Quality Health Services: A Planning Guide (WHO Quality Toolkit)

Overview

The guide is for staff working at all levels of the health system who have a role in enhancing the quality of health services. It is also relevant to all stakeholders initiating and supporting action at facility, district and/or national levels both in the public and private sectors.

Quality health services: a planning guide supports implementation of key actions at the national, district and facility levels to enhance the quality of health services. It highlights the need for a health systems approach to enhancing quality of care, and for a common understanding of the essential activities among all stakeholders.

Activities within the guide are categorized as either ‘start-up’ or ‘ongoing’, although in practice these phases tend to overlap. Activities that can be conducted during the initial stages of improvement – and that will help make progress faster – are listed as start-up activities. Activities that either take a longer time to carry out, or are needed on an ongoing basis for sustainability, are listed as ongoing activities.

The litmus test for any health system is the quality of health services that are delivered at the point of care and the health outcomes that the system achieves for its populations. The guide helps to organize thinking on the multi-level actions required for quality health services.

Guiding Principles

To avoid quality improvement efforts becoming a vertical, this standalone initiative requires building quality-related capacity among the existing health system leadership at all levels, with a strong emphasis on primary health care. These system considerations are critical for the sustainability of the actions taken to enhance quality, and together contribute to a set of guiding principles that underpin the guidance described in this resource:

1. Start fast. The only way to reduce mortality and improve experience of care is to change what is happening at facilities and communities; therefore, the focus should be on initiating improvement activities as soon as possible. Planning is most effective when it is informed by implementation..

2. Build on existing structures and functions. Improving quality is a fundamental activity of the health system. The responsibility for quality must lie with system leadership, managers and frontline staff. Sustainability of quality activities is dependent on how aligned they are to existing structures and functions.

3. Support health workers. Health workers often work in conditions that are difficult, under-resourced and that hinder excellence. Systemic conditions – such as poor organization of care, unclear goals, wasteful rules, inadequate information flows – prevent health workers from carrying out their tasks successfully. Thus, a clear focus is required to support health workers.

4. Improve care for people. All efforts to improve service delivery must be directed towards improving clinical outcomes and patient experience of care. Effective and compassionate care for patients and the community should be central to all activities. Changes in systems and processes of service delivery should aim to put people at the centre of care.

5. Adapt to context. Activity plans should be adapted based on evidence from implementation as well as local context. We need to learn what different levels of the system need to do to enhance quality. There is always room for doing things better. It is only when we identify problems that they can be addressed. Good ideas should be shared across the system to support further adaptation.

Five foundational requirements for quality health services are relevant to national, district and facility levels.

• Onsite support 
• Measurement
• Sharing and learning
• Stakeholder and community engagement
• Management