As countries begin national efforts to improve quality of care, many have recognized the benefits of developing a coherent plan that provides structure, guidance and direction on quality at all levels of the health system. NQPS can help clarify the linkages with national health policies, plans and priorities, can highlight the importance of quality-focused processes in achieving overall health priorities, and also help to define lines of accountability to work towards quality people-centred health services. This handbook aims to support the process of developing NQPS. The handbook is not a prescriptive guide, but rather a structured approach that helps ensure that the development and implementation of NQPS are as comprehensive and smooth as possible.
This handbook is designed to support those governments and policy-makers (at the national, state and provincial levels) considering whether and how to develop an NQPS or those already in the process of developing one. It may also be helpful for technical advisers, donors and other stakeholders supporting governments in areas related to NQPS. While much of this handbook has been designed to support the development of NQPS in low- and middle-income countries, which may face particular challenges to improving quality of care, the processes outlined are relevant to any national or subnational authority preparing or reviewing their national efforts on quality of care.
While terminology varies between different countries and organizations, the handbook proposes that there is value in countries developing both a quality policy and a strategy. The policy is a statement of the vision, direction and rationale for the national effort to improve quality of care, and may outline broad priorities to be addressed. It may be expressed in a number of different ways, for example as a separate policy document, a national quality statement, or as part of a broader national health policy document. Policy can be a useful tool for engaging stakeholders, building support for the national quality effort and establishing the structures and environment needed for success. The strategy then goes on to provide a clear explanation of how the policy will be put into practice, including detail on how each of the priorities will be met, and provides a clear framework for organizing the initiative. Strategy provides the level of detail needed to drive implementation. Policy and strategy should, of course, be developed and applied in an integrated manner, taking account of country needs and context.
Each country will approach the development of NQPS differently, but the handbook stresses the critical importance of integration with existing health plans and priorities. Development of NQPS should build on and complement the national health planning process. Quality is a key consideration as countries move towards universal health coverage, and the success of NQPS requires action all the way across the health system. For more information on national health policy and planning, please see the WHO Health Systems Governance webpage.
No. This handbook outlines an approach towards the development of NQPS and has been co-developed with the input of countries that have embarked on their own national quality efforts, as well as technical partners, and experts from across WHO. It has also been informed by a review of existing national policies and strategies.
In many countries, existing disease or population specific programmes are already engaged in important work to improve the quality of care, and these can be key assets to supporting the development and implementation of NQPS. This handbook discusses options for meaningful integration of NQPS and relevant technical programmes, but envisages that further resources will then be developed to support these efforts. Further information on the Quality of Care Network for Maternal, Newborn and Child Health is available here.
Measuring quality of care is extremely difficult and complex. The handbook outlines a basic approach to strengthening information systems and selecting indicators to support NQPS, and proposes carrying out a review of existing illustrative indicator lists as part of this process. The focus is on quality measurement that is achievable, of practical value, and context-specific. Further resources are available in the accompanying tools compendium, available on the WHO Global Learning Laboratory for Quality UHC.
The handbook focuses on the process for developing national policy and strategy on quality of care, which can provide structure to national initiatives. Quality improvement plays a critical role in improving processes across the health care system, and dedicated training and reference materials are available from a number of specialist technical organizations on this aspect.
Infection prevention and control (IPC) and patient safety are critical foundations for achieving quality care. While the handbook focuses specifically on the development of national policy and strategy, WHO has produced detailed technical resources to support assessment and interventions for IPC and patient safety, both of which may be key early action areas within a national effort to improve quality of care.
The WHO Global Learning Laboratory (GLL) for Quality UHC links the experiences, expertise, passion and wisdom of people across the world, representing multiple disciplines, on important issues relating to quality in the context of UHC. The focus is to accelerate global learning informed by local action in the area of quality service delivery.
The handbook is supplemented by a compendium of tools and resources, which provides tools, country examples and other knowledge products that can be used by teams developing national quality policy and strategy. The compendium is available on The WHO Global Learning Laboratory (GLL) for Quality UHC within the NQPS learning pod, providing a “safe space” in which tools and resources can be shared, discussed, refined and adapted.
WHO continues to respond to country requests for technical support to develop national quality policy and strategy, through country offices, regional offices and at WHO headquarters.
The approach outlined in the handbook will continue to be refined, based on learning shared by countries developing national quality policy and strategy. Further tools and resources will be collated and developed based on country need.
Translations of the handbook into other WHO languages are also planned.