional and complementary practitioners, academics and researchers, communities and the general public, NGOs and other related stakeholders.
The document intends to present what professional experts and health regulators consider to be standard procedures of reasonable practice for providers with different backgrounds. It will not only serve as a reference tool of quality evaluation and improvement for relevant stakeholders, but also contribute to the formulation of traditional and complementary medicine service mode in the context of integrated, people-centred health care.
Serves as a reference tool of quality evaluation and improvement for relevant stakeholders.
5. People-centred care
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
Participatory assessment and planning toolkit to support implementation of the Framework on integrated people-centred health services at the sub-national level
Capacity-building
Sub-national health authorities
The Participatory Assessment and Planning (PAP) toolkit will contribute to building capacity of sub-national (district) authorities to steer local health systems towards IPHCS. It encompasses assessing performance, setting priorities and preparing strategic action plans. More specifically, the PAP toolkit aims to support sub-national health authorities to identify opportunities for the delivery of integrated people-centred health services based on a comprehensive and shared diagnosis of current health structures, processes, activities and outcomes. It is based on the five interdependent strategies defined in the Framework on IPCHS and covers a defined territory/population catchment area, including all levels and settings of care, disease-specific programmes and coordination with other relevant sectors (social, education, transport, etc.). The application of PAP toolkit with sub-national governance structures will be a critical element of the Framework’s implementation success by helping to bring integrated people-centred health services higher up on the policy agenda and building a vision for advancement of the model(s) of care
The PAP toolkit will incorporate a score card made up of 20-30 indicators for monitoring and evaluation of IPCHS progress at the sub-national level.
Quality improvement resources in development
Improving the quality of
health services: tools and resources50
6. Emergency and essential surgery
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
Manual on optimal resources for children’s surgery
Guidance Policy-makers, government authorities, academics and researchers
Describes the optimal resources that should be available to enable safe paediatric surgery service delivery, including equipment and supplies, essential medicines, trained health workforce, infrastructure needs, etc. The document provides a reliable benchmark for paediatric surgery service delivery.
Maternal and child health, essential medicines
National surgical, obstetric and anaesthesia plan development manual
Manual Policy-makers, government authorities, academics and researchers
This document aims to enable health ministries and governments to implement optimal surgical, obstetric and anaesthesia care delivery. A national plan will provide the basis for building service delivery capacity, including establishing information management with M&E.
Surgical sub-specialties:anaesthesia,obstetrics, maternal and child health, reproductive health emergencies, non-communicable diseases, HIV, neglected tropical diseases, medicines
Emergency surgery on sepsis
Guidance Health workers Possible checklist and algorithm for the optimal prevention and treatment of sepsis.
Infection prevention and control plays a critical role in sepsis and hospital acquired infections.
Anaesthesia guidelines Guidance Policy-makers, government authorities, academics and researchers
Safe standards for anaesthesia care delivery under a range of conditions and settings, including equipment and supplies, essential medicines, trained health workforce, infrastructure needs, etc. The document is aimed at improving surgical and anaesthesia outcomes.
Surgical sub-specialties:anaesthesia,obstetrics, maternal and child health, reproductive health emergencies, non-communicable diseases, HIV, neglected tropical diseases, medicines
Surgical safety checklist Guidance Health professionals, policy-makers, government authorities, academics and researchers
This document incorporates three “time out” periods before, during and after surgery to reduce the risk of complications that may arise from multiple system failures within the operating theatre.
Surgical subspecialties,Anaesthesia,Obstetrics, VIP, maternal adolescent and child health, reproductive health, emergencies, non-communicable diseases, HIV, neglected tropical diseases.
Ebola and Marburg Virus guidelines for surgical teams
Guidance Health professionals, policy-makers, government authorities, academics and researchers
These are the guidelines to help reduce the risk of EVD transmission to surgical, obstetric and anaesthesia health care workers and all operating room team members.
Surgical subspecialties,Anaesthesia,Obstetrics, VIP, maternal adolescent and child health, reproductive health, emergencies, non-communicable diseases, HIV, neglected tropical diseases.
51
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
Surgical Treatment of Hydroceles secondary to Lymphatic Filariasis
Guidance Health professionals, policy-makers, government authorities, academics and researchers
This document provides guidance on the surgical treatment of hydroceles secondary to Lymphatic Filariasis for surgeons and other health care providers in endemic areas.
Surgical subspecialties,neglected tropical diseases.
7. Hospital management
Name of tool Type of tool
Audience Summary description Interlinkages with other areas
Hospital transformations towards integrated and people-centred health services for universal health coverage
Guidance Policy-makers, academics/researchers, international partners
This document is part of a suite of WHO resources to support implementation of the Framework on Integrated People-centred Health Services (IPCHS). It sets out a vision for hospitals to take on population-based responsibilities and actively implement integrated and people centred health services, on the way to towards UHC. It highlights pressure points for hospital sector transformation and calls for reassessing the role of hospitals and their position in the health system and for strengthening their organization and internal operations. It then suggests a series of policy orientations at the system level and at the organizational level to enable and sustain a paradigm shift from “hospitals operating in isolation as individual entities” to “hospitals fully embedded in the local service delivery architecture and its community”.
It is primarily aimed at decision-makers at the national and sub-national level to accompany them in thinking about health system transformations and more specifically about hospital planning and management within the wider health system architecture. It also offers the international community a renewed agenda on hospitals and seeks to generate a constructive dialogue towards a shared vision of how hospitals will function in the future.
8. Infection prevention and control
Name of tool Type of tool Audience Summary description Interlinkages with other areas
Surgical site infection implementation tools
A range of tools encompassing the WHO multimodal improvement strategy
Policy-makers and implementers responsible for IPC and AMR, IPC leads/focal persons and teams, and surgical teams, in acute health care facilities responsible for implementing safe surgery, including health care facility managers
Tools include those to monitor processes and outcome related to surgical site infection prevention, raise awareness and address the safety culture in a facility related to safe surgery. A publication has already informed this toolkit as well as the WHO SSI guidelines. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30107-5/fulltext
WASH, quality, patient safety, antimicrobial stewardship accreditation/regulation, public health/disease control, occupational health.
Quality improvement resources in development
Improving the quality of
health services: tools and resources52
Published literature on quality improvement demonstrate its benefits in a variety of settings, particularly those with limited resources (4,5,6). The science of improvement has evolved over time. The well-known Donabedian (7) model describes three parameters for quality of care: structure (or input), process and outcomes. This can be a useful approach to conceptualize the wide range of potential improvement methods and interventions. Structures, or inputs, refers to the setting in which care is delivered, for example the health facility and the human and financial resources underpinning it; process relates to the provision of care
4 Singh, Kavita et al. Can a Quality Improvement Project Impact Maternal and Child Health Outcomes at Scale in Northern Ghana? Health Research Policy and Systems 14 (2016): 45. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910198/ , assessed 20 August 2018).
5 Sheila Leatherman et al. The role of quality improvement in strengthening health systems in developing countries, International Journal for Quality in Health Care, Volume 22, Issue 4, 1 August 2010, Pages 237–243, (https://doi.org/10.1093/intqhc/mzq028 assessed 20 August 2018 )
6 Franco LM, Marquez L Effectiveness of collaborative improvement: evidence from 27 applica-tions in 12 less-developed and middle-income countries BMJ Quality & Safety 2011;20:658-665.( http://qualitysafety.bmj.com/content/20/8/658.long , assessed 20 August 2018)
7 Donabedian A. The quality of care. How can it be assessed? J Am Med Assoc 1988;260:1743–8.
itself, including all aspects of the transaction between the receivers and providers of care; and outcome is the measurable effect on health status, which may be affected by a wide range of factors. Inputs, process indicators and output measures act as key drivers for achieving improved quality of care, person satisfaction, positive experience and desired health outcomes.
A commonly cited concept in health care improvement efforts is the Juran Trilogy. The Juran Trilogy comprises three separate but related approaches that must all be considered when thinking through efforts to enhance
Annex 1: Rapid mapping
of quality improvement
definitions
53 Annex 1: rapid mapping of quality
improvement definitions
quality: quality planning, quality control, and quality improvement. This can be a useful structure to conceptualize the different domains that can be addressed when selecting quality interventions. The approach highlights how the deliberate efforts by all stakeholders through the design and implementation phase of an intervention can improve health services and lead to improved outcomes. Quality planning includes the involvement of all stakeholders in the design phase of an intervention. It is
at this stage that aims, processes and goals are developed. Quality control includes the monitoring of established processes to ensure their functionality. Quality improvement is a disciplined approach that improves the level of performance of a process. These same principles are echoed by Edward Deming who proposed that by focussing on management, organizations can improve productivity, quality and efficiency.
Table 1: Rapid mapping of quality improvement definitions
Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvements in health care services and the health status of targeted patient groups
Institute of Medicine https://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/
Quality Improvement is the attainment, or process of attaining, a new level of performance or quality that is superior to any previous level of quality.
Joint Commission on Economic and Technological Cooperation
Continuous quality improvement is a management approach involving the continuous study and improvement of the processes of providing health care services to always better meet the needs of patients and other persons.
Joint Commission on Economic and Technological Cooperation
Quality improvement / continuous quality improvement is the sum of all the activities which create the desired change in quality. In the health care setting, quality improvement requires a feedback loop which involves the identification of patterns of the care of individuals (or of the performance of other systems involved in care), the analysis of those patterns in order to identify opportunities for improvement (or instances of departure from standards of care), and then action to improve the quality of care for future patients. An effective quality improvement system results in step-by-step increases in quality of care.
WHO Kobe Center http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf
QI is an approach to the improvement of service systems and processes through the routine use of health and programme data to meet patient and programme needs.
WHO, 2008 http://www.who.int/hiv/pub/imai/om_11_quality_improvement.pdf
Quality Improvement entails understanding the complex health care environment; applying a systematic approach; designing, testing, and implementing changes using real-time measurement for improvement, in order to make a difference to patients by improving safety, effectiveness and experience of care.
Academy of Medical Royal Colleges, 2016
http://aomrc.org.uk/wp-content/uploads/2016/06/Quality_improvement_key_findings_140316-2.pdf
Improving the quality of
health services: tools and resources54
A quality improvement effort aims at making changes in the health care system that address the causes of poor quality. To do so requires implementing an improvement strategy with three phases:
• Identify issues and effective solutions through a small-scale pilot improvement project;
• Replicate effective changes/interventions and the QI process to the entire health care system
• Institutionalize an improvement dynamic throughout.
Abt Associates http://www.abtassociates.com/reports/0847_Intro_Field_Qual_Improv_Hlth_Care_0206.pdf
QI is an organizational strategy that formally involves the analysis of process and outcomes data and the application of systematic efforts to improve performance
Agency for healthcare research and quality, 2010
https://ahrq-ehc-application.s3.amazonaws.com/media/pdf/disparities-quality-improvement_research-protocol.pdf
Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.
Department of Health and Human Services, 2011
https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf
Theoretical findings
Quality improvement denotes both a philosophy (the pursuit of continuous performance improvement) and a family of discrete technical and managerial methods.
Leatherman et al https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzq028
Improving health care processes, drawing on a number of disciplines. Heiby, 2014 https://academic.oup.com/intqhc/article/26/2/117/1802645/The-use-of-modern-quality-improvement-approaches
Quality improvement can be defined as the combined and unceasing efforts of everyone —health care professionals, patients and their families, researchers, payers, planners and educators— to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.
Batalden & Davidoff, 2007
http://qualitysafety.bmj.com/content/16/1/2.short
Continuous quality improvement is embedded within five main components:
1. Improvement of organizational processes;2. Use of structured problem-solving processes incorporating
statistical methods and measurement to diagnose problems and monitor progress;
3. Use of teams, including employees from multiple departments and from different organizational levels, as a mechanism for introducing improvements in organizational processes;
4. Empowering employees to identify quality problems and improvement opportunities and to take action on these problems and opportunities; and
5. An explicit focus on “customers”- both external and internal.
Brennan et al 2009 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003319.pub2/full
55Annex 1: rapid mapping of quality
improvement definitions
Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality in services or processes which achieve equity and improve the health of the community.
Beitsch et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/25494050
Quality improvement processes use systems thinking, data analysis and teams of professionals to bring about better outcomes for patients and improved clinical processes.
Plsek,1999 http://acmd615.pbworks.com/w/file/fetch/46352558/QIMethodsInClinicalPractice.pdf
The term CQI can be defined briefly as a comprehensive management philosophy that focuses on continuous improvement by applying scientific methods to gaining knowledge and control over various work processes.
Kahan & Goodstadt 1999
http://idmbestpractices.ca/pdf/CQI.pdf
Health care delivery requires structure (eg. people, equipment, education, prospective registry data collection) and process (eg. policies, protocols, procedures), which, when integrated, produce a system (eg. programmes, organizations, cultures) leading to certain outcomes such as patient safety, quality, satisfaction.
Kronick et al 2015 http://circ.ahajournals.org/content/132/18_suppl_2/S397.long
Continuous quality improvement (CQI) is a management approach or set of principles that aims to constantly increase the efficiency and effectiveness of organizational systems to better meet the needs and expectations of patients and other stakeholders. These principles include a positive focus on creating better functioning organizational systems rather than isolated issues or personal blame, and organization-wide involvement to foster ownership and build quality improvement capacity.
Gibson-Helm et al 2016
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0892-1
Continuous quality improvement can be defined as a planned approach to transform organizations by evaluating and improving systems to achieve better outcomes.
Colton, 2000 https://www.ncbi.nlm.nih.gov/pubmed/10787951
Quality improvement in health care is the structured analysis of a health care system with a view to improving its performance.
Arasaratnam, 2012 https://www.ncbi.nlm.nih.gov/pubmed/22585323
Activities intended to close the gap between desired processes and outcomes of care and what is actually delivered.
Ferris et al 2001 https://www.ncbi.nlm.nih.gov/pubmed/11134448
Quality improvement is a distinct management process and set of tools and techniques that are coordinated to ensure that departments consistently meet the health needs of their communities.
Riley et al 2010 http://journals.lww.com/jphmp/Abstract/2010/01000/Defining_Quality_Improvement_in_Public_Health.3.aspx
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Continuous quality improvement is a movement from the standard definitions of quality, which looked back at work already done, to a method of prevention. This involves defining and meeting customers’ needs, leading to exemplary service.
Foreman, 1993 https://www.ncbi.nlm.nih.gov/pubmed/10129027
Quality improvement and continuous quality improvement focus on proactively improving and continually enhancing the quality of care and services by combining professional knowledge with knowledge about making improvements (14,15). Their philosophy is focused on continuous improvement of processes associated with services that meet or exceed the expectations of the patient or referring clinician. For quality improvement and continuous quality improvement, clear standards should be identified for every activity or process in an imaging facility. These standards should be measurable to allow processes to be continually improved.
Kelly & Cronin, 2015 http://pubs.rsna.org/doi/10.1148/rg.2015150057?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
57Annex 2: further information
Annex 2: Further information
Related organizational links
• Service Delivery and Safety – webpage with links to a range of service delivery areas to support countries http://www.who.int/servicedeliverysafety/en/
• Quality improvement and hospitals: http://www.who.int/hospitals/en/
• External Web pages showcasing the application of modern quality improvement approaches in a range of technical areas:
• Institute for Healthcare Improvement: http://www.ihi.org/Pages/default.aspx
• International Society for Quality in Health Care: https://isqua.org
• Jhpiego: https://www.jhpiego.org/
• The Organisation for Economic Co-operation and Development: http://www.oecd.org/els/health-systems/health-care-quality-and-outcomes.html
• The World Bank: http://www.worldbank.org/en/topic/health
• USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project: https://www.usaidassist.org/
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annex 3: Process note – WHO
SDS improvement cross-cut
Three interdependent cross-cutting areas of work – measurement, engagement and improvement – were established in the Service Delivery and Safety department at WHO headquarters, to
maximize the effectiveness of all technical work and to ensure timely response on quality improvement matters to WHO regional and country offices.
The SDS improvement cross-cut was activated in August 2017 to bring coherence on quality improvement within service delivery and to enhance
support to Member States. To achieve this, specific objectives include:
1. to outline existing quality improvement approaches in service delivery in support of Member States;
2. to explore the relationship between quality improvement and service delivery;
3. to outline a number of practical case studies that ground the application of the identified tools and resource.
Sep 20176 grounding themes developed and agreed upon
Nov 2017Mapping exercise for SDS tools and resourcesinitiated
Jan 2018QI and measurement linkage identified and tools and resources narrowed to focus on QI
April 2018Phase II prioritization exercise to cull focussing on country application
July 2018Agreed definition of Ql. Quality improvement is the action of every person working to implement iterative measurable changes to make health services more effective, safe and people-centred.
Oct 2017Strategic direction from Director to focus on quality improvement
Aug 2017Improvement cross-cutactivated by SDS
Dec 2017Check-in with members to ensure that cross-cut is on the right track
March 2018Draft v0 of Compendium with input from across SDS
June 2018Prioritizationexercise to cull focusing on country application
August 2018Final draft compendium of "Improving the quality of health services: tools and resources"
Figure 1: development of the QI compendium
59 annex 3: Process note – WHO SDS
improvement cross-cut
The cross-cut solicited representation from each of the units within the SDS department. WHO/SDS technical units involved in this compendium included those working on engagement; infection prevention and control; innovation in service delivery; knowledge management; measurement; patient safety and risk management; quality systems and resilience; services organization and clinical interventions; and traditional, complementary and integrative medicine.
A structured and collaborative approach was employed which resulted in input from across SDS. Cross-cut members, serving in liaison roles, were asked to feed back from cross-cut meetings and report back from their respective units. Monthly meetings (see Figure 1) were held to agree on direction and continued sustained development. Consensus-building was used to arrive at strategic decision points and inputs fed into the final compendium.
A conductive listening and engaging environment was created to ensure that everyone’s perspective was reflected in the final products.
The work of the improvement cross-cut is grounded in three core principles. It is:
• country-focused, ensuring that SDS is well positioned technically to respond to emerging needs from Member States on quality improvement;
• evidence-based, grounding the work in practical and tested front-line quality improvement approaches to improve overall health care outcomes;
• service-oriented, focusing on service delivery.
The work of the improvement cross-cut was informed by the draft thirteenth general programme of work, 2019−20238. The three strategic priorities articulated by the GPW, namely achieving UHC, addressing health emergencies and promoting healthier populations, are strongly linked with quality improvement. In order to move forward on UHC, quality improvement approaches need to be placed within the grasp of health systems designers and implementers.
In addressing health emergencies, quality improvement approaches can support preparedness and response efforts as well. Finally, in promoting healthier populations, improvement approaches can support multiple proposed flagship efforts, for example, care for mothers and newborns. Quality improvement approaches must be incorporated into all technical programmes as a means of strengthening health systems.
8 Draft thirteenth general programme of work 2019 – 2023. World Health Organization (http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_R2-en.pdf?ua=1 , assessed 20 August 2018)
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