NATIONAL QUALITY POLICY AND STRATEGY€¦ · The WHO Handbook for national quality policy and...

NATIONAL QUALITY POLICY AND STRATEGY

TOOLS AND RESOURCES COMPENDIUM

National quality policy and strategy tools and resources compendium

ISBN 978-92-4-151654-9

© World Health Organization 2019

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i

Contents

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

The NQPS Tools and Compendium at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Introduction and background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

NQPS tools and resources compendium: an overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Accessing the NQPS tools and resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Developing the NQPS tools and resources compendium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

NQPS tools and resources compendium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

The eight elements of national quality policy and strategyNational health priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Local definition of quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Stakeholder mapping and engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Situational analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Governance and organizational structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Improvement methods and interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Health management information systems (HMIS) and data systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Quality indicators and core measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Operational planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Integrating technical programmes with NQPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Community engagement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Cross-cutting tools and resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Useful links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ii


Acknowledgements

The National quality policy and strategy tools and resources compendium principal writing team consisted of Laura Simpson, Matthew Neilson and Shams Syed. It was developed under the overall technical direction of Shams Syed from the Service Delivery and Safety Department, WHO headquarters, Geneva. Sheila Leatherman provided critical technical advice on development of the document, given her role as Lead Adviser to the WHO initiative on national quality policy and strategy.

Ongoing review and contributions were received by WHO NQPS Team members at different stages of the process: Nana Mensah Abrampah, Lopa Basu, Rhea Bright, Breda Cosgrove, Ruben Frescas, Lauren Hoisl, Geraldine Mcdarby, Sepideh Bagheri Nejad and Linda Tawfik.

Valuable inputs in the form of contributions and suggestions were provided by Kelley Ambrose, Esha Ray Chaudhuri, Dominic Dormenyo Gadeka, Alex Rowe, Alain Blaise Tatsinkou, Charles Shaw and David Weakliam.

A first working draft of the compendium was reviewed at a technical meeting in Geneva, Switzerland, in March 2018 with the following participants: Bruce Agins, Pierre Barker, Bruno Lucet, Rashad Massoud, Edgar Necochea, and Renzo Sotomayor. The meeting was also attended by WHO regional experts, namely Nino Dal Dayanghirang, Jonas Gonseth-Garcia, Mondher Letaief and Juan Eduardo Tello. Also in attendance were the following WHO experts from headquarters: Melissa Bingham, Neelam Dhringa-Kumar, Wasiq Khan, Blerta Maliqi, Zainab Naimy, Asiya Odugleh-Kolev and Irina Papieva.

Development of this document was kindly supported by USAID, through a financial contribution to the World Health Organization.


iii

Abbreviations and acronyms

DHIS2 District Health Information System 2

HIQA Health Information and Quality Authority

HMIS health management information system

IPC infection prevention and control

LMIC low- and middle-income country

NHPSP national health policies, strategies and plans

NQPS National quality policy and strategy

OECD Organisation for Economic Co-operation and Development

PHC primary health care

PHCPI Primary Health Care Performance Initiative

RHIS routine health information system

SDG Sustainable Development Goal

SDS WHO Department of Service Delivery and Safety

UHC universal health coverage

USAID United States Agency for International Development

WASH water sanitation and hygiene

WHO World Health Organization

iv


Situational analysis

Quality indicators &core measures

Health management information systems and

data systems

Stakeholder mapping& engagement

National healthpriorities

Governanceand organizational

structure

The

eigh

t el

emen

ts o

f NQ

PSLocal definition

of quality

Improvement methods &

interventions

What is it?A non-prescriptive menu of freely available tools and resources collated to support countries at various stages of NQPS development. A curated set of products from WHO & external agencies.

Who is it for?Those with responsibility for developing, implementing and supporting national quality efforts.

Why do I need it?• To supplement the NQPS handbook, external

technical support and locally-available expertise • To signpost to body of expert literature

and practical tools.

WHO country engagement responding to demand for support to organize national quality efforts

Initial development and consultation on

the WHO NQPS handbook

NQPS partner country consultation meeting

to identify critical needs for further support

Identification of existing relevant tools and resources

from within WHO and external organisations

Consensus review of tools and resources

by NQPS team

National efforts to promote and plan for improved quality of care can be systematized and strengthened by the development of a National Quality Policy and Strategy (NQPS). The WHO Handbook for NQPS outlines an approach to the development of NQPS, based around eight key elements.

How should I use the compendium?Users should see this document as a resource to help develop quality policies and strategies that are responsive to their specific country needs, whilst building on support from existing in-country expertise, literature, lessons from the field and expert consultation.Products are presented in twelve categories, further split down into practical tools and resources that can be applied in the NQPS process, and illustrative country examples. Within the relevant category, users can review a summary of the product and its applicability to the NQPS process. Detail is provided on how to access each product. It is emphasised that this is a menu of tools and resources, and users should expect to use only a small selection of the products as required to meet the needs of their specific context.

Exam

ple

How the compendium was developed

Resource Institution/author & yearHow does the tool/resource support

the NQPS process?NQPS getting prepared for situational analysis toolNQPS Learning Pod

WHO NQPS team, 2017 This tool provides an approach to preparation for situational analysis. It includes an example set of assessment criteria in the form of a structured set of questions that can be adapted and used by countries in the initial planning phase of the NQPS effort.

Cross

cutting

tools and

resources

Cross

cutting

Tools and resources categories

Comm

unity

enga

gem

ent


Operational planning

NQPS handbook

eight elements

Critical for NQPS

implementation

Identifi

ed

by par

tner

countri

es

as a

priorit

y

National health priorities Local

definition

of quality

Quality

indicators

and core

measures

Stakeholder

mapping and

engagement

Inte

grat

ing

tech

nica

l pr

ogra

mm

es

wit

h N

QPS

Improvement

methods and

interventions

Gover

nanc

e

and

orga

niza

tiona

l

stru

ctur

e

HMIS and data systems

Brief summary of the product and its applicability to NQPS

Name of tool, resource or example and hyperlink to source

Tools and resources listed non-preferentially,

in chronological order

The NQPS Tools and Compendium at a glance

https://workspace.who.int/sites/GLL4QUHC/NQPS/SitePages/Welcome.aspx


1

Improvement in the quality of health care is a pivotal entry point for health systems strengthening. Development of national quality policy and strategy (NQPS) encourages systemwide efforts for improvement and helps to secure political and financial commitment to improving the quality of health care systems and ultimately achieving enhanced population health.

The United Nations’ Sustainable Development Goals (SDGs) (1) place a clear emphasis on improving access to quality health services for all, with the attainment of universal health coverage (UHC) included as a key target (2). The WHO framework on integrated people-centred health services also presents a vision for the future that includes safe and effective health systems that are of good quality, and designed to treat people rather than illness (3).

This National quality policy and strategy (NQPS) tools and resources compendium is an adjunct to the wider World Health Organization (WHO) initiative on NQPS, which seeks to support and respond to the unmet needs of countries at any stage of the NQPS process (4).

The WHO Handbook for national quality policy and strategy (referred to hereafter as the handbook) outlines a practical approach that countries can follow as they develop, refine and implement national quality policies and strategies.

During development of the handbook, it became apparent that there is a significant unmet need for further tools and resources in some key areas relevant to NQPS. It also emerged that there already exist a number of relevant tools and resources from a variety of sources, both within WHO and externally.

This tools and resources compendium presents some of these products, focusing on those of greatest utility in the process of developing and refining national quality directions.

The resources that follow are not intended to be prescriptive, but aim to support a structured approach to the development of a comprehensive national direction on quality, and to assist countries in facilitating its implementation.

Introduction and background

Universal health coverageEnsuring that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring the use of these services does not expose the user to financial hardship.

The WHO National Quality Policy and Strategy Initiative • NQPS technical foundation

– Handbook for national quality policy and strategy – Tools and resources compendium – Operational planning for NQPS – Integrating technical programmes with NQPS

• Shared learning and knowledge• Technical support for countries• Partner collaboration• Quality in settings of fragility, conflict, and vulnerability (FCV)

NQPS tools and resources compendium: an overviewWhat is the NQPS tools and resources compendium?

Drawing from existing products published by WHO as well as other organizations, the compendium comprises tools, resources, peer-reviewed literature, country examples and case studies. These are supplemented by de novo tools developed to address the unmet needs identified by countries engaging in the NQPS process. This is not intended to be an exhaustive list of all the tools and resources able to support the NQPS process, but rather a pragmatic collection of the most relevant material, with a focus on meeting the needs of countries engaged on this journey. It will be further added to and complemented over time, based on iterative learning through the NQPS initiative.

The compendium may be of particular relevance to countries at an early stage of NQPS development, but many of the tools included will have relevance beyond this. Users are encouraged to select and use a range of tools and resources –within and beyond the compendium– as appropriate for their setting and stage in the process.

2


Users should see this document as a resource to support the development of NQPS, to be used alongside the WHO NQPS Handbook, and building on guidance from existing literature, lessons from the field and expert consultation. While all the tools and resources referenced here have been carefully appraised for their utility to the NQPS process, their inclusion does not imply endorsement or rigorous testing by WHO. Consideration of the included illustrative country examples should be viewed as just one aspect of the NQPS development process.

Who is the compendium for?The primary target audience for the compendium is the focal persons or teams with responsibility for driving the development and practical implementation of NQPS within countries. Often this effort will be led by ministries of health, with the support of stakeholders from across the system, partner organizations and external consultants.

Why has it been developed?As outlined in the WHO NQPS Handbook, the approach to the development of NQPS will vary significantly depending on the individual country environment and circumstances. As a result, the support and tools required for each step of the process will differ depending on the needs, priorities, capabilities, resources and procedures for policy and strategy development within that setting.

There are a number of pre-existing tools and resources relevant to NQPS originating from a variety of sources within the public domain. Despite this, country engagement has revealed a significant unmet need for tools and resources in some critical areas. This may be because some existing tools are not easily identified or accessed, or are of insufficient quality to provide useful guidance, or simply that relevant tools for some areas do not exist.

Some of the products identified in this compendium are not readily available elsewhere on the World Wide Web, for example those that have been shared by countries or remain in draft “development” format. Such documents will be accessible through the NQPS learning pod in the WHO Global Learning Laboratory for Quality UHC, where they will be available for further co-development or use by those who require them.

Accessing the NQPS tools and resourcesIn order to access the tools and resources within the Compendium, hyperlinks for each suggested document have been provided to connect users directly to the relevant item. In the case of those tools and resources that are not freely available online, the hyperlink will lead to the WHO Global Learning Laboratory for Quality UHC (Global Learning Laboratory), where these items are also housed.

The Global Learning Laboratory is an interactive knowledge platform created to connect people from diverse backgrounds and disciplines. It has been designed as a space to share lessons, front-line experiences and ideas, and to challenge those ideas and spark new thinking and innovation (5).

Both the WHO NQPS Handbook and this compendium link very closely with the Global Learning Laboratory, which provides an effective forum to share, discuss and refine tools and resources related to NQPS. It hosts de novo tools as developed by the WHO NQPS team in response to unmet need, and country examples included in this compendium that are not available elsewhere online. This includes a repository of national quality policy and strategy documents, collated as part of ongoing partnership with countries on NQPS.

The NQPS Learning Pod is placed within the Global Learning Laboratory and aims to:

• foster knowledge sharing between countries on NQPS to trigger country action;• enhance capacity of participating members in technical areas related to NQPS; • collate and share tools and resources to support NQPS; • identify different pathways for developing and implementing NQPS;• explore case studies of impact from across different levels of the health system.

For more information regarding how the Global Learning Laboratory supports NQPS and to register, please visit:http://www.who.int/servicedeliverysafety/areas/qhc/gll/en/

http://www.who.int/servicedeliverysafety/areas/qhc/gll/en/


3

Developing the NQPS tools and resources compendiumA consultation meeting was held at WHO headquarters in June 2017 to bring together the initial co-development partner countries to discuss the technical foundation of the NQPS initiative (6). The meeting brought the WHO NQPS team together with representatives from WHO regional and country offices and national quality leads from eight partner countries. The meeting considered an advanced draft of the WHO NQPS Handbook.

A collective examination of tools and resources required to support NQPS also took place. This was based on a review of the WHO NQPS Handbook and on partner country consultation. The proceedings led to the identification of key areas of unmet need on NQPS development. These priority areas were organized to form the basis of the structure of the tools and resources compendium.

The e

ight

elem

ents

of N

QPS

National health priorities

Aligning the national direction on quality with national health goals and priorities

Local definition of quality

Creating a local definition of quality to ground policy and strategy in shared local understanding of quality

Stakeholder mapping and engagement

Identifying stakeholders and mapping their role and influence on NQPS


Assessing the current state of quality and identifying factors that might determine the success of the NQPS

Governance and organisational structure

Ensuring effective governance of the NQPS development and implementation

Improvement methods and interventions

Selecting an appropriate package of interventions to best address the identified priorities

Health management information systems and data systems

Data supported by reliable information management systems drives decision-making and improvement

Quality indicators and core measures

Taking a practical approach to selection of an indicator framework for quality

Criti

cal t

o NQ

PS

impl

emen

tatio

n Operational planning

Moving from policy and strategy to detailed implementation planning, assigning roles, responsibility and budget

Integrating technical programmes with NQPS

Ensuring alignment, building on the foundations of disease and population-specific programmes

Coun

try

prio

rity Community engagement

Promoting and sustaining a culture of community engagement and empowerment in relation to quality of care, and in the development of the policy and strategy

Cros

s-cu

tting

Cross-cutting

Identifying resources considered to be relevant across more than one element of the NQPS process, including seminal reports on quality of care

Sub-teams within the WHO NQPS Iinitiative carried out scoping exercises for each category to identify relevant resources. This process has been repeated over time. This has included definition of search criteria, searching of open access sources and liaison with country representatives and external partners to identify relevant resources in each of the categories. An open co-development call was disseminated via the WHO Global Learning Laboratory for Quality UHC and provided a further opportunity to identify tools of particular relevance to the NQPS process.

4


Each identified tool or resource was examined by a member of the WHO NQPS team. The tools and resources included in this compendium were selectively curated to meet country need in relation to NQPS. Initial screening of tools and resources was based on assessment against agreed criteria. Emphasis was placed on tools and resources that were action-focused rather than products focusing on theory.

Several tools and resources were deemed of high value in the field of quality improvement but not directly related to NQPS – these are retained for sharing among the members of the NQPS learning pod on the Global Learning Laboratory.

A final selection of tools and resources was conducted based on the consensus of the WHO NQPS team. A careful final review process was carried out whereby each tool or resource was appraised for its specific utility to NQPS and its added value to the compendium, before being included. The process was also used to identify key gaps in necessary tools and resources for country action on NQPS – this will form the basis of continued development of the NQPS tools and resources compendium.


5

Cross-cutting tools and resources

Community engagement

Integrating technical programmes

with NQPS

Operational planning


Health management information systems

and data systems

DHIS20%45%


Standards

Licensing

Inspection

Workforce

Incentives

Benchmarking

Engagement

Governance and organizational

structure

Government

Committee

Ministry Ministry Ministry



HealthProvider

CivilSociety

DistrictHealthOffice

Local definition of quality

Safe Effective Integrated Efficient Accessible People-centered Equitable

National health

priorities

NQPS tools and resources compendium

6


The eight elements of national quality policy and strategy — National health priorities

National health prioritiesDeveloping and setting national health goals and priorities is a mechanism by which countries can direct quality efforts towards meeting the most pressing demands of their population. Any NQPS should aim to align the quality agenda with any pre-existing health goals and priorities, as well as existing processes for national health planning and priority setting. This will be closely linked with situational analysis and stakeholder engagement activities. The resources below can help countries to begin the process of assessing national health and quality priorities.

Please click on the blue text in the “Resource” column to access resources online. Register here for the WHO Global Learning Laboratory for Quality UHC before accessing any resources held within the NQPS learning pod.

ResourceInstitution/ author and year

How does the tool/resource support the NQPS process?

Tools and resourcesNQPS goals and priorities toolNQPS Learning Pod

WHO NQPS team, 2017

This worksheet was developed with the aim of assisting countries in identifying quality goals related to existing national health priorities. This approach can help to ensure that quality efforts are aligned and integrated with wider health systems strengthening. The tool provides a structure for examining potential barriers to improving quality, considering the feasibility of remedial actions, and assigning roles to responsible organizations, teams or individuals.

Strategizing National Health in the 21st Century: a handbookPriority setting for national health policies, strategies and plans

WHO, 2016 This chapter is extracted from “Strategizing National Health in the 21st Century.” This practical handbook provides guidance on national health planning and strategizing for health, characterising a wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs). This particular section provides a comprehensive explanation of the rationale for priority setting, and the political, societal, contextual and financial factors that should be considered. It sets out a step-by-step guide for the actions required and discusses key criteria to consider when health priority setting at national level.

Country examplesWHO Global Learning Laboratory for Quality UHC action brief: Aligning the national quality strategy to the national health sector transformation plan in Ethiopia NQPS Learning Pod

Federal Ministry of Health, Ethiopia, 2019

This action brief documents the process undertaken by the Ethiopian Ministry of Health to ensure that their national health care quality strategy aligns with their national health sector transformation plan, including successes, challenges and next steps.

Liberia National Health Quality Policy Statement NQPS Learning Pod

Liberia Ministry of Health, WHO, 2018

This policy statement sets out some of the current challenges for Liberia in achieving quality at system and facility level, and also highlights challenges specific to quality in the context of resilience to health emergencies. It brings together, in one place, the commitments made in various national policy documents, as well as the proposed mechanisms for addressing these challenges.

Mexico National Strategy for Strengthening Quality in Health Care Services: Prioritiesp 28–29NQPS Learning Pod

Secretariat of Health, Mexico, 2017

This national quality strategy document details Mexico’s national health priorities, organized by priority health conditions and system-related actions that can support the process of addressing these priority conditions. Also provides a brief explanation of the thinking behind the choice of priority health conditions for Mexico.

Ethiopian National Health Care Quality Strategy 2016–2020Health of the Population: Priority Health AreasSection 3.1 p 5–6

Federal Democratic Republic of Ethiopia, Ministry of Health, 2016

Within the Ethiopian National Health Care Quality Strategy, policy‑makers highlight a set of five key national priority health areas. These public health needs have been identified as producing the greatest potential impact on health outcomes through improvement of quality of the health service.

Shared commitment to quality – from the National Quality BoardNational Priorities

National Quality Board, England, 2016

The National Quality Board brings together senior leaders responsible for quality across the National Health Service, as well as public health and social care sectors in England. This section of the document sets out the nine health priority areas chosen by the National Quality Board as having the most potential impact for improving quality, and briefly articulates strategic actions and objective targets.


https://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter4-eng.pdf

https://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter4-eng.pdf




https://www.medbox.org/ethiopian-national-health-care-quality-strategy-2016-2020/download.pdf


https://www.england.nhs.uk/wp-content/uploads/2016/12/nqb-shared-commitment-frmwrk.pdf#page=7



https://www.who.int/servicedeliverysafety/areas/qhc/schematic-GLL.pdf?ua=1

7The eight elements of national quality policy and strategy — Local definition of quality


Local definition of qualityA locally developed and championed definition of quality should underpin any national direction on quality. This process can be used as an entry point to open meaningful dialogue about quality with a variety of stakeholders, ensuring a shared understanding and common language around quality that is applicable and acceptable for the local context. A locally endorsed definition of quality can both support the development of national quality policy, and guide strategy process.


Safe Effective Integrated Efficient Accessible People-centered Equitable



Tools and resources

Creating a local definition of qualityNQPS Learning Pod

WHO NQPS team, 2018 This brief concept document provides an overview of key considerations to shape thinking on the process of creating a local definition of quality. This process can be helpful in opening a dialogue among stakeholders and arriving at a shared understanding of the language used to define quality in the local context.

Country examples

Definitions of quality: country examples NQPS Learning Pod

WHO NQPS team, 2018 This tool collates various existing country definitions of quality, extracted from national quality documents. Countries across various regions are represented. While not validated nor specifically endorsed by WHO, these examples provide a sample of the diversity of such definitions and may be useful for those at early stages of the process of crafting and agreeing on their own definitions.

Ghana National Healthcare Quality Strategy 2017–2021Section 2.1Stakeholder Definition of Quality

Ministry of Health, Ghana, 2016

Ghana’s definition of health care quality, as developed by the stakeholders involved in developing the Ghana National Healthcare Quality Strategy, including a brief explanation of this process in their context.

Shared commitment to quality – from the National Quality Board

A single shared view of quality

National Quality Board, England, 2016

The National Quality Board brings together leadership responsible for quality across the National Health Service (NHS), public health and social care sectors in England. The “single shared view of quality” builds on the existing definition of quality for NHS England, including their quality domains as related to patients and providers.



http://www.moh.gov.gh/wp-content/uploads/2017/06/National20Quality20Strategy20Ghana.pdf#page=21






8


The eight elements of national quality policy and strategy — Stakeholder mapping and engagement


The WHO NQPS Handbook outlines the range and roles of stakeholders that it may be important to involve in the process of developing NQPS. The tools in this section can be used to help identify stakeholders and map their influence, which in turn will guide the development and implementation of the policy and strategy.




Tools and resources

FHI 360 stakeholder analysis tool

FHI 360, 2012 The tool provides a simple template for stakeholder mapping and was developed to assist research teams in the identification of stakeholders, both globally and in-country. The methodology could also be applied to NQPS development.

Stakeholder analysis World Bank, 2001 The article provides a concise summary of the principles of stakeholder analysis; when and how to conduct a stakeholder analysis; and how to manage and analyse the information collected.

How to do (or not to do) a stakeholder analysis

Journal of Health Policy and Planning, 2000(open access peer-reviewed publication)

The paper concisely discusses the principles of stakeholder analysis. It uses lessons learnt from developing an alcohol policy in Hungary but is also applicable to work on NQPS. The paper sets out key steps and messages, including how to identify and approach stakeholders; data collection sources and methods; organization, analysis, presentation and use of data; and assessing data validity and reliability.

Guidelines for conducting a stakeholder analysis

Partnerships for Health Reform, Abt Associates Inc., 1999

The guidelines provide an overview of the process required for mapping stakeholders and assessing their contribution and influence in health policy-making. Stakeholder analysis “at a glance” is included, as well as a step-by-step guide to conducting a stakeholder analysis.

Country examples

Process for Developing National Standards

Health Information and Quality Authority (HIQA), Ireland, 2018

HIQA is a government-funded authority that monitors the safety and quality of the health and social care system in Ireland. This simple one-page diagram gives an example of the process used by the HIQA to develop national quality standards, illustrating one of the ways stakeholder engagement fits into a process of developing national direction on quality. A more detailed description of stakeholder communication is included in the document below.

Communications and Stakeholder Engagement Strategy 2019–2021

Health Information and Quality Authority (HIQA), Ireland, 2018

This document sets out HIQA’s approach to engaging and communicating with stakeholders in relation to achieving their objectives set out in a three-year plan. It contains their agreed principles for stakeholder engagement and examples of how stakeholder engagement has been conducted.

Stakeholder engagement framework

Australian Government, Department of Health, 2015

This framework from the Australian Department of Health sets out key principles of stakeholder engagement, a stakeholder engagement model and discusses barriers to successful stakeholder engagement. While more general and not specifically developed for NQPS activity, it could be applied to it.

HealthProvider

CivilSociety

DistrictHealthOffice

https://www.k4health.org/toolkits/research-utilization/fhi-360-stakeholder-analysis-tool

https://www.k4health.org/toolkits/research-utilization/fhi-360-stakeholder-analysis-tool

http://www1.worldbank.org/publicsector/anticorrupt/PoliticalEconomy/stakeholderanalysis.htm

http://dess.fmp.ueh.edu.ht/pdf/Zsuzsa_Varvasovsky_2000_stakeholder_analysis.pdf

http://dess.fmp.ueh.edu.ht/pdf/Zsuzsa_Varvasovsky_2000_stakeholder_analysis.pdf

http://www.who.int/management/partnerships/overall/GuidelinesConductingStakeholderAnalysis.pdf

http://www.who.int/management/partnerships/overall/GuidelinesConductingStakeholderAnalysis.pdf

https://www.hiqa.ie/sites/default/files/2018-10/The-process-for-developing-national-standards_0.pdf

https://www.hiqa.ie/sites/default/files/2018-10/The-process-for-developing-national-standards_0.pdf

https://www.hiqa.ie/sites/default/files/2019-01/HIQA-Communications-and-Stakeholder-Engagement-Strategy-2019-2021.pdf



http://www.health.gov.au/internet/main/publishing.nsf/Content/stake-frame

http://www.health.gov.au/internet/main/publishing.nsf/Content/stake-frame



9The eight elements of national quality policy and strategy — Situational analysis


Situational analysisIn order to develop an understanding of the strengths and weaknesses present in any health system, it is important to develop a detailed understanding of the current state of both the health system, as well as the current state of quality. This section outlines tools and resources that can be used to assess those aspects of the current state of the health system environment that will have an impact on NQPS. For example, this may include assessing the current quality of services across the health system, the political context in which the policy is being developed, the barriers and facilitators to successful implementation, or specific technical areas related to quality.




Tools and resources

Desk review to inform situational analysis for NQPSNQPS Learning Pod

WHO NQPS team, 2019

Examining a range of key health sector documents forms the fundamental groundwork for conducting a comprehensive situational analysis. This tool provides an approach for reviewing these documents and gathering key information on existing policies and programmes, facilitating the alignment of further NQPS development with current efforts.

Building up from the ground on NQPS: gathering health worker perspectives on the current state of quality NQPS Learning Pod

WHO NQPS team, and Sudan Ministry of Health, 2017

The tool provides a template to guide fact‑finding during facility visits in order to develop a foundation for further discussion. It is adapted from a tool co-developed and used during a situational analysis carried out in Sudan.It also contains example interview questions that can be used to gather perspectives regarding the current state of quality, according to facility staff. Engagement, involvement and empowerment of the health workforce are key drivers for quality improvement.

NQPS getting prepared for situational analysis tool NQPS Learning Pod

WHO NQPS team, 2017

This tool provides an approach to prepare for a situational analysis. It includes an example set of assessment criteria in the form of a structured set of questions that can be adapted and used by countries in the initial planning phase of the NQPS effort.

Strategizing National Health in the 21st Century: a handbookChapter 3: Situation analysis of the health sector

WHO, 2016 This chapter is extracted from “Strategizing National Health in the 21st Century.” This practical handbook provides guidance on national health planning and strategizing for health, characterizing a wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs). This section documents an approach to the process of conducting a situational analysis of the health sector in a country. It discusses both the rationale for conducting situational analysis overall and for each step in the process.

Country examples

Quality of Care Review in Kyrgyzstan

WHO Regional Office for Europe, 2018

This report provides an overview of the current state of quality of care in Kyrgyzstan. It includes an overview of existing quality policies and strategies, governance mechanisms for quality, information on metrics and measurement and recommendations for improvement.

Ethiopian National Health Care Quality Strategy 2016–2020Pages 7–9

Ministry of Health, Ethiopia, 2015

This section of the Ethiopian National Health Care Quality Strategy provides an example of an assessment of the current state of health care quality in Ethiopia i.e. a completed situational analysis.

Situation analysis of quality improvement in health care, United Republic of Tanzania

USAID: Health Care Improvement Project, 2012

This resource provides a detailed example of a completed situational analysis performed in the United Republic of Tanzania to inform strategic planning for quality improvement in health care.




http://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter3-eng.pdf?sequence=19

http://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter3-eng.pdf?sequence=19

http://www.euro.who.int/__data/assets/pdf_file/0004/383890/kgz-qoc-eng.pdf?ua=1

http://www.euro.who.int/__data/assets/pdf_file/0004/383890/kgz-qoc-eng.pdf?ua=1



http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_groups_clusters/cluster_2/health/Sub_Sector_Group/Quality_Assurance/11.a_Situation_Analysis_of_Quality_Improvement_in_Health_Care_Tanzania_-_Final.pdf





10


The eight elements of national quality policy and strategy — Governance and organizational structure

Governance and organizational structure

Governance of national quality efforts should be considered throughout the NQPS process, both during policy and strategy development and afterwards, to ensure accountability and implementation. Activities may include the mapping of existing governance structures, the appraisal of technical capacity, an assessment of leadership and the assignment of roles and responsibilities. The resources presented in this section include indicative and actual examples of how the governance of national efforts on quality can be organized.




Tools and resources

Strengthening Governance to Improve the Quality of Health Service: A Consensus Statement

The Health Finance and Governance and USAID Applying Science To Strengthen And Improve Systems (ASSIST) Projects 2018

This Statement was developed by multiple international contributors during a multilateral workshop “Governing to Improve Quality” in 2017. It explains the relationship between strengthened governance and improvement in quality, and sets out some priority actions that countries can consider adopting when instituting or seeking to improve existing governance mechanisms. Also suggested are some key investment opportunities that can support increased capacity for governance of health care quality.

Defining Institutional Arrangements When Linking Financing to Quality in Health Care: A Practical Guide

Health Finance & Governance Project, Abt Associates Inc. 2018

This guide is intended as a diagnostic and planning tool to help policy-makers understand key concepts around quality governance and planning system reform. Specifically, it supports clarification of institutional roles and responsibilities and discusses financing strategies that can be used to improve quality of care, both of which may be important considerations for teams addressing this element of the NQPS process.It provides useful detail on practical steps for addressing quality governance, but it is important to recognize that not all financing reforms will be appropriate in every setting and their use should be guided by multiple considerations, including evidence appropriate to the setting.The Health Finance and Governance and USAID Applying Science To Strengthen And Improve Systems (ASSIST) projects have developed other materials relevant to governance of quality which are available here.

Governance of quality: example organogramsNQPS Learning Pod

WHO NQPS team, 2017 This document contains illustrative example organograms of organizational structures for governance of quality.

Government

Committee

Ministry Ministry Ministry

https://www.usaidassist.org/sites/default/files/strengthening_governance_to_improve_quality_may2018.pdf




https://www.hfgproject.org/defining-institutional-arrangements-when-linking-financing-to-quality-in-health-care-a-practical-guide/








https://www.hfgproject.org/governing-quality-health-care/

11The eight elements of national quality policy and strategy — Governance and organizational structure




Country examples

National Health Care Quality BoardTerms of ReferenceNQPS Learning Pod

Liberia Ministry of Health, 2018

Terms of reference are used to describe the scope and limitations of a particular activity. This document describes the structure, objectives and proposed activities of the Liberia National Health Quality Board, formed as an advisory body to guide the national direction on quality. Mention is also made of accountability and evaluation mechanism for the activities of the Board.

Exploring the Institutional Arrangements for Linking Health Financing to the Quality of Care: Lessons from Indonesia, the Philippines, and Thailand

Health Finance & Governance Project, Abt Associates Inc., 2018

This qualitative study report describes lessons learned in attempts to link quality of care with health financing initiatives in a low‑income country context. Such financing initiatives might be considered by policy‑makers as they determine the governance arrangements and interventions package as part of their NQPS. This paper adds to the body of knowledge that can inform these efforts.

Overview of Governance for Quality and Safety

Health Service Executive, Ireland, 2016

This explanatory overview on quality governance and safety outlines Ireland’s Framework for Improving Quality, and the structures and processes by which governance for quality is organized within the Irish health service.

Governing for Quality Improvement in the Context of UHC

Health Finance and Governance Project, Abt Associates and USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, URC, 2016

This series of seven country case studies includes Mexico, Malaysia and the Philippines. It describes the experiences of these countries in creating governance structures as they endeavour to ensure quality in health services.

Ghana National Healthcare Quality Strategy 2017–2021Chapter 7: Making this happenSection 7.1


The strategy document explains Ghana’s Ministry of Health plan for integrating a quality governance structure, with a diagrammatic example.

Uganda Health Sector Quality Improvement Framework and Strategic Plan 2015/16–2019/20Section 4.3

Ministry of Health, Uganda, 2016

The plan includes a diagrammatic example of Uganda’s national quality improvement coordination structure, with explanations of the roles and responsibilities of committees and individuals at each level.

Ethiopian National Quality Strategy 2016–2020

Section 6: Making this happen

Ministry of Health, Ethiopia, 2015

The strategy discusses the proposed formation of a core quality team, comprising a health service quality directorate and multidisciplinary quality steering committee. It explains their development, roles and responsibilities in relation to driving the quality agenda for health care.

The Tanzania Quality Improvement Framework in Health Care 2011–2016Section 5

Ministry of Health and Social Welfare, United Republic of Tanzania, 2011

The framework includes a diagrammatic example of the Tanzanian organizational structure for quality improvement in health care, as well as the functions and responsibilities of stakeholders at each level of the system.


https://www.hfgproject.org/exploring-the-institutional-arrangements-for-linking-health-financing-to-the-quality-of-care-lessons-from-indonesia-the-philippines-and-thailand/






https://www.hse.ie/eng/about/who/qid/governancequality/resourcespublications/governance-for-quality-and-safety-overview.pdf

https://www.hse.ie/eng/about/who/qid/governancequality/resourcespublications/governance-for-quality-and-safety-overview.pdf

https://www.usaidassist.org/resources/institutional-roles-and-relationships-governing-quality-health-care-country-experiences





http://www.health.go.ug/download/file/fid/1051






https://www.jica.go.jp/project/tanzania/006/materials/ku57pq00001x6jyl-att/framework_in_health.pdf#page=52



12


The eight elements of national quality policy and strategy — Improvement methods and interventions


Improving quality across a health system requires judicious selection of interdependent interventions, which are carefully implemented across all levels. This task is complicated by limited resources, evidence of impact, feasibility and acceptability. The resources in this section support the process of selecting the interventions appropriate to their context. The resources highlighted are not individual methods or interventions, but knowledge products that can help countries select those most appropriate to their individual environments.




Tools and resources

Selecting interventionsNQPS Learning Pod

WHO NQPS team, 2019 This resource provides more detail on considerations for teams selecting and prioritizing interventions as part of their national direction on quality. It suggests a number of criteria that can be applied to guide decision-making as intervention packages are developed, refined and implemented. This may be of use both in the strategy development phase and in the operational planning phase.

Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review

Rowe et al, Lancet Global Health, 2018(open access peer-reviewed publication)

A systematic review of over 600 quantitative studies which examine strategies used to improve health care provider performance in low- and middle-income countries. As well as the review report, there is an online database which allows users to search and download evidence examined during the systematic review, filtering by evidence for what works in different settings.A webinar with a more detailed discussion of this resource, accompanied by a presentation slide set can be downloaded here: HCPPR webinarThe searchable evidence database is available here: https://www.hcpperformancereview.org

Delivering Quality Health Services: A Global Imperative for Universal Health Coverage

Chapter 5.3 Quality Interventions

WHO, The Organisation for Economic Co-operation and Development (OECD), World Bank, 2018

This seminal joint report describes the essential role of quality in health care service delivery. The section highlighted here, focuses on the impact that carefully selected quality interventions can have on pursuing and achieving quality goals, and improving the performance of the health system. This includes a list of illustrative quality interventions.

PHC health systems evidence Primary Health Care Performance Initiative (PHCPI), 2017

The database provides access to quantitative and qualitative research evidence for strengthening PHC systems, including governance and financial issues and implementation strategies that can support change in health systems. Policy briefs and systematic reviews of the literature on particular topics are available and can be searched for evidence to support NQPS in relation to primary care.

Designing national quality reforms: a framework for action

International Journal for Quality in Health Care, 2007(open access peer-reviewed publication)

Based on many years of work within the UK health system, this conceptual framework was developed to guide the process of organizing and translating available research evidence into decision-making for quality improvement. It provides a detailed classification system for organizing the evidence available around quality improvement interventions, and an approach for selecting and implementing appropriate interventions at various levels of the health system.

Quality of care: a process for making strategic choices in health systems

WHO, 2006 This resource incorporates guidance on several components related to the NQPS process, including tools to guide the development, selection, mapping and implementation of quality-related interventions.

Standards

Licensing

Inspection

Workforce

Incentives

Benchmarking

Engagement


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185992/pdf/main.pdf



https://who-meeting.webex.com/mw3300/mywebex/nbrshared.do?action=playback&siteurl=who-meeting&portalLink=nbrRecordingPlayback&recordID=64784852&recordKey=4832534b000000044545f4b32d45dbb8b372f7b990bce05ed710b5489632912084c115894e8c55ab&serviceRecordID=64785302

https://www.hcpperformancereview.org/

http://documents.worldbank.org/curated/en/482771530290792652/pdf/127816-REVISED-quality-joint-publication-July2018-Complete-vignettes-ebook-L.pdf



https://academic.oup.com/intqhc/article/19/6/334/1792599

https://academic.oup.com/intqhc/article/19/6/334/1792599

http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf







https://improvingphc.org/tools

13The eight elements of national quality policy and strategy — Improvement methods and interventions




Country examples

Mexico National Strategy for Strengthening Quality in Health Care Services: Levels and actionsp 30–40NQPS Learning Pod

Secretariat of Health, Mexico 2017

This strategy document outlines a series of thirty actions (interventions) to be implemented as part of the strategy. These are presented by health system level: national; regional/state; institutional/organizational; community; and person (users and workforce). The strategy document also highlights whether these are new interventions, previous interventions no longer in place that should be recovered, or existing interventions that should be strengthened. An overview is provided for each selected intervention. Such a framework is recommended as part of the NQPS approach and this strategy from Mexico provides a helpful example of how packages of interventions can be tailored to local need and included in the national strategic approach.

The quest for quality: refining the NHS reforms. A Policy Analysis and Chartbook

Nuffield Trust, 2008(Open access peer-reviewed publication)

This paper presents a detailed policy analysis and presentation of data reflecting the state of quality and impact of reforms. It acts as a useful reference for policy‑makers embarking on a national quality effort, providing a country example that presents a range of quality-sensitive indicators, reflecting on the implications of these for potential policy and strategy options. The paper has detailed discussion of various quality interventions applied in the context of the English national health system.


https://www.nuffieldtrust.org.uk/files/2017-01/quest-for-quality-report-web-final.pdf



14


The eight elements of national quality policy and strategy — Health management information systems (HMIS) and data systems

Health management information systems (HMIS) and data systems

Development and implementation of NQPS is supported by access to reliable data on health status and provider performance. Planning for improvement of data and measurement systems is likely to be a key element of policies and strategies. The tools and resources outlined in this section support assessment and improvement of current data and measurement systems to support NQPS development, implementation and monitoring of progress.




Tools and resources

Routine health information systems: a curriculum on basic concepts and practice

MEASURE Evaluation, 2017

This document forms part of a core course developed to improve capacity in relation to routine health information systems (RHIS). It provides guidance for programme planners and analysts to review, analyse and manage data collected from health facilities using an RHIS, and to use this information to strengthen service delivery and inform decision-making for health service improvement.

Data quality review (DQR) toolkit

WHO, Gavi, the Vaccine Alliance, Global Fund to Fight AIDS, Tuberculosis and Malaria, USAID, MEASURE Evaluation, 2017

This toolkit outlines an approach to assessing the quality of data generated by health facility information systems. It is divided into three modules: framework and metrics; desk review of data quality; and data verification and system assessment. Each section contains guidelines, explanations, and examples to assist with each step in the process.

Health facility and community data toolkit

WHO, 2014 This toolkit sets out the ideal attributes of a health facility information system and presents tools and resources to support countries in strengthening health information systems. It includes an “action agenda” that sets out the steps required for comprehensive systems improvement, signposting to further technical information, and a checklist of key items and attributes.

Strengthening health information infrastructure for health care quality governance: good practices, new opportunities and data privacy protection challenges

Organisation for Economic Co operation and Development (OECD), 2013

The report details the progress made in developing health information infrastructure in OECD countries, with a focus on electronic health record systems and the link between health and health care data.

Improving health information systems for decision-making across five sub-Saharan African countries: implementation strategies from the African Health Initiative

BMC Health Services Research, 2013

The African Health Initiative established population health implementation and training partnerships in five countries (Ghana, Mozambique, Rwanda, United Republic of Tanzania and Zambia) to catalyse advances in strengthening health information systems. The article describes the experiences of these countries, compares their approaches, and details the resulting challenges and positive impacts on strengthening of health information systems.

District Health Information System 2 (DHIS2)

Health Information Systems Programme, University of Oslo

DHIS2 is currently used in more than 40 countries in Africa, Asia and Latin America. DHIS2 is a free software platform for reporting, analysing and disseminating data in health systems. It can be used to collate and store information regarding individuals, events and facilities. The Health Information Systems Programme provides tutorials, demonstrations and training for potential users.

Country examples

Health management information systems (HMIS) capacity building resource


The resource presents training materials used to support the implementation of a health management information system in Ethiopia, including a facilitator’s guide and practical training manuals.

Indicators of the Status of a Health Information System


The Health Information System Strengthening Model (HISSM) developed by MEASURE Evaluation, represents the project’s current understanding of HMIS in low‑ and middle‑income countries. A list of 30 indicators which reflect the model have been selected. Associated country profiles explore the status of a country’s information systems through these indicators. Each profile includes links to national health strategies, streamlined health indicators, links to national health statistics websites, and health statistics reports, where available. At least 40 countries worldwide (including ones from sub-Saharan Africa, South-east Asia and South and Central America) currently have a populated profile available.

DHIS20%45%

https://www.measureevaluation.org/resources/publications/sr-16-135a



http://www.who.int/healthinfo/tools_data_analysis/dqr_modules/en/

http://www.who.int/healthinfo/tools_data_analysis/dqr_modules/en/

http://www.who.int/healthinfo/facility_information_systems/Facility_Community_Data_Toolkit_final.pdf?ua=1

http://www.who.int/healthinfo/facility_information_systems/Facility_Community_Data_Toolkit_final.pdf?ua=1

https://read.oecd-ilibrary.org/social-issues-migration-health/strengthening-health-information-infrastructure-for-health-care-quality-governance_9789264193505-en#page1






https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668230/pdf/1472-6963-13-S2-S9.pdf






https://www.dhis2.org/about

https://www.dhis2.org/about

https://www.measureevaluation.org/resources/training/capacity-building-resources/health-management-information-systems-hmis-1



https://www.measureevaluation.org/his-strengthening-resource-center/country-profiles/indicators-of-the-status-of-a-health-information-system

https://www.measureevaluation.org/his-strengthening-resource-center/country-profiles/indicators-of-the-status-of-a-health-information-system



15The eight elements of national quality policy and strategy — Quality indicators and core measures



Without robust measurement, it is impossible to know whether given activities are leading to improvement. Standardized indicators allow health care providers and policy-makers to assess progress across all levels of health care and all stages of the process of implementing a national quality initiative. Development of a pragmatic quality indicators framework, drawing on existing guidance and illustrative indicator lists, allows data to drive policy, decision-making and improvement.




Tools and resources

The 2018 Global Reference List of 100 Core Health Indicators (plus health-related SDGs)

WHO, 2018 The second edition of the Global Reference List builds on the 2015 standard set of core health indicators prioritized by the global health community, to provide concise information on the health situation and trends of a country. It aims to provide guidance for the selection of standard indicators and their definitions that countries can use for monitoring, in accordance with their individual circumstances, capacity and health goals and priorities.

High-quality health systems in the Sustainable Development Goals era: time for a revolution Fig. 14Sample high-quality health system dashboard with illustrative indicators

Lancet Global Health Commission on High Quality Health Systems in the SDG Era (HQSS), 2018

This sample quality data dashboard, published as part of the Lancet Commission on High-quality health systems in the Sustainable Development Goals era (HQSS) provides an illustrative infographic that could be used to provide a holistic overview of the state of quality within a country. It is structured in broad domains of system competence, positive user experience, health and well‑being, and confidence and economic development. Within each of these, illustrative indicators are proposed, though these could be adjusted dependent on local priorities and the availability of data. This dashboard is a useful example of the type of indicator framework a country might consider developing to support the presentation of data, that can be used to drive improvement through national quality policy and strategy.

Towards a common mapping tool for measurement in health service delivery

WHO, 2018 To meet the global need for capacity-building to measure service delivery and health care quality, the WHO Department of Service Delivery and Safety (SDS) developed an interim concept note that discusses the concepts and principles of measuring health service delivery. The document presents a mapping tool for health service delivery measurement; a list of pre‑existing measurement and evaluation efforts; and a brief plan for identifying and analysing gaps in these efforts and for building capacity in quality measurement.

Global efforts in measuring quality of care

WHO, 2018 This document classifies 29 existing global indicator lists in relation to various quality domains. It signposts to the source of each indicator list, giving a brief explanation of its content and relevance to quality-related work.

OECD Health Care Quality and Outcomes Programme

The Organisation for Economic Co-operation and Development (OECD), 2017

This links to the main OECD webpage which hosts a variety of publications related to health care quality indicators, including the OECD Health Statistics Database, the full dataset of their health care quality indicators, links to the most recent versions of other publications such as Health at a Glance, and also explains the OECD Framework For Health System Performance Measurement.

PHC vital signs user guide Primary Health Care Performance Initiative (PHCPI), 2016

This guide explains the PHCPI 25 PHC vital signs database. It contains indicators for PHC system performance in LMICs, with instructions on how to interpret them, compare countries in relation to the indicators, and assess country performance over time. It also explains the implications of these data for policy recommendations and improvement initiatives.

http://apps.who.int/iris/bitstream/10665/259951/1/WHO-HIS-IER-GPM-2018.1-eng.pdf?ua=1



https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(18)30386-3.pdf#page=34



https://apps.who.int/iris/bitstream/handle/10665/260555/WHO-HIS-SDS-2018.5-eng.pdf?ua=1



http://apps.who.int/iris/bitstream/handle/10665/260544/WHO-HIS-SDS-2018.1-eng.pdf

http://apps.who.int/iris/bitstream/handle/10665/260544/WHO-HIS-SDS-2018.1-eng.pdf

http://www.oecd.org/health/health-care-quality-framework.htm

http://www.oecd.org/health/health-care-quality-framework.htm

https://improvingphc.org/tools/phc-vital-signs-user-guide



16


The eight elements of national quality policy and strategy — Quality indicators and core measures



Monitoring, evaluation and review of national health strategies: a country-led platform for information and accountability

WHO, IHP+, 2011 This resource presents guidance on developing country capacity for the monitoring and evaluation of national health strategic plans, including illustrative indicators and a tool for conducting a situational analysis of the health information system.

Getting the measure of quality: opportunities and challenges

The King’s Fund, 2010

The document discusses how quality is defined, and how quality measures can be used – and misused. It sets out the difficulties and choices faced by those involved in measuring and using data on quality and outlines some practical issues to be considered when choosing and using quality measures and making use of this information to improve patient care.

Country examples

Ghana National Healthcare Quality Strategy 2017–2021

Chapter 8: Measuring Improvement


Ghana’s National Healthcare Quality Strategy (NHQS) includes a set of indicators related to quality and measuring improvement. Draws from existing indicators included in the country’s Health Sector Medium-Term Development Plan and also proposes new quality-related indicators.

Ethiopian National Quality Strategy 2016–2020

Section 7: Measuring Improvement

Ministry of Health Ethiopia, 2015

This section of the Ethiopia National Quality Strategy details the country’s quality indicator framework. Explains the set of prioritization criteria used when selecting quality indicators, and provides a detailed description of each, mapped out over their selected quality domains.

Quality of healthcare in Canada: a chartbook

Canadian Health Services Research Foundation, 2010

This quality chartbook from Canada is a helpful example of how to provide an overview of the state of health care quality in a country, drawing on a range of sources to build a comprehensive picture that can allow shared understanding among policy-makers. It presents data on quality across the health system, and is structured according to six domains: effectiveness, access, safety, capacity, patient-centredness and equity. The chartbook collates data produced by national, sub-national, academic, professional and patient organizations. While the setting is a high-income country, the approach and principles could be usefully replicated by any country looking to gather and present data on the state of quality, as part of their efforts to develop and implement national directions on quality.

https://www.internationalhealthpartnership.net/fileadmin/uploads/ihp/Documents/Tools/M_E_Framework/M%26E.framework.2011.pdf




https://www.kingsfund.org.uk/sites/default/files/Getting-the-measure-of-quality-Veena-Raleigh-Catherine-Foot-The-Kings-Fund-January-2010.pdf

https://www.kingsfund.org.uk/sites/default/files/Getting-the-measure-of-quality-Veena-Raleigh-Catherine-Foot-The-Kings-Fund-January-2010.pdf

http://www.moh.gov.gh/wp-content/uploads/2017/06/National20Quality20Strategy20Ghana.pdf

http://www.moh.gov.gh/wp-content/uploads/2017/06/National20Quality20Strategy20Ghana.pdf



https://www.cfhi-fcass.ca/migrated/pdf/chartbook/CHARTBOOK Eng_June_withdate.pdf

https://www.cfhi-fcass.ca/migrated/pdf/chartbook/CHARTBOOK Eng_June_withdate.pdf

17Operational planning


Operational planningThe purpose of the tools and resources listed in this section is to assist countries in moving from policy and strategy to detailed planning for implementation. Operations plans can support practical implementation and execution of NQPS, assigning roles and responsibilities to various stakeholders, identifying timeframes and budgets, and outlining monitoring arrangements.




Tools and resources

NQPS operational planning: sample template NQPS Learning Pod

WHO NQPS team, 2017

The resource gives an illustrative example of a basic operational planning template, outlining the elements included in an operational plan, and providing an example of how this may be constructed.

Strategizing national health in the 21st century: a handbookChapter 6: Operational planning: transforming plans into action

WHO, 2016 This chapter is extracted from “Strategizing National Health in the 21st Century.” This practical handbook provides guidance on national health planning and strategizing for health, characterising a wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs).

Key characteristics of strategic and operational planningTable 6.1

The table summarizes the differences between strategic planning and operational planning.

Example of a hypothetical operational plan using the pivot table function of a spreadsheetBox 6.5

The box provides an explanation, using the pivot table function of a spreadsheet, in relation to providing an operational plan.

Key stakeholders and their roles in operational planningTable 6.2

A table setting out the roles and responsibilities of various actors, which could easily be applied to NQPS activities related to operational planning.

District health profileBox 6.7

A district health profile can be a useful tool in establishing an understanding of the health situation locally. Those involved in the operation plan can then use this as a foundation for operational planning, according to local needs.

Country examples

Sudan national health care quality policy and strategySection 7: high-level milestones and timeline for 24 monthsNQPS Learning Pod

Ministry of Health, Sudan, 2017

Related to the initial implementation phase of the Sudan national health care quality policy and strategy, this section of the document clarifies the roadmap and structure, as well as the roles and responsibilities of stakeholders.

Strategizing national health in the 21st century: a handbookChapter 6: Operational planning: transforming plans into action Box 6.2

WHO, 2016 An example operational planning checklist from a Cambodian provincial health department office. Provides a sample checklist of the tasks, timeline and responsible parties involved in creating the operational plan. This can easily be adapted for quality-related work.

Ghana National Healthcare Quality Strategy 2017–2021Part 2: Coordination and accountability framework


The resource describes the strategy implementation plan that accompanies the Ghana National Healthcare Quality Strategy. The document is divided into three parts: general considerations governing implementation; coordination of the action plan and accountability; and financial management for interventions.


https://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter6-eng.pdf;jsessionid=6E942D58BAF766D5887186B42038DE0E?sequence=20




http://apps.who.int/iris/bitstream/10665/250221/20/9789241549745-chapter6-eng.pdf#page=16

















18




In many countries, existing disease‑ or population‑specific programmes ‑ such as those addressing HIV or maternal and child health - are already engaged in important work to improve the quality of care. These can be key assets to supporting the development and implementation of NQPS, facilitating engagement of key stakeholders, maximizing the impact and efficiency of existing work and identifying entry points to improving quality. Integration of these programmes with NQPS efforts is critical.




Tools and resources

Options for Integrating Infection Prevention & Control (IPC) into National Strategic Direction on QualityNQPS Learning Pod

WHO, 2018 This cross‑walk paper sets out an approach for integrating IPC efforts with NQPS development, explaining how each of the eight NQPS elements and core components of an IPC programme align. This provides a useful example of how integration with technical programmes can support NQPS.It was used as the basis for a group exercise during the WHO Tackling Deadly Diseases in Africa Program (TDDAP) workshop held in Kampala, Uganda, where 12 countries were represented. The meeting report is available here.

WASH and Quality: Deep dive approach paperNQPS Learning Pod

WHO, 2016 This paper presents a methodology for a deep dive exercise which can be used by countries to examine the linkages between water, sanitation and hygiene (WASH) and quality UHC. It makes the case for using WASH as a pathfinder for quality and describes the relationship between strengthening WASH infrastructure and improving quality. It presents an approach specifically for linking WASH improvement efforts with NQPS.

Country examples

WHO Global Learning Laboratory for Quality UHC Action Brief: Integrating Infection Prevention and Control into National Directions on Quality in LiberiaNQPS Learning Pod

Liberia Ministry of Health, 2019

This brief describes the efforts taken forward by Liberia on quality of care, building on initial efforts on IPC during the 2014‑2016 Ebola virus disease outbreak in West Africa. It articulates how structures and functions developed during the outbreak were strengthened and repurposed with a holistic systems-approach to quality of care.

WHO Global Learning Laboratory for Quality UHC Action Brief: Utilizing Maternal and Child Health as a pathfinder for moving forward on national quality policy in MalawiNQPS Learning Pod

Quality Management Department, Ministry of Health Malawi, 2018

Two‑page briefing document describing the ways in which Malawi is using the improvement of maternal and newborn care as an entry point and pathfinder for quality of care at the national level. It also describes the role of the Malawi Health Sector Strategic Plan, and Quality Management Policy in this process.

WHO Global Learning Laboratory for Quality UHC Action Brief: Integrating Quality and Health Security in the United Republic of TanzaniaNQPS Learning Pod

WHO, 2017 This brief explains the cross-linkages between emergency preparedness and quality of health service delivery in the Tanzanian context. It details the steps taken to ensure that health security capacity development and health care quality are integrated and planned for at the national strategic and policy level.









19Community engagement


Community engagementMeaningful engagement and empowerment of communities served by health services are essential for quality of care. It is important to consider how a culture of engagement can be promoted and sustained, both in the development and in the implementation of the quality policy and strategy. Although there remain critical gaps in the products available to support community engagement in health policy and strategy development, the resources outlined here provide a starting point for teams involved in such efforts.




Tools and resources

WHO community engagement framework for quality, people-centred and resilient health services

WHO, 2017 This report details the process underpinning the collaborative development of the WHO community engagement framework for quality, people-centred and resilient health services. It describes the strategy undertaken to conceptualize a definition of community engagement related to quality, integrated, people-centred and resilient health services. The framework can inform NQPS activities.

WHO recommendation on community mobilization through facilitated participatory learning and action cycles with women’s groups for maternal and newborn health

WHO, 2014 A summary of the evidence found on the effectiveness of community mobilization through facilitated participatory learning and action cycles with women’s groups involved in improving maternal and newborn health outcomes. It also explains the principles of community mobilization and participatory learning, which could be applied to the development and implementation of any policy or strategy, including NQPS.

A framework for community engagement in primary health

Primary Health and Chronic Disease Management, Saskatoon Health Region, Canada, 2012

This framework comprises a “virtual GPS” roadmap for successful community engagement, drawing on experiences from the Primary Health Care Team of the remote Saskatoon region of Canada. It includes a step-by-step process guide for successful community engagement in a change process (e.g. NQPS implementation), with reflective questions to guide the process.

Principles of community engagement: second edition

Clinical and Translational Science Awards Consortium: Community Engagement Key Function Committee Task Force on the Principles of Community Engagement, 2011

This resource presents a broad but comprehensive overview of the principles of community engagement (including case examples). It also includes a discussion on the organizational capacity required to support community engagement, and the relationship between community engagement and evaluation of improvement initiatives. The material is relevant to NQPS development in that it provides a useful introduction to a complex topic that is central to achieving quality.

Engaging communities for health improvement: a scoping study for the Health Foundation

Health Foundation, 2009 This scoping study was carried out to identify entry points for the Health Foundation to assist in health systems quality improvement through community engagement. It discusses several of the principles of community engagement in health, providing context and evidence for its success as a quality improvement method. It also contains examples of existing projects in the United Kingdom that promote community engagement, with some specific examples of the interface between community engagement and quality improvement.

Country examples

A rough guide to community engagement in performance-based incentive programmes with lessons from Burundi, Indonesia and Mexico

USAID, Health Systems 20/20, 2012

This guide examines performance-based incentive programmes from the perspective of communities playing an active role in their design or implementation, rather than offering incentives for entering into community engagement. Lessons and recommendations in the guide are based, in part, on research conducted in three countries implementing performance-based incentive programmes, namely Burundi, Indonesia and Mexico.

http://apps.who.int/iris/bitstream/10665/259280/1/WHO-HIS-SDS-2017.15-eng.pdf




http://www.who.int/maternal_child_adolescent/documents/community-mobilization-maternal-newborn/en/







https://www.saskatoonhealthregion.ca/locations_services/Services/Primary-Health/Documents/SHR framework for community engagement.pdf

https://www.saskatoonhealthregion.ca/locations_services/Services/Primary-Health/Documents/SHR framework for community engagement.pdf

https://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf

https://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf

http://www.health.org.uk/sites/health/files/EngagingCommunitiesForHealthImprovement.pdf




https://www.hfgproject.org/rough-guide-community-engagement-performance-based-incentive-programs-lessons-burundi-indonesia-mexico/








20


Cross-cutting tools and resources

Cross-cutting tools and resourcesThere are a number of published tools and resources and seminal guidance documents with relevance across many elements of the NQPS planning and implementation process, which are listed below.

Of note, a number of finalized national quality policy and strategy documents are available in a repository housed within the WHO Global Learning Laboratory for Quality UHC.




Tools and resources

Delivering Quality Health Services: A Global Imperative for Universal Health Coverage

WHO, Organisation for Economic Co-operation and Development (OECD), World Bank, 2018

This joint report describes the essential role of quality in health care service delivery and emphasizes the critical linkages between quality and universal health coverage. It articulates a quality call to action for policy-makers and governments and sets out the key actions required in order to achieve the goal of access to high-quality, people-centred health services for all.

Crossing the Global Quality Chasm: Improving Health Care Worldwide

The National Academies of Science, Engineering and Medicine, 2018

Following on from the landmark Institute of Medicine (IOM) report: Crossing the Quality Chasm: A New Health System for the 21st Century (2001), this further seminal report from the National Academies of Sciences, Engineering and Medicine examines in detail the impacts of poor quality health care. It reviews global research evidence on quality of care, highlighting deficiencies in progress towards the achievement of universal health coverage worldwide, and makes the case for comprehensive investment in the improvement of health care quality in order that the benefits of UHC may be realized.

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Lancet Global Health Commission on High Quality Health Systems in the SDG Era (HQSS), 2018

This significant piece of work aims to bring quality to the forefront in health systems and galvanize research and action on improving quality of care. The Commission brings together 30 academics, policy-makers, and health system experts from 18 countries. The report proposes a new definition for high quality health systems, describes the current state of health system quality, examines the ethics of good quality care, and reviews the current status of quality measurement in LMICs. A set of recommendations are presented to guide policy and investment for high quality health systems.

Improving the quality of health services – tools and resources

WHO, 2018 This tools and resources compendium is concerned with improving quality as related to health services and service delivery. It is a collation of the resources currently used within the WHO Service Delivery and Safety department with a focus on quality improvement.

Technical Series on Primary Health Care: Quality in Primary Health Care

WHO, 2018 This background document for the Global Conference on Primary Care, which took place in Astana, Kazakhstan, in October 2018, provides an overview of the key issues relating to quality in primary health care and its importance in achieving universal health coverage. Aimed at governments and policy-makers, it explains quality improvement as a core function of primary health care, and the importance of NQPS in quality efforts. It outlines the relationship between health systems and high-quality primary health care and suggests some example interventions which may be implemented to improve care at the PHC level.

National quality policy and strategy: driving change for stronger health systems and improved health outcomes

WHO NQPS team, 2018 Advocacy for NQPS cuts across all stages of NQPS development. The purpose of this document is to support countries in engaging with stakeholders on NQPS. With the establishment of quality directorates in a number of countries, this document is intended to facilitate discussions and help obtain high-level commitment to quality.

Strategizing national health in the 21st century: a handbook

WHO, 2017 This practical handbook provides guidance on national health planning and strategizing for health, outlining the wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs).




http://www.nationalacademies.org/hmd/Reports/2018/crossing-global-quality-chasm-improving-health-care-worldwide.aspx



https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(18)30386-3.pdf




https://apps.who.int/iris/bitstream/handle/10665/310944/9789241515085-eng.pdf?ua=1



http://www.who.int/docs/default-source/primary-health-care-conference/quality.pdf?sfvrsn=96f411e5_2



http://www.who.int/servicedeliverysafety/areas/qhc/national-quality-policy-strategy.pdf





http://www.who.int/healthsystems/publications/nhpsp-handbook/en/

http://www.who.int/healthsystems/publications/nhpsp-handbook/en/



21Cross-cutting tools and resources




Tools and resources

Eight core tenets of primary health care improvement in middle- and high-income countries

Primary Health Care Performance Initiative (PHCPI), 2017

The resource describes eight core principles that are fundamental to establishing a quality PHC system in low-, middle- or high-income countries (based on the China health study).

HSE Framework for Improving Quality in our Health Service

Health Service Executive, Ireland, 2016

The “Framework for Improving Quality” resource has been developed to articulate the strategic approach to improving quality across various levels of the health service in Ireland. It describes the various “drivers of quality” within the Framework and details the key components of each, as they relate to strengthening quality.

So what? Strategies across Europe to assess quality of care

European Commission Expert Group on Health Systems Performance Assessment, 2016

This report includes suggestions and recommendations for policy-makers with reference to the design, set-up, running and evaluation of systems to assess quality of care, including examples from several different European countries.

Quality of care: what are effective policy options for governments in low- and middle-income countries to improve and regulate the quality of ambulatory care?

WHO Regional Office for the Western Pacific, 2015

The report presents a summary of evidence for the different policy options available to governments wishing to improve quality of care in ambulatory settings in LMICs.

Service availability and readiness assessment (SARA)

WHO, 2015 This health facility assessment tool assists users in assessing health systems readiness and gathering data for health systems planning and management. Of note, the revised version (likely to be called Health Facility Assessment tool) will contain a quality module. This is currently in development and being field tested in‑country.

National Health Planning Tools Resource Centre

WHO, 2010 This online portal enables users to search a selection of published WHO tools and resources that support national health planning.

Guidance on developing quality and safety strategies with a health system approach

WHO Regional Office for Europe, 2008

The guidance gives an overview of key considerations to take into account when developing a quality and safety strategy and includes a tool to support situational analysis and selection of strategic approaches.

The Alberta Quality Matrix for Health

Health Quality Council of Alberta, 2005

This tool is based on the work of the landmark Institute of Medicine (IOM) report: Crossing the Quality Chasm: A New Health System for the 21st Century (2001). It can be applied to various activities in relation to NQPS development, as an educational tool to define the concept of quality in health care or to introduce common language when developing a shared quality definition. Population of the matrix that composes this tool will differ according to the individual user and context, and not all the cells will be relevant to every situation. It can easily be adapted to apply to a country’s own quality domains or dimensions and priority areas.

Country examples

WHO Global Learning Laboratory for Quality UHC Action Brief: Developing and implementing the Sudanese Quality Policy and StrategyNQPS Learning Pod

Quality Directorate, Sudan Ministry of Health, 2019

This briefing document summarizes the process of NQPS development and implementation in Sudan over a three-year period. It highlights the successes and challenges experienced during implementation of the Sudanese NQPS, for example the difficulties experienced in the rollout of the country’s hospital accreditation programme.

Uganda’s Health Care Quality Improvement Journey

USAID Applying Science to Strengthen and Improve Systems Project, 2018

This report documents the story of efforts in Uganda to improve quality of care. Uganda represents a rare example of a low-income setting with a long history of focused, strategic efforts to improve quality of care across the system. The report outlines a number of key lessons that may help guide the efforts of teams developing national quality policy and strategy. In particular, it provides a useful overview of how different parts of the quality system can work together, notably the complementarity of national strategic efforts and point of care improvement initiatives.

https://improvingphc.org/8-core-tenets-primary-health-care-improvement-middle-and-high-income-countries




https://www.hse.ie/eng/about/who/qid/framework-for-quality-improvement/framework-for-improving-quality-2016.pdf

https://www.hse.ie/eng/about/who/qid/framework-for-quality-improvement/framework-for-improving-quality-2016.pdf

https://ec.europa.eu/health/sites/health/files/systems_performance_assessment/docs/sowhat_en.pdf



https://apps.who.int/iris/bitstream/handle/10665/208217/9789290616955_eng.pdf?sequence=1&isAllowed=y

http://www.who.int/healthinfo/systems/sara_introduction/en/

http://www.who.int/healthinfo/systems/sara_introduction/en/

https://extranet.who.int/nhptool/default.aspx

https://extranet.who.int/nhptool/default.aspx

http://www.euro.who.int/__data/assets/pdf_file/0011/96473/E91317.pdf?ua=1



https://www.hqca.ca/wp-content/uploads/2018/05/HQCA_User_Guide_Web.pdf

https://www.hqca.ca/wp-content/uploads/2018/05/HQCA_User_Guide_Web.pdf


https://www.usaidassist.org/sites/default/files/usaid_assist_uganda_qi_journey_dec2018.pdf

https://www.usaidassist.org/sites/default/files/usaid_assist_uganda_qi_journey_dec2018.pdf






22


WHO Global Learning Laboratory for Quality Universal Health Coverage: http://www.who.int/servicedeliverysafety/areas/qhc/gll/en/

or contact [email protected]

WHO quality in universal health coverage: http://www.who.int/servicedeliverysafety/areas/qhc/en/

WHO maternal, newborn, child and adolescent health quality of care: http://www.who.int/maternal_child_adolescent/topics/quality‑of‑care/definition/en/

International Society for Quality in Health Care:https://isqua.org

Institute for Healthcare Improvementhttp://www.ihi.org/Pages/default.aspx

The Organisation for Economic Co-operation and Development: http://www.oecd.org/els/health-systems/health-care-quality-and-outcomes.htm

USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project: https://www.usaidassist.org/

The World Bank: http://www.worldbank.org/en/topic/health

Jhpiego: https://www.jhpiego.org/

Useful links

http://www.who.int/servicedeliverysafety/areas/qhc/gll/en/

mailto:[email protected]

http://www.who.int/servicedeliverysafety/areas/qhc/en/

http://www.who.int/maternal_child_adolescent/topics/quality-of-care/definition/en/

https://isqua.org

http://www.ihi.org/Pages/default.aspx

http://www.oecd.org/els/health-systems/health-care-quality-and-outcomes.htm

https://www.usaidassist.org/

http://www.worldbank.org/en/topic/health

https://www.jhpiego.org/


23

References

1. Sustainable Development Goals. New York: United Nations (http://www.un.org/sustainabledevelopment/sustainable-development-goals/, accessed 24 October 2019).

2. Health financing for universal coverage. Geneva: World Health Organization (http://www.who.int/health_financing/universal_coverage_definition/en/, accessed 24 October 2019).

3. Service delivery and safety: World Health Assembly adopts Framework on Integrated People-centred Health Services. Geneva: World Health Organization; 2016 (http://www.who.int/servicedeliverysafety/areas/people-centred-care/framework-wha/en/, accessed 24 October 2019).

4. National quality policy and strategy: WHO initiative. Geneva: World Health Organization (http://www.who.int/servicedeliverysafety/areas/qhc/nqps/en/, accessed 24 October 2019).

5. Service delivery and safety: WHO Global Learning Laboratory for Quality UHC. Geneva: World Health Organization (https://www.who.int/servicedeliverysafety/areas/qhc/gll/en/, accessed 24 October 2019).

6. National quality policy and strategy. WHO meeting report: co‑defining a pathway for impact. WHO Global Learning Laboratory for Quality UHC, 14–16 June 2017. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/10665/258989/1/WHO-HIS-SDS-2017.14-eng.pdf, accessed 24 October 2019).

http://www.un.org/sustainabledevelopment/sustainable-development-goals/

http://www.un.org/sustainabledevelopment/sustainable-development-goals/

http://www.who.int/health_financing/universal_coverage_definition/en/

http://www.who.int/health_financing/universal_coverage_definition/en/

http://www.who.int/servicedeliverysafety/areas/people-centred-care/framework-wha/en/

http://www.who.int/servicedeliverysafety/areas/people-centred-care/framework-wha/en/

http://www.who.int/servicedeliverysafety/areas/qhc/nqps/en/

http://www.who.int/servicedeliverysafety/areas/qhc/nqps/en/

https://www.who.int/servicedeliverysafety/areas/qhc/gll/en/



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