improving the quality of health services - tools and …...improving the quality of health services...

Improving the quality

of health services -

tools and resources

Improving the quality of health services: tools and resources

ISBN 978-92-4-151508-5

© World Health Organization 2018

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Improving the

quality of

health services -

tools and resources

compiled by the

WHO Service Delivery and Safety Department DECEMBER 2018

This document has been developed by an Improvement cross-cut team within the Department of Service Delivery and Safety (SDS) at WHO headquarters. The document aims to support implementation of quality improvement approaches to make health services more effective, safe and people-centred. The document brings together the main tools and resources focused on quality improvement currently in use within the SDS department.

Contents

8 Introduction

10 Service delivery and quality

improvement

12 Tools and resources for improving

the quality of health services

45 Quality improvement resources in

development

52 Annex 1: Rapid mapping of quality

improvement definitions

57 Annex 2: Further information

58 Annex 3: Process note – WHO SDS

improvement cross-cut

THE COMPENDIUM AT A GLANCE

What is the compendium?

The tools and resources described in this document (hereafter referred to as “the compendium”) are a resource for WHO Member States aiming to improve the quality of service delivery. The compendium collates current tools and resources on quality improvement (QI) developed by the WHO Service Delivery and Safety Department (SDS) and provides examples of how the tools and resources have been applied in country settings.

Who is the compendium for?

• Ministries of health, quality improvement teams, researchers and development agencies.

• WHO technical programmes, regional and country offices in their technical cooperation work with country counterparts and donors.

• Those working to improve the quality of health service delivery.

Why is it needed?

• The compendium has been developed to collate existing resources that facilitate quality improvement in service delivery.

• As a technical resource for countries in support of quality improvement efforts within health service delivery.

• Highlight adaptable tools and resources that can support local quality improvement efforts.

SDS technical areas and type of tools

Technical AreasTraditional complementary and integrative medicine

Emergency and essential surgery

Primary care

Blood safety

Palliative care

Hospital management

People-centred care

Infection prevention and control

Emergency

Policies, strategies and plans

Community engagement

Institutional health partnerships

Patient safety

Types of tools and resources

Guidance

Implementation

Advocacy

Manuals

Capacity-building

Guidelines

Frameworks

Research

Assessment

Training resources

How could I use the compendium?

• As a reference list of helpful tools and resources aimed at improving the quality of health services.

• As an overview of available tools and resources for quality improvement that have been developed by WHO.

• As a starting point for further technical collaboration with partners and WHO expertise in these respective subject areas.

• The current compendium is not an exhaustive list of QI interventions. It should be used in conjunction with other existing evidence-based guidance. The compendium is grouped into two sections: the first part of the compendium provides an overview of finalized tools and resources. The second part of the compendium collates tools and resources currently under development. Where applicable, case studies have been provided.

7

Improving the quality of

health services: tools and resources8

Introduction

The adoption of the sustainable development goals (SDGs) placed additional emphasis

on improving overall human development by 2030. Improving health outcomes is at the forefront of this global commitment, with Goal 3 calling on all stakeholders to “ensure healthy lives and promote well-being for all at all ages”. The SDGs also reaffirm a global commitment to advancing universal health coverage (UHC). Its focus is to ensure that all people and communities have access to the quality health services they need, without facing financial hardship. The momentum towards UHC is rooted in the principles of the Alma-Ata Declaration (1) which identified health as a human right. To realize the goal of health for all and achieve universal access to quality health services, the

1 Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12: World Health Organization (http://www.who.int/publications/almaata_declaration_en.pdf?ua=1 accessed 20 August 2018)

WHO Framework for Integrated People-Centred Health Services (IPCHS) calls for a fundamental shift from health systems designed around diseases and health institutions towards health systems designed for people (2). Globally, there is a need to look beyond service coverage and financial protection and emphasize improvements in quality service delivery at the core of country action. This is because quality of health services, coupled with service coverage will play a critical role in strengthening national health systems and improving health outcomes.

Global consensus on quality is emerging. Three major publications on quality have been published in 2018: first, the joint WHO-World Bank-OECD publication on the delivery of quality health services as a global imperative for UHC; then, the Lancet Global

2 Framework on integrated people-centred health services. Report by the secretariat: World Health Organization ( http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1 accessed 20 August 2018)

http://www.who.int/publications/almaata_declaration_en.pdf?ua=1

http://www.who.int/publications/almaata_declaration_en.pdf?ua=1

http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1



9INTRODUCTION

high quality health systems in the SDG era; and third, the US National Academies of Science Report on Improving the Quality of Health Care Globally. Each call for action on quality improvement. This document is developed in anticipation of and in support of this collective call and will be refined further over time.

There is an increasing collective recognition that quality health services should be:

• effective: providing evidence-based health care services to those who need them;

• safe: avoiding harm to people for whom the care is intended and reducing the risk of unnecessary harm associated with health care to an acceptable minimum;

• people-centred: adopting the perspectives of individuals, carers, families and communities as participants in, and beneficiaries of, trusted health systems that are organized around the comprehensive needs of people, rather than individual diseases, and that respect social preferences.

In addition, in order to achieve the benefits of quality health care, health services should also be:

• timely: reducing waiting times and sometimes harmful delays for both those who receive and those who give care;

• equitable: providing care that does not vary in quality on account of age, sex, gender, race, ethnicity, geographical location, religion, socioeconomic status, linguistic or political affiliation;

• integrated: providing care that is coordinated across the entire spectrum of health care services and providers and makes available the full range of health services throughout the life course;

• efficient: maximizing the benefit of available resources and avoiding waste.



Service delivery and quality

improvement

Improvement in the quality of health care is a pivotal entry point for health systems strengthening. Quality

improvement (QI) approaches play a role in improving the quality of health services delivered across the various levels of the health system – primary, secondary and tertiary. QI approaches support the identification of various service delivery gaps, produce solutions to address identified gaps and mitigate potential service delivery bottlenecks. The experience surrounding QI approaches in improving care in specific areas such as maternal, neonatal and child health, HIV/AIDS, TB/Malaria programmes is well documented. Technical programmes and development agencies have adhered to various definitions of quality improvement.

Findings from a rapid mapping of these quality improvement definitions can be found in Annex 1.

The collation of these definitions points to a consensus on certain essential principles for quality improvement to be effective and sustainable.

Principles:

• commitment from senior leadership

• ownership by people and teams

• developing locally identified solutions

• improvement of input structures

• clearly identified roles and responsibility of team members

• continuous monitoring and learning for improvement

• feedback and incentive mechanisms.

11Service delivery and quality improvement

Building on this rapid scanning and the grounding principles, a quality improvement intervention can be defined across various levels of the health system.

Focusing on change processes, a quality improvement intervention can be defined as “a change process in health care systems, services, or suppliers for the purpose of increasing the likelihood of optimal clinical quality of care measured by positive health outcomes for individuals and populations” (3).

At the organizational level, a quality improvement intervention can be defined as “an organizational strategy that formally involves the analysis of process and outcomes data and the application of systematic efforts to improve performance” (3).

Building further, a working definition of quality improvement definition co-developed by the WHO headquarters SDS Improvement cross-cut team reads as follows:

3 Evidence-based Practice Center systematic review protocol: closing the quality gap 2010:quality improvement interventions to address health disparities. Rockville, MD: Agency for Healthcare Research and Quality; 2012 (https://effectivehealthcare.ahrq.gov/topics/ disparities-quality-improvement/research-protocol, accessed 19 February 2018)

Quality improvement is the action of every person working to implement iterative, measurable changes, to make health services more effective, safe and people-centred.



Tools and resources for

improving the quality

of health services

Goal and objectives

The overall goal of this document is to provide a resource for countries seeking to improve the

quality of their health service delivery.

The document:

• collates existing WHO tools and resources on quality improvement; and

• outlines the use of the tool or resource as applied in service delivery.

The primary inclusion criteria for the tools and resources included in this document is that they must be applicable for country support. Thereby, the document provides practical examples of how the tool was applied in-country, including relevant links with other areas, such as measurement.

The document focuses on tools and resources developed within the WHO Service Delivery and Safety Department. It is not, therefore, an exhaustive list of service delivery and safety tools and resources across WHO or

beyond. Of particular note, the document is not designed as a standards setting tool.

The categorization of the tools and resources in this document has been informed by the WHO publications categorization system. Types of tools include training and capacity-building tools, along with text books and guidance documents. Resources include advocacy documents, country reports, meeting reports and technical reports. Documents listed as guidelines have all gone through the WHO Guideline Review Committee process.

Target audience

The target audience for this document are ministries of health, facility quality improvement teams, researchers and development agencies.

WHO technical programmes, regional and country offices can also use the document in their technical cooperation work with the identified audience. Those working to improve the quality of health service delivery can also make good use of this resource.

13Tools and resources for improving the

quality of health services

Gaps

Development of the document allowed gaps to be identified in the quality improvement tools and resources that exist. Of particular note is that:

• improvement and measurement are inter-related; however, a number of the identified QI tools and resources made little or no mention of measurement considerations;

• there is currently no mechanism to track the application of SDS tools and resources in-country, once finalized, such an approach would contribute to the refinement of the tools, informed by implementation experience.

These gaps will allow a set of recommendations to be developed that will inform future development of quality improvement resources.

A feedback loop mechanism is currently under development to prospectively track the application of the resource at the country level. This feedback mechanism will allow for input into the adoption and usage of tools at the country level. It could also help to shed light on the adaptation of emerging global tools and to identify promising case studies at the country level. This mechanism will be linked strongly with the WHO SDS corporate web page, once activated.

Implications for countries and WHO

The document has clear implications for the work on service delivery for country level engagement and internally within WHO. The document can:

• provide framing and catalyse action on quality improvement activities and facilitate WHO’s support to ministries of health on quality of care;

• support the implementation of WHO normative standards on quality of care by highlighting available tools and resources in service delivery;

• serve as a facilitator and bring about convergence of the work on quality improvement within WHO, working closely with the WHO Taskforce for Quality UHC.

Structure of the document

Each section addresses a technical area. The structure is standardized with detailed information on finalized WHO SDS documents. The first level of the document provides an overview of WHO SDS tools and resources. Where applicable, case studies and key lessons learnt have been provided. A second section of the document outlines tools and resources that are currently in development within SDS.



Part I. structure Tools and resources finalized

Name of tool (Year)

Type of tool Audience Summary description

Key lessons learnt Interlinkages with other areas

1. Quality improvement in emergency settings

Name of tool (year)

Type of tool

Audience Summary description Key lessons learnt Interlinkages with other areas

Recovery Toolkit (2015)

Training / capacity-building

Policy-makers, front-line staff, civil society, academic researchers

The Recovery Toolkit is a library of guidance resources in a single place which can be quickly and easily accessed, to guide action. A key purpose of the Recovery Toolkit is to support countries in the reactivation of health services which may have suffered as a result of a public health emergency. These services include ongoing programmes such as maternal and child health services, and noncommunicable diseases. But in addition, and because the Toolkit contains core information needed to achieve functioning national and sub-national health systems, it also supports countries to implement their national health plans during the recovery phase of a public health emergency.

Use of the early Recovery Toolkit addresses a key challenge – how to identify and access the best and most up-to-date technical resources to support action planning and action. Bringing together the resources of vertical programmes in one place has the potential to enhance efficiency.

The “resource supplement” of the WHO, World Bank and OCED report “Delivering quality health services: a global imperative for UHC” provides a compendium of resources that measure and report quality of care at the international level, according to pre-determined measurement tools.

Building back from the Ebola outbreak in Liberia: spotlight on country voices

Liberia: I’m confident that the early recovery toolkit will increase awareness and access among partners and countries of the products/resources available. This awareness can help to achieve high standards, prevent inefficient duplication of effort and wheel reinvention and encourage communication and coordination when it is most needed.

- Alex Gasasira, WHO Representative, Liberia

http://www.who.int/csr/resources/publications/ebola/recovery-toolkit/en/

http://www.who.int/csr/resources/publications/ebola/recovery-toolkit/en/



2. P

olicies, s

tra

teg

ies

and

plans

Nam

e of

tool

(y

ear)

Type

of

tool

Audi

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Su

mm

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Inte

rlink

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prov

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uilt

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alth

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ach

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the

goal

of

acce

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hig

h qu

ality

, peo

ple-

cent

red

heal

th se

rvic

es

for a

ll. F

or m

ore

info

rmat

ion

visi

t http

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w.wh

o.in

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edel

ivery

safe

ty/q

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y-re

port/

en/

No le

sson

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s yet

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com

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easu

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n

WHO

Ha

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Qual

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The

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out

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s and

thos

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th e

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secu

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early

stak

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buy-

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as re

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end

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Cou

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Hand

book

reve

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fforts

to b

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ruct

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and

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thro

ugh

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ussi

on.

https://apps.who.int/iris/bitstream/handle/10665/272465/9789241513906-eng.pdf?ua=1








http://www.who.int/servicedeliverysafety/quality-report/en/

http://www.who.int/servicedeliverysafety/quality-report/en/

http://www.who.int/servicedeliverysafety/measurement/en



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







Case

stud

y 1: N

atio

nal q

ualit

y pol

icy a

nd st

rate

gy in

Sud

an

In S

udan

, the

app

roac

h ou

tline

d in

the

NQPS

Han

dboo

k ha

s bee

n us

ed to

gui

de th

e pr

oces

s of d

evel

opin

g a

natio

nal q

ualit

y pol

icy a

nd st

rate

gy. W

orki

ng in

col

labo

ratio

n wi

th th

e W

HO

Suda

n Co

untry

Offi

ce, W

HO E

aste

rn M

edite

rrane

an R

egio

nal O

ffice

, and

WHO

hea

dqua

rters

Ser

vice

Del

ivery

and

Saf

ety d

epar

tmen

t, th

e Su

dan

Fede

ral M

inis

try o

f Hea

lth le

d a

mul

ti-st

akeh

olde

r pro

cess

to d

evel

op a

nd im

plem

ent a

nat

iona

l qua

lity p

olic

y and

stra

tegy

. Sud

an h

as a

rela

tivel

y lon

g hi

stor

y of e

fforts

to im

prov

e qu

ality

of c

are,

with

a q

ualit

y dire

ctor

ate

havi

ng b

een

esta

blis

hed

in th

e Fe

dera

l Min

istry

of H

ealth

in 2

001.

Fol

lowi

ng so

me

succ

ess w

ith se

tting

stan

dard

s and

rolli

ng o

ut in

itiat

ives o

n pa

tient

safe

ty a

nd in

fect

ion

prev

entio

n an

d co

ntro

l, the

re w

as in

crea

sing

mom

entu

m b

ehin

d a

new

push

for q

ualit

y car

e dr

iven

by p

ublic

exp

ecta

tions

, res

ourc

e co

nstra

ints

, and

the

ongo

ing

thre

at o

f em

ergi

ng o

utbr

eaks

and

em

erge

ncie

s.

Deve

lopm

ent o

f the

nat

iona

l qua

lity p

olic

y and

stra

tegy

in S

udan

invo

lved

cons

ider

atio

n of

all

eigh

t ess

entia

l ele

men

ts o

utlin

ed in

the

Hand

book

: ide

ntifi

catio

n of

nat

iona

l hea

lth

goal

s and

prio

ritie

s; c

o-de

velo

pmen

t of a

loca

l def

initi

on o

f qua

lity;

stak

ehol

der m

appi

ng a

nd e

ngag

emen

t; co

mpr

ehen

sive

situ

atio

nal a

naly

sis;

sele

ctio

n of

impr

ovem

ent m

etho

ds

and

inte

rven

tions

; cla

rific

atio

n of

gov

erna

nce

and

orga

niza

tiona

l stru

ctur

es; a

sses

smen

t and

stre

ngth

enin

g of

hea

lth m

anag

emen

t inf

orm

atio

n sy

stem

s; a

nd id

entif

icat

ion

of q

ualit

y in

dica

tors

and

cor

e m

easu

res.

Eac

h st

age

of th

e pr

oces

s was

supp

orte

d by

WHO

wor

king

in c

lose

col

labo

ratio

n wi

th c

olle

ague

s lea

ding

eac

h el

emen

t in

the

Fede

ral M

inis

try o

f Hea

lth.

Tool

s and

reso

urce

s to

supp

ort t

he p

roce

ss, s

uch

as th

ose

for s

ituat

iona

l ana

lysi

s, we

re a

dapt

ed to

the

spec

ific

loca

l con

text

, and

dat

a co

llect

ion

tool

s wer

e co

-dev

elop

ed.

A ke

y obs

erva

tion

of a

pply

ing

the

Hand

book

pro

cess

in S

udan

is th

at th

e ei

ght e

lem

ents

are

not

to b

e se

en a

s sep

arat

e en

titie

s in

a lin

ear p

roce

ss, b

ut a

s int

erco

nnec

ted

cons

ider

atio

ns

in a

bro

ader

pro

cess

of p

olic

y and

stra

tegy

dev

elop

men

t. Fo

r exa

mpl

e, id

entif

icat

ion

of n

atio

nal g

oals

, dev

elop

men

t of t

he lo

cal q

ualit

y def

initi

on, a

nd e

lem

ents

of t

he si

tuat

iona

l an

alys

is w

ere

all i

ncor

pora

ted

in a

larg

e st

akeh

olde

r eng

agem

ent p

roce

ss.

Anot

her k

ey le

sson

from

the

Suda

n NQ

PS e

xper

ienc

e is

the

impo

rtanc

e of

ear

ly e

ngag

emen

t of k

ey st

akeh

olde

rs. F

or e

xam

ple,

it wa

s ide

ntifi

ed e

arly

on,

that

whi

le th

e Fe

dera

l Min

istry

of

Hea

lth w

as re

spon

sibl

e fo

r pol

icy a

nd st

rate

gy d

evel

opm

ent,

othe

r sta

te m

inis

tries

wou

ld b

e re

spon

sibl

e fo

r im

plem

entin

g. T

hus,

thei

r ear

ly a

nd m

eani

ngfu

l eng

agem

ent w

as c

ritic

al

to su

cces

s.

The

Suda

n ex

perie

nce

also

em

phas

ized

the

impo

rtanc

e of

ens

urin

g th

at th

e pr

oces

s out

lined

in th

e Ha

ndbo

ok is

supp

orte

d by

det

aile

d op

erat

iona

l pla

nnin

g an

d m

onito

ring

of th

e im

plem

enta

tion

effo

rt. S

ituat

iona

l ana

lysi

s rev

eale

d th

at, w

here

this

had

not

occ

urre

d, p

revi

ous n

atio

nal e

fforts

had

bee

n le

ss su

cces

sful

.

In g

ener

al, t

he n

atio

nal t

eam

dev

elop

ing

the

polic

y and

stra

tegy

felt

that

the

NQPS

pro

cess

was

rele

vant

to th

eir s

ettin

g an

d us

eful

as a

foun

datio

n fo

r the

ir in

itiat

ive. H

owev

er, s

ome

tool

s, re

sour

ces a

nd a

spec

ts o

f the

app

roac

h di

d ha

ve to

be

adap

ted

to th

e lo

cal c

onte

xt, a

nd fu

rther

tech

nica

l sup

port

was r

equi

red

to b

uild

the

capa

city

of t

he lo

cal t

eam

to c

ompl

ete

the

NQPS

pro

cess

. Pop

ulat

ion

leve

l im

pact

is n

ot ye

t kno

wn, b

ut th

e NQ

PS p

roce

ss it

self

prom

otes

bui

ldin

g of

syst

ems o

f mea

sure

men

t to

asse

ss th

e im

pact

of n

atio

nal q

ualit

y effo

rts.



3. C

ommun

ity e

nga

gemen

t

Nam

e of

tool

(yea

r)Ty

pe o

f to

olAu

dien

ce

Sum

mar

y des

crip

tion

Key l

esso

ns le

arnt

In

terli

nkag

es w

ith o

ther

are

as

Enha

nced

Cap

acity

Bu

ildin

g Tr

aini

ng fo

r Fr

ont-l

ine

Staf

f on

Build

ing

Trus

t and

Co

mm

unic

atio

n:

Faci

litat

or’s

Guid

e (2

016)

Trai

ning

/

Capa

city

-bu

ildin

g

Tech

nica

l st

aff

work

ing

in su

rvei

llanc

e an

d em

erge

ncy

This

trai

ning

gui

de c

ontri

bute

s to

impr

ovin

g th

e qu

ality

of e

mer

genc

y re

spon

ses.

It w

as d

esig

ned

to im

prov

e th

e qu

ality

of s

urve

illan

ce a

ctiv

ities

by

equi

ppin

g fro

nt-li

ne st

aff w

ith th

e sk

ills

and

tool

s to

enga

ge w

ith c

omm

uniti

es

in w

ays t

hat b

uild

trus

t, su

ppor

t the

up

take

of p

ublic

hea

lth in

terv

entio

ns

and

cont

ribut

e ov

eral

l to

achi

evin

g in

fect

ion

prev

entio

n an

d co

ntro

l ob

ject

ives,

such

as d

urin

g an

Ebo

la

outb

reak

.

1. T

rain

ed st

aff d

emon

stra

ted

grea

ter

know

ledg

e an

d m

ore

posi

tive

attit

udes

re

gard

ing

trust

bui

ldin

g an

d co

mm

unic

atio

n wi

th c

omm

uniti

es.

2. T

rain

ed st

aff r

epor

ted

high

er le

vels

of

conf

iden

ce in

thei

r abi

lity t

o bu

ild tr

ust a

nd

com

mun

icat

e ef

fect

ively.

3.

Fro

nt-li

ne st

aff b

oth

repo

rted

and

dem

onst

rate

d a

grea

ter a

bilit

y to

turn

fru

stra

tion

into

opp

ortu

nitie

s for

dia

logu

e.

4. F

ront

-line

staf

f wor

ked

to b

uild

trus

t by

work

ing

with

com

mun

ity m

embe

rs to

im

prov

e liv

ing

cond

ition

s eve

n th

ough

such

ta

sks a

re c

onsi

dere

d ou

tsid

e th

eir ‘

norm

al’

job

func

tions

.

Alth

ough

spec

ifica

lly d

evel

oped

for t

he

2014

Ebo

la re

spon

se in

Sie

rra L

eone

, co

nten

t of t

his f

acili

tato

r’s g

uide

can

be

ada

pted

and

use

d by

hea

lth st

aff

acro

ss va

rious

func

tions

that

dire

ctly

in

tera

ct w

ith c

omm

unity

mem

bers

.

Unde

rsta

ndin

g an

d M

anag

ing

Fear

- Tr

aini

ng fo

r Hu

man

itaria

n W

orke

rs

in E

mer

genc

ies

[vid

eo]

(201

6)

Capa

city

-bu

ildin

g

Fron

t-lin

e st

aff i

n em

erge

ncie

s

This

tech

nica

l vid

eo c

ontri

bute

s to

qual

ity im

prov

emen

t in

resp

onse

op

erat

ions

. It w

as sp

ecifi

cally

de

velo

ped

as p

art o

f a tr

aini

ng p

acka

ge

to h

elp

heal

th p

rofe

ssio

nals

and

re

spon

se st

aff p

repa

re to

eng

age

and

com

mun

icat

e wi

th E

bola

-affe

cted

co

mm

uniti

es. T

he vi

deo

desc

ribe

how

fear

influ

ence

s bio

logi

cal, p

hysi

olog

ical

, em

otio

nal, c

ogni

tive

and

beha

viou

ral

resp

onse

s and

the

impo

rtanc

e of

this

kn

owle

dge

for h

ealth

pro

fess

iona

ls to

be

abl

e to

pro

mot

e co

nnec

tivity

and

bu

ild tr

ust w

ith in

divi

dual

s, fa

mili

es a

nd

com

mun

ities

who

are

exp

erie

ncin

g fe

ar.

The

vide

o is

rele

vant

for e

mer

genc

y pr

epar

edne

ss, r

espo

nse

and

reco

very

. It

can

also

be

appl

ied

to lo

ng-te

rm

heal

th sy

stem

s stre

ngth

enin

g ef

forts

.

http://www.who.int/servicedeliverysafety/areas/qhc/trust-communication_training-guide.pdf?ua=1






https://www.youtube.com/watch?v=jwjVYDJUXs8







Nam

e of

tool

(yea

r)Ty

pe o

f to

olAu

dien

ce

Sum

mar

y des

crip

tion

Key l

esso

ns le

arnt

In

terli

nkag

es w

ith o

ther

are

as

Com

mun

ity

enga

gem

ent

fram

ewor

k fo

r qua

lity,

peop

le-c

entre

d an

d re

silie

nt h

ealth

se

rvic

es

(201

7)

Mee

ting

repo

rt Pr

ogra

mm

e, m

anag

ers,

polic

y-m

aker

s, re

sear

cher

s, an

d te

chni

cal

partn

ers

The

CEQ

mee

ting

repo

rt in

trodu

ces

a fra

mew

ork

that

inst

itutio

naliz

es

com

mun

ity e

ngag

emen

t as a

fu

ndam

enta

l com

pone

nt o

f hea

lth

serv

ice

desi

gn a

nd d

elive

ry. T

he C

EQ

fram

ewor

k de

scrib

es ke

y fea

ture

s th

at th

e he

alth

syst

em n

eeds

to h

ave

to b

e pr

epar

ed a

nd re

ady t

o en

gage

wi

th se

rvic

e us

ers,

thei

r fam

ilies

and

lo

cal c

omm

uniti

es. T

he p

roce

ss u

sed

to g

ener

ate

the

CEQ

fram

ewor

k is

als

o de

scrib

ed.

The

CEQ

fram

ewor

k wa

s gen

erat

ed b

y id

entif

ying

impo

rtant

inte

rface

poi

nts b

etwe

en

heal

th se

rvic

es, s

ervi

ce u

sers

and

loca

l co

mm

uniti

es th

at im

pact

serv

ice

qual

ity,

peop

le-c

entre

dnes

s and

resi

lienc

e. T

he C

EQ

fram

ewor

k wi

ll be

use

d to

gen

erat

e ev

iden

ce

arou

nd a

pac

kage

of e

ngag

emen

t int

erve

ntio

ns

that

supp

ort c

ontin

uous

qua

lity i

mpr

ovem

ent.

The

CEQ

was d

evel

oped

join

tly w

ith th

e He

alth

Pro

mot

ion

and

Soci

al D

eter

min

ants

Un

it in

the

WHO

Afri

can

Regi

onal

Offi

ce a

nd

will

be fi

eld-

test

ed w

ith th

e Gl

obal

Mal

aria

Pr

ogra

mm

e, M

ater

nal a

nd C

hild

Hea

lth, H

IV

and

Imm

uniza

tion

depa

rtmen

ts w

ithin

WHO

.

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








Case

stud

y 2: C

omm

unity

eng

agem

ent a

s a m

echa

nism

to im

prov

e th

e qu

ality

of s

urve

illan

ce a

nd b

uild

trus

t with

com

mun

ities

dur

ing

the

2013

-201

6 Eb

ola

viru

s dis

ease

res

pons

e in

Si

erra

Leo

ne

This

cap

acity

-bui

ldin

g pr

ojec

t (th

e in

terv

entio

n) re

spon

ded

to a

n id

entif

ied

need

in E

bola

-affe

cted

cou

ntrie

s to

addr

ess c

omm

unity

trus

t and

impr

ove

the

qual

ity o

f rel

atio

nshi

ps

betw

een

front

-line

staf

f and

com

mun

ities

, par

ticul

arly

surv

eilla

nce

staf

f who

wer

e co

nduc

ting

case

inve

stig

atio

n an

d co

ntac

t tra

cing

act

iviti

es –

crit

ical

to p

reve

ntin

g an

d co

ntro

lling

fu

rther

spre

ad o

f Ebo

la vi

rus d

isea

se.

Som

e of

the

outc

omes

soug

ht w

ere

grea

ter r

ecep

tivity

of f

ront

-line

staf

f to

com

mun

ities

, incr

ease

d tru

st b

etwe

en fr

ont-l

ine

staf

f and

qua

rant

ined

fa

mili

es a

nd im

prov

ed c

apac

ity o

f loc

al st

aff t

o de

sign

and

del

iver f

ollo

w-up

trai

ning

s.

A co

nsul

tativ

e an

d ite

rativ

e pr

oces

s of c

o-de

velo

pmen

t and

co-

lear

ning

bet

ween

mul

tiple

stak

ehol

ders

(dis

cipl

inar

y exp

erts

and

par

tner

s) a

t glo

bal, n

atio

nal a

nd lo

cal l

evel

s was

m

anag

ed b

y WHO

thro

ugho

ut d

esig

n an

d im

plem

enta

tion

of th

e pr

ojec

t. Th

e in

terv

entio

n wa

s rol

led

out i

n Si

erra

Leo

ne in

col

labo

ratio

n wi

th th

e He

alth

Edu

catio

n Un

it an

d th

e De

partm

ent o

f Dis

ease

Pre

vent

ion

and

Cont

rol.

Ove

r 600

hea

lth p

erso

nnel

acr

oss t

hree

dis

trict

s wer

e tra

ined

by a

mixe

d in

tern

atio

nal a

nd n

atio

nal t

eam

of t

rain

ers.

The

trai

ning

pr

ogra

mm

e ce

ntre

d on

faci

litat

ed a

nd e

xper

ient

ial a

dult-

cent

red

lear

ning

. Int

erlin

ked

mod

ules

incl

uded

: rea

ctive

and

rece

ptive

em

otio

nal s

tate

s; d

ialo

gic

tech

niqu

es to

man

age

conv

ersa

tion

chal

leng

es; t

rust

bui

ldin

g;, u

nder

stan

ding

cul

ture

, etc

.

Key l

esso

ns le

arnt

.

1.

The

desi

gn o

f int

erdi

scip

linar

y tra

inin

g to

impr

ove

serv

ice

deliv

ery h

as to

be

led

and

deliv

ered

by c

onte

nt sp

ecia

lists

abl

e to

des

ign

and

deliv

er tr

aini

ng a

nd w

ho a

re sk

illed

in

faci

litat

ion.

Thi

s ena

bled

trai

ners

to c

ontin

uous

ly a

dapt

and

resp

ond

to th

e ne

eds o

f par

ticip

ants

.

2.

Havi

ng m

ixed

coho

rts th

at in

clud

ed su

rvei

llanc

e of

ficer

s, vi

llage

and

relig

ious

lead

ers,

soci

al m

obili

zatio

n st

aff a

nd E

bola

surv

ivors

enh

ance

d th

e pr

oces

s of l

earn

ing

and

also

bui

lt im

porta

nt re

latio

nshi

ps b

etwe

en d

iffer

ent g

roup

s who

nee

ded

to w

ork

toge

ther

.

3.

It wa

s im

porta

nt to

ens

ure

that

the

train

ing

team

had

the

right

com

posi

tion

to e

nsur

e th

at re

leva

nt te

chni

cal c

onte

nt w

as a

vaila

ble

and

ques

tions

cou

ld b

e an

swer

ed. I

t als

o en

sure

d th

at e

ngag

emen

t cap

abili

ty w

as b

uilt

and

stay

ed w

ithin

loca

l sys

tem

s.

In-tr

aini

ng e

valu

atio

n sh

owed

that

mea

n pa

rtici

pant

com

fort

in e

ngag

ing

with

the

com

mun

ity in

crea

sed

and

post

-trai

ning

cas

e st

udy i

nter

view

s als

o sh

owed

that

fron

t-lin

e st

aff w

ere

bette

r abl

e to

turn

frus

tratio

ns in

to o

ppor

tuni

ties f

or d

ialo

gue,

bette

r de-

esca

late

tens

ions

and

nur

ture

gre

ater

trus

t. Th

is w

as a

lso

obse

rved

by W

HO st

aff o

n th

e gr

ound

who

saw

surv

eilla

nce

offic

ers q

uick

ly d

e-es

cala

ting

tens

e si

tuat

ions

.

Look

ing

ahea

d, th

is e

xper

ienc

e sh

ould

serv

e as

a c

all f

or fu

rther

wor

k to

inte

grat

e co

mm

unity

eng

agem

ent m

ore

syst

emat

ical

ly w

ithin

nat

iona

l sur

veill

ance

syst

ems,

as a

way

of

impr

ovin

g th

e qu

ality

, res

pons

ivene

ss a

nd p

eopl

e-ce

ntre

dnes

s of s

urve

illan

ce sy

stem

s.



4. Inst

itut

ional

healt

h pa

rtner

ships

Nam

e of

tool

(y

ear)

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt

Inte

rlink

ages

with

oth

er a

reas

Twin

ning

Pa

rtner

ship

s for

Im

prov

emen

t: St

eps 1

-6

(201

8)

Trai

ning

/Ca

paci

ty-

build

ing

Adm

inis

trato

rs,

front

-line

staf

f, po

licy-

mak

ers

The

mod

el is

bas

ed o

n a

6-st

ep c

ycle

wh

ich

begi

ns w

hen

two

partn

ers a

gree

to

esta

blis

h a

partn

ersh

ip. T

PI g

uide

s the

re

spec

tive

partn

ers t

hrou

gh a

syst

emat

ic

proc

ess,

in o

rder

to id

entif

y are

as fo

r im

prov

emen

t, de

velo

p an

act

ion

plan

to

impl

emen

t im

prov

emen

ts, a

nd th

en

eval

uate

the

prog

ress

ion

and

chan

ges

mad

e to

ward

s qua

lity i

mpr

ovem

ent.

The

6 st

eps r

elat

ed to

impr

ovem

ent i

nclu

de:

partn

ersh

ip d

evel

opm

ent,

need

s ass

essm

ent,

gap

anal

ysis

, act

ion

plan

ning

, act

ion

and

eval

uatio

n.

1. A

ckno

wled

ge th

at g

aps

exis

t, th

at im

prov

emen

ts

are

need

ed a

nd a

gree

/co

mm

it to

a p

artn

ersh

ip

appr

oach

as t

he m

eans

of

impr

ovem

ent.

2. J

oint

iden

tific

atio

n of

pro

blem

s and

co-

deve

lopm

ent o

f the

in

terv

entio

ns u

sing

a

syst

emat

ic a

ppro

ach

to

addr

ess t

he im

prov

emen

t ar

ea(s

).3.

Con

side

r spr

ead

and

sust

aina

bilit

y of h

ealth

se

rvic

e im

prov

emen

ts fr

om

onse

t of a

ctiv

ity(s

) at t

he

hosp

ital l

evel

(inc

ludi

ng

natio

nal a

nd su

b-na

tiona

l le

vel)

Step

6 o

f the

par

tner

ship

mod

el is

dire

ctly

re

late

d to

mea

sure

men

t. In

the

Libe

ria/J

apan

co

untry

exa

mpl

e, th

e pa

rtner

s wor

ked

toge

ther

to

colle

ctive

ly d

evel

op a

mon

itorin

g an

d ev

alua

tion

plan

. Thi

s will

be

plac

ed w

ithin

the

cont

ent o

f th

e co

mpe

ndiu

m. T

ools

and

reso

urce

s rel

atin

g to

ev

alua

tion

are

also

cap

ture

d in

this

doc

umen

t.

https://www.who.int/servicedeliverysafety/twinning-partnerships/en/






Case

stud

y 3: P

artn

ersh

ip d

evel

opm

ent a

nd co

ntin

ued

stre

ngth

enin

g –

Japa

n an

d Li

beria

The

Partn

ersh

ip b

etwe

en N

agas

aki U

nive

rsity

Hos

pita

l (NU

H) a

nd T

elle

wayo

n M

emor

ial H

ospi

tal (

TMH)

in L

ofa

Coun

ty, L

iber

ia, w

as fo

rmed

in A

ugus

t 201

6. A

t the

tim

e, TM

H wa

s re

cove

ring

from

the

Wes

t Afri

can

Ebol

a ou

tbre

ak o

f 201

4 an

d re

lyin

g on

inte

rnat

iona

l sup

port

to re

activ

ate

its e

ssen

tial h

ealth

serv

ices

and

mov

ing

forw

ard

with

reco

very

effo

rts in

al

ignm

ent w

ith n

atio

nal r

ecov

ery p

lans

. Dur

ing

the

reco

very

at T

MH,

it w

as q

uick

ly re

alize

d th

at im

pact

of t

he E

bola

resp

onse

had

dep

lete

d m

any r

esou

rces

and

that

ext

ensi

ve w

ork

was n

eede

d to

impr

ove

qual

ity. N

UH sa

w th

at th

e ne

eds a

t TM

H we

re e

xten

sive

and

agr

eed

to fo

rm a

par

tner

ship

with

TM

H. T

he M

inis

try o

f Hea

lth a

nd th

e Co

unty

aut

horit

ies i

n Li

beria

su

ppor

ted

this

par

tner

ship

at t

he o

nset

of t

he fo

rmal

TPI

agr

eem

ent.

Care

ful c

onsi

dera

tion

was g

iven

to th

e ar

chite

ctur

e of

the

partn

ersh

ip, r

ecog

nizin

g th

e di

ffere

nt c

ultu

re a

nd

cont

ext o

f the

resp

ectiv

e pa

rtner

s.

Mov

ing

forw

ard

from

this

initi

al p

artn

ersh

ip, a

situ

atio

nal a

sses

smen

t and

gap

ana

lysi

s wer

e co

mpl

eted

at T

MH

in O

ctob

er 2

016.

Fol

lowi

ng th

e ga

p an

alys

is, a

n of

ficia

l “ac

tion

plan

ning

” mee

ting

took

pla

ce in

Dec

embe

r 201

6 wh

ere

both

par

tner

s agr

eed

to ta

ckle

som

e ar

eas w

ithin

infe

ctio

n pr

even

tion

and

cont

rol (

IPC)

such

as h

and

hygi

ene

and

wast

e m

anag

emen

t. It

was n

oted

that

by i

mpr

ovin

g th

ese

two

serv

ices

, ove

rall

qual

ity c

ould

be

impr

oved

thro

ugho

ut th

e wh

ole

hosp

ital.

The

partn

ersh

ip u

nder

took

two

partn

ersh

ip e

xcha

nge

visi

ts in

Lib

eria

and

Jap

an re

spec

tivel

y. Th

e pr

inci

ples

of t

he p

artn

ersh

ip w

ere

rein

forc

ed th

roug

hout

whi

le th

e im

prov

emen

t wor

k pr

ocee

ded.

The

bi-d

irect

iona

lity o

f the

par

tner

ship

lear

ning

was

em

phas

ized.

For

exa

mpl

e, th

e TM

H te

am le

ader

gav

e a

talk

abo

ut th

eir e

xper

ienc

e in

the

Ebol

a re

spon

se, w

hich

NUH

st

ated

they

ben

efite

d gr

eatly

from

bec

ause

they

lear

nt a

bout

the

real

ities

of d

iagn

osis

and

trea

ting

Ebol

a-af

fect

ed p

atie

nts.

In L

iber

ia, t

he te

chni

cal i

mpr

ovem

ents

alig

ned

with

ove

rall

proc

ess a

nd m

anag

eria

l im

prov

emen

ts w

ithin

TM

H.

In li

ght o

f the

thre

e ob

ject

ives o

f TPI

(par

tner

ship

, impr

ovem

ent a

nd sp

read

), th

e 6-

step

mod

el g

uide

d th

e pa

rtner

ship

thro

ugh

the

thre

e cr

ossc

uttin

g ar

eas o

f im

prov

emen

t. In

add

ition

to

the

impr

ovem

ents

mad

e to

IPC

prac

tices

at T

MH,

mea

sure

men

t pro

cess

es w

ere

also

impl

emen

ted

by u

sing

such

tool

s as t

he W

HO h

and

hygi

ene

asse

ssm

ent s

trate

gy. E

ngag

emen

t of

the

com

mun

ity a

nd o

ther

hos

pita

ls in

the

regi

on w

as o

ne o

utco

me

of ‘s

prea

ding

’ the

impr

ovem

ents

. For

exa

mpl

e, th

e le

ader

ship

in L

ofa

Coun

ty h

oste

d a

lear

ning

even

t for

the

impr

ovem

ents

at T

MH

to b

e sh

ared

with

thre

e ot

her a

rea

hosp

itals

. In

sum

mar

y, TP

I is a

com

preh

ensi

ve, c

ross

-cut

ting

mod

el fo

cuse

d on

bui

ldin

g re

latio

nshi

ps, im

prov

emen

ts a

nd th

en

shar

ing

the

know

ledg

e ga

ined

.

The

activ

ities

und

erta

ken

were

in a

lignm

ent w

ith th

e na

tiona

l and

cou

nty h

ealth

pla

ns w

hich

con

tinue

d to

evo

lve a

s the

par

tner

ship

pro

gres

sed.



5. P

atient s

afe

ty

Nam

e of

tool

(y

ear)

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt

Inte

rlink

ages

with

oth

er

area

s

Safe

Chi

ldbi

rth

Chec

klis

t (2

015)

Guid

ance

Do

ctor

s, nu

rses

, m

idwi

ves,

paed

iatri

cian

s, ge

nera

l pr

actit

ione

rs,

and

othe

r birt

h at

tend

ants

in

mat

erni

ty

faci

litie

s

The

WHO

Saf

e Ch

ildbi

rth C

heck

list i

s a to

ol in

tend

ed

to im

prov

e th

e qu

ality

of c

are

for w

omen

and

bab

ies a

t th

e tim

e of

chi

ldbi

rth. T

he C

heck

list i

s an

orga

nize

d lis

t of

evi

denc

e-ba

sed

esse

ntia

l birt

h pr

actic

es ta

rget

ing

maj

or c

ause

s of m

ater

nal d

eath

s, in

trapa

rtum

-rela

ted

still

birth

s and

neo

nata

l dea

ths t

hat o

ccur

in fa

cilit

ies

arou

nd th

e wo

rld.

A co

llabo

rativ

e fie

ld-te

stin

g ex

erci

se w

as c

arrie

d ou

t fro

m 2

012

thro

ugh

2015

to e

xplo

re q

uest

ions

add

ress

ing

com

plia

nce

with

, bar

riers

to a

nd su

cces

s fac

tors

of

effe

ctive

and

sust

aine

d us

e of

the

Chec

klis

t in

a ra

nge

of

setti

ngs a

roun

d th

e wo

rld. T

he re

sults

are

pub

lishe

d at

ht

tp://

www.

who.

int/p

atie

ntsa

fety

/topi

cs/s

afe-

child

birth

/ch

ildbi

rth_c

olla

bora

tion_

enga

ging

/en/

.

The

Chec

klis

t is i

n lin

e wi

th th

e co

mpr

ehen

sive

WHO

Fr

amew

ork

for I

mpr

ovem

ent o

f the

Qua

lity o

f Mat

erna

l an

d Ne

wbor

n Ca

re th

at a

ims t

o ac

hiev

e co

vera

ge o

f ke

y pra

ctic

es, p

eopl

e-ce

ntre

d ou

tcom

es a

nd e

vent

ually

im

prov

ed h

ealth

out

com

es.

1. G

ain

buy-

in fr

om m

anag

ers/

adm

inis

trato

rs in

the

first

inst

ance

. 2.

Ens

ure

that

staf

f hav

e ad

equa

te

know

ledg

e an

d sk

ills t

o ha

ndle

co

mpl

icat

ions

. Men

torin

g an

d tra

inin

g is

one

exa

mpl

e of

bui

ldin

g sk

ills a

nd c

ompe

tenc

ies.

3.

Lac

k of

supp

lies a

nd e

quip

men

t is

a m

ajor

bar

rier t

o su

cces

sful

im

plem

enta

tion

of th

e Ch

eckl

ist.

4. L

ocal

ada

ptat

ion

and

cont

extu

aliza

tion

are

key.

5. In

tegr

ate

Chec

klis

t use

into

the

broa

der q

ualit

y of c

are

impr

ovem

ent

effo

rts fo

r mot

hers

and

new

born

s, in

clud

ing

mot

hers

’ cas

e no

tes.

This

tool

is c

lose

ly li

nked

with

th

e wo

rk o

n im

prov

ing

qual

ity

of m

ater

nal a

nd n

ewbo

rn

care

. For

mor

e in

form

atio

n,

plea

se se

e ht

tp://

www.

who.

int/m

ater

nal_c

hild

_ad

oles

cent

/topi

cs/q

ualit

y-of

-ca

re/e

n/.

Case

stud

y 4: B

ette

r Birt

h st

udy i

n In

dia

The

Bette

rBirt

h st

udy,

cond

ucte

d by

Aria

dne

Labs

(www

.aria

dnel

abs.

org)

from

201

4-20

16 w

as a

mul

ti-ce

ntre

d ra

ndom

ized

cont

rolle

d tri

al to

test

the

WHO

Saf

e Ch

ildbi

rth C

heck

list

(SCC

) in

Utta

r Pra

desh

, Ind

ia. A

t the

hea

rt of

this

stud

y wer

e th

e co

ncep

ts o

f ‘en

gage

’ (bu

y-in

at d

istri

ct a

nd fa

cilit

y lev

el, p

rom

otin

g sy

stem

atic

cha

nge)

, ‘lau

nch’

(impl

emen

tatio

n of

th

e SC

C), a

nd fi

nally

‘sup

port’

(coa

chin

g, m

ainl

y with

pee

r-to-

peer

mod

els f

or th

e up

take

of e

ssen

tial b

irth

prac

tices

). Th

is is

one

of t

he la

rges

t fac

ility

-bas

ed ra

ndom

ized

cont

rolle

d tri

als,

whic

h m

easu

red

the

impa

ct o

f a m

ulti-

pron

ged

appr

oach

(che

cklis

t + c

oach

ing

+ da

ta fe

edba

ck) o

n ea

rly (7

–day

) mat

erna

l and

per

inat

al m

orbi

dity

and

mor

talit

y in

inst

itutio

nal

child

birth

s in

reso

urce

-lim

ited

setti

ngs.

The

out

com

es a

cros

s 161

000

del

iverie

s wer

e ve

ry p

rom

isin

g, sh

owin

g a

dram

atic

impr

ovem

ent i

n ad

here

nce

to e

ssen

tial b

est p

ract

ices

in si

tes

wher

e th

e SC

C wa

s int

rodu

ced.

Whi

le th

ere

was n

o m

easu

rabl

e im

prov

emen

t in

mat

erna

l and

neo

nata

l mor

bidi

ty a

nd m

orta

lity i

n th

e in

terv

entio

n ar

m, it

was

reco

gnize

d th

at th

e SC

C ca

nnot

be

a st

anda

lone

tool

. Rat

her t

he W

HO S

CC e

mbo

dies

the

basi

c es

sent

ial b

est p

ract

ices

for o

ptim

al m

ater

nal a

nd n

eona

tal c

are.

The

Che

cklis

t is n

ow in

corp

orat

ed a

s par

t of t

he

qual

ity o

f car

e to

olki

t in

Indi

a.

https://www.who.int/patientsafety/topics/safe-childbirth/childbirth-checklist/en/

https://www.who.int/patientsafety/topics/safe-childbirth/childbirth-checklist/en/

http://www.who.int/patientsafety/topics/safe-childbirth/childbirth_collaboration_engaging/en/

http://www.who.int/patientsafety/topics/safe-childbirth/childbirth_collaboration_engaging/en/

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




http://www.ariadnelabs.org



Nam

e of

tool

(y

ear)

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt

Inte

rlink

ages

with

oth

er

area

s

Safe

Chi

ldbi

rth

Chec

klis

t im

plem

enta

tion

guid

e (2

015)

Guid

ance

He

alth

car

e pr

ofes

sion

als

A gu

ide

to h

elp

heal

th c

are

man

ager

s and

lead

ers,

and

birth

atte

ndan

ts in

trodu

ce, im

plem

ent,

and

use

the

Safe

Chi

ldbi

rth C

heck

list i

n fa

cilit

y-ba

sed

deliv

erie

s.

It co

vers

how

to in

trodu

ce a

nd e

nsur

e co

ntin

uous

use

of

the

Chec

klis

t, ho

w to

laun

ch it

form

ally,

and

how

to

prov

ide

supp

ort f

or im

plem

enta

tion

thro

ugh

coac

hing

an

d da

ta sh

arin

g. T

he Im

plem

enta

tion

guid

e pr

ovid

es

a st

ep-b

y-st

ep a

ppro

ach

for e

ffect

ive a

nd su

stai

nabl

e us

e of

the

Chec

klis

t in

heal

th c

are

faci

litie

s, wh

ich

will

in tu

rn im

prov

e ad

here

nce

to e

ssen

tial b

irth

prac

tices

. Th

e Gu

ide

prov

ides

furth

er d

etai

ls o

n th

e ke

y fac

ilita

ting

fact

ors i

dent

ified

, and

hig

hlig

hts i

mpo

rtant

fact

ors

for e

ngag

emen

t, la

unch

of t

he C

heck

list a

nd o

ngoi

ng

supp

ort.

Targ

eted

for f

acili

ty le

vel u

se b

ut in

clud

es

advi

ce fo

r a n

atio

nal l

evel

app

roac

h.

1.

Gain

buy

-in fr

om m

anag

ers/

adm

inis

trato

rs in

the

first

inst

ance

. 2.

En

sure

that

staf

f hav

e ad

equa

te

know

ledg

e an

d sk

ills t

o ha

ndle

co

mpl

icat

ions

. Men

torin

g an

d tra

inin

g is

one

exa

mpl

e of

bui

ldin

g sk

ills a

nd c

ompe

tenc

ies.

3.

La

ck o

f sup

plie

s and

equ

ipm

ent

is a

maj

or b

arrie

r to

succ

essf

ul

impl

emen

tatio

n of

the

Chec

klis

t. 4.

Lo

cal a

dapt

atio

n an

d co

ntex

tual

izatio

n ar

e ke

y.5.

In

tegr

ate

Chec

klis

t use

into

th

e br

oade

r qua

lity o

f car

e im

prov

emen

t effo

rts fo

r mot

hers

an

d ne

wbor

ns, in

clud

ing

mot

hers

’ ca

se n

otes

.

This

tool

is c

lose

ly li

nked

with

th

e wo

rk o

n im

prov

ing

qual

ity

of m

ater

nal a

nd n

ewbo

rn

care

. For

mor

e in

form

atio

n,

plea

se se

e ht

tp://

www.

who.

int/m

ater

nal_c

hild

_ad

oles

cent

/topi

cs/q

ualit

y-of

-ca

re/e

n/.

Case

stud

y 5: S

afe

Child

birth

Che

cklis

t use

in S

ri La

nka

The

WHO

Saf

e Ch

ildbi

rth w

as im

plem

ente

d in

a te

rtiar

y car

e ho

spita

l in

Sri L

anka

. Afte

r int

rodu

cing

the

Chec

klis

t, he

alth

car

e wo

rker

s wer

e tra

ined

to u

se it

. It w

as to

be

used

for

each

wom

an a

dmitt

ed to

the

labo

ur ro

om. A

regu

lato

ry re

quire

men

t was

put

in p

lace

for n

ursi

ng st

aff t

o ad

opt a

nd im

plem

ent t

he C

heck

list,

and

coac

hing

was

pro

vide

d fo

r the

birt

h at

tend

ants

.

The

aver

age

num

ber o

f chi

ldbi

rth p

ract

ices

che

cked

in th

e Ch

eckl

ist w

as 2

1 ou

t of 2

9. It

ems r

elat

ed to

edu

catin

g th

e m

othe

r to

seek

hel

p du

ring

labo

ur, a

fter d

elive

ry a

nd a

fter

disc

harg

e fro

m h

ospi

tal, s

eeki

ng a

n as

sist

ant d

urin

g la

bour

, ear

ly b

reas

t-fee

ding

, mat

erna

l HIV

infe

ctio

n an

d di

scus

sing

con

trace

ptive

opt

ions

wer

e ch

ecke

d le

ast o

ften.

The

mea

n le

vel

of k

nowl

edge

on

the

SCC

amon

g he

alth

wor

kers

was

60.

1%. A

ttitu

des t

o ac

cept

ance

of u

sing

the

Chec

klis

t wer

e sa

tisfa

ctor

y. Av

erag

e ad

here

nce

to C

heck

list p

ract

ices

was

71.

3%.

Incr

ease

d wo

rklo

ad, p

oor e

nthu

sias

m o

f hea

lth w

orke

rs to

ward

s new

add

ition

s to

thei

r rou

tine

sche

dule

and

leve

l of u

ser-f

riend

lines

s of t

he C

heck

list w

ere

limita

tions

to it

s wid

er u

se.

Amon

g us

ers,

attit

ude

towa

rds t

he C

heck

list w

as sa

tisfa

ctor

y. Ad

optio

n ra

te a

mon

g al

l hea

lth w

orke

rs w

as 4

5.8%

and

kno

wled

ge re

gard

ing

the

Chec

klis

t was

60.

1%. T

hese

two

fact

ors

are

prob

ably

link

ed. T

here

fore

prio

r to

intro

duci

ng it

to a

faci

lity,

awar

enes

s abo

ut th

e va

lue

and

corre

ct u

se o

f the

SCC

nee

ds to

be

incr

ease

d, w

hile

giv

ing

atte

ntio

n to

satis

fact

ory

staf

fing

leve

ls.

Less

ons l

earn

t: 1)

The

SCC

can

be

impl

emen

ted

as a

nat

iona

l app

roac

h; 2

) The

leve

l of k

nowl

edge

of s

taff

mus

t be

addr

esse

d pr

ior t

o im

plem

enta

tion;

3) C

ontin

uous

staf

f edu

catio

n an

d m

otiva

tion

is e

ssen

tial;

4) E

ncou

rage

men

t mus

t orig

inat

e fro

m th

e to

p do

wn, w

ith e

arly

eng

agem

ent o

f the

MOH

, and

pol

icy-

mak

ers;

5) T

he S

CC m

ust b

e ad

apte

d ac

cord

ing

to th

e co

untry

setti

ng a

nd fa

cilit

y it i

s im

plem

ente

d in

. [Re

fere

nce:

Impl

emen

tatio

n of

the

WHO

safe

chi

ldbi

rth c

heck

list p

rogr

amm

e at

a te

rtiar

y car

e se

tting

in S

ri La

nka.

BM

C Pr

egna

ncy a

nd

Child

birth

201

5.]

https://www.who.int/patientsafety/topics/safe-childbirth/childbirth-checklist_implementation-guide/en/










Nam

e of

tool

Type

of t

ool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt:

Inte

rlink

ages

with

oth

er a

reas

:

Min

imal

Info

rmat

ion

Mod

el U

ser G

uide

: M

inim

al In

form

atio

n M

odel

for P

atie

nt

Safe

ty (M

IM P

S)(2

017)

Guid

ance

He

alth

car

e pr

ofes

sion

als

A to

ol to

faci

litat

e co

llect

ion,

an

alys

is, c

ompa

rison

, sha

ring

and

glob

al le

arni

ng fr

om a

dver

se e

vent

s, wh

ich

can

be u

sed

by c

ount

ries

or in

stitu

tions

look

ing

to se

t up

or

impr

ove

thei

r cur

rent

pat

ient

safe

ty

repo

rting

and

lear

ning

syst

ems.

Seve

ral h

ospi

tals

and

co

untri

es a

dapt

ed M

IM

PS fo

r the

ir re

porti

ng a

nd

lear

ning

syst

ems.

The

tool

is a

lso

stro

ngly

link

ed w

ith

mea

sure

men

t effo

rts w

ith th

e in

clus

ion

of a

st

ruct

ured

tem

plat

e co

ntai

ning

the

defin

ition

an

d th

e ra

tiona

le fo

r eve

ry e

ntity

(cat

egor

y or

rela

tions

hip)

of a

min

imal

adv

erse

eve

nt

repo

rting

syst

em.

Patie

nt S

<afe

ty

Rese

arch

: A g

uide

fo

r dev

elop

ing

train

ing

prog

ram

mes

(2

012)

Guid

ance

Ac

adem

ic

inst

itutio

ns

This

gui

de is

des

igne

d to

aid

cu

rricu

lum

dev

elop

men

t and

the

orga

niza

tion

of tr

aini

ng p

rogr

amm

es

in th

e fie

ld o

f pat

ient

safe

ty re

sear

ch.

Clos

ely l

inke

d to

the

work

on

natio

nal q

ualit

y po

licy a

nd st

rate

gy, a

nd in

fect

ion

prev

entio

n an

d co

ntro

l

Sum

mar

y of t

he

evid

ence

on

patie

nt

safe

ty: I

mpl

icat

ions

fo

r res

earc

h (2

008)

Rese

arch

Po

licy-

mak

ers,

heal

th c

are

adm

inis

trato

rs a

nd

regu

lato

rs, a

cade

mic

in

stitu

tions

, re

sear

cher

s, qu

ality

m

anag

ers

This

doc

umen

t pro

vide

s gui

danc

e fo

r set

ting

WHO

’s pr

iorit

ies f

or

patie

nt sa

fety

rese

arch

on

unsa

fe

care

in c

linic

al c

onte

xts i

n va

rious

co

untri

es a

nd th

e un

derly

ing

caus

es

cont

ribut

ing

to u

nsaf

e ca

re.

The

docu

men

t has

rele

vanc

e to

a n

umbe

r of

serv

ice

deliv

ery r

elat

ed a

reas

: nat

iona

l qu

ality

pol

icy a

nd st

rate

gy, in

fect

ion

prev

entio

n an

d co

ntro

l, prim

ary h

ealth

car

e.






http://apps.who.int/iris/bitstream/10665/75359/1/9789241503440_eng.pdf?ua=1










Nam

e of

tool

Type

of t

ool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt:

Inte

rlink

ages

with

oth

er a

reas

:

Patie

nt S

afet

y Cu

rricu

lum

Gui

de

(201

1)

Guid

ance

trai

ning

/Ca

paci

ty-b

uild

ing

Prof

essi

onal

as

soci

atio

ns,

acad

emic

in

stitu

tions

, ed

ucat

ion

coun

cils

This

doc

umen

t is a

com

preh

ensi

ve

guid

e to

ass

ist e

ffect

ive c

apac

ity-

build

ing

in p

atie

nt sa

fety

edu

catio

n by

hea

lth c

are

acad

emic

inst

itutio

ns

and

is ta

rget

ed a

t den

tistry

, med

ical

, m

idwi

fery

, nur

sing

and

pha

rmac

y sc

hool

s. It

con

tain

s inf

orm

atio

n fo

r all

leve

ls o

f fac

ulty

staf

f and

a

com

preh

ensi

ve c

urric

ulum

cov

erin

g th

e es

sent

ial p

atie

nt sa

fety

prin

cipl

es

and

conc

epts

. The

Gui

de c

an b

e ea

sily

inte

grat

ed in

to e

xist

ing

curri

cula

to m

eet i

ndiv

idua

l nee

ds

and

is a

pplic

able

to d

iffer

ent c

ultu

res

and

cont

exts

.

The

first

par

t of t

he G

uide

is a

imed

at

heal

th c

are

educ

ator

s and

pro

vide

s a

syst

emat

ic a

ppro

ach

to b

uild

ing

inst

itutio

nal

capa

city

and

hig

hlig

hts t

he e

duca

tiona

l pr

inci

ples

ess

entia

l to

teac

hing

pat

ient

sa

fety

to d

iffer

ent c

ateg

orie

s of h

ealth

ca

re p

rofe

ssio

nals

. The

seco

nd p

art o

f th

e Gu

ide

cont

ains

11

topi

cs, s

ome

of

them

cro

ss-c

uttin

g na

ture

, incl

udin

g IP

C,

inva

sive

pro

cedu

res,

med

icat

ion

safe

ty,

qual

ity im

prov

emen

t met

hods

, rep

ortin

g an

d le

arni

ng, e

ngag

ing

patie

nts.

Patie

nt S

afet

y Cu

rricu

lum

Gui

de fo

r M

edic

al S

choo

ls (2

009)

Guid

ance

Tra

inin

g/Ca

paci

ty-b

uild

ing

Acad

emic

in

stitu

tions

(m

edic

al sc

hool

s),

prof

essi

onal

or

gani

zatio

ns,

educ

atio

nal c

ounc

ils

This

Cur

ricul

um g

uide

pro

vide

s a

com

preh

ensi

ve p

rogr

amm

e fo

r im

plem

enta

tion

of p

atie

nt sa

fety

ed

ucat

ion

in m

edic

al sc

hool

s wo

rldwi

de.

The

first

par

t of t

he G

uide

is a

imed

at h

ealth

ca

re e

duca

tors

and

pro

vide

s a sy

stem

atic

ap

proa

ch to

bui

ldin

g in

stitu

tiona

l cap

acity

an

d hi

ghlig

hts t

he e

duca

tiona

l prin

cipl

es

esse

ntia

l to

teac

hing

pat

ient

safe

ty in

m

edic

al sc

hool

s. T

he se

cond

par

t of t

he

Guid

e co

ntai

ns 1

1 to

pics

, som

e of

them

cr

oss-

cutti

ng in

nat

ure,

incl

udin

g IP

C,

inva

sive

pro

cedu

res,

med

icat

ion

safe

ty,

qual

ity im

prov

emen

t met

hods

, rep

ortin

g an

d le

arni

ng, a

nd e

ngag

ing

patie

nts.



http://apps.who.int/iris/bitstream/10665/44091/1/9789241598316_eng.pdf





Nam

e of

tool

Type

of t

ool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lear

nt:

Inte

rlink

ages

with

oth

er a

reas

:

Conc

eptu

al

Fram

ewor

k fo

r th

e In

tern

atio

nal

Clas

sific

atio

n fo

r Pa

tient

Saf

ety (

ICPS

)(2

009)

Guid

ance

Po

licy-

mak

ers,

heal

th c

are

adm

inis

trato

rs a

nd

regu

lato

rs, q

ualit

y m

anag

ers

The

Fram

ewor

k pr

ovid

es a

met

hod

for o

rgan

izing

pat

ient

safe

ty d

ata

and

info

rmat

ion.

It p

rovi

des g

uida

nce

to c

ompa

re d

ata

acro

ss d

isci

plin

es/

orga

niza

tions

, exa

min

e th

e ro

le

of sy

stem

and

hum

an fa

ctor

s, id

entif

y pot

entia

l pat

ient

safe

ty

issu

es, d

evel

op p

riorit

ies a

nd sa

fety

so

lutio

ns.

ICPS

has

bee

n wi

dely

use

d to

dev

elop

the

repo

rting

an

d le

arni

ng sy

stem

s at

faci

lity a

nd n

atio

nal l

evel

s.

Inte

rnat

iona

l Cla

ssifi

catio

n of

Dis

ease

s (IC

D) -1

1’s

Safe

ty a

nd Q

ualit

y Top

ic

Advi

sory

Gro

up h

as b

een

work

ing

on m

appi

ng IC

PS to

IC

D-11

.

The

ICPS

is d

esig

ned

to b

e a

genu

ine

conv

erge

nce

of in

tern

atio

nal p

erce

ptio

ns

of th

e m

ain

issu

es re

late

d to

pat

ient

safe

ty

and

to fa

cilit

ate

the

desc

riptio

n, c

ompa

rison

, m

easu

rem

ent,

mon

itorin

g, a

naly

sis a

nd

inte

rpre

tatio

n of

info

rmat

ion

to im

prov

e pa

tient

car

e.

High

5’s:

Sta

ndar

d Op

erat

ing

Proc

edur

es

Guid

ance

Polic

y-m

aker

s, he

alth

car

e ad

min

istra

tors

and

re

gula

tors

, qua

lity

man

ager

s, cl

inic

ians

an

d ot

her h

ospi

tal

staf

f

This

pro

ject

aim

s to

faci

litat

e th

e de

velo

pmen

t, im

plem

enta

tion

and

eval

uatio

n of

thre

e SO

Ps. T

he

thre

e SO

Ps re

late

d to

med

icat

ion

reco

ncili

atio

n, c

orre

ct si

te su

rger

y, an

d co

ncen

trate

d in

ject

able

m

edic

ines

, hav

e be

en d

evel

oped

, im

plem

ente

d an

d ev

alua

ted.

The

tool

pre

sent

s the

exe

mpl

ary i

ndic

ator

s an

d th

e gu

idel

ines

to m

easu

re th

ree

area

s, na

mel

y med

icat

ion

reco

ncili

atio

n, th

e pe

rform

ance

of t

he c

orre

ct p

roce

dure

at t

he

corre

ct b

ody s

ite, a

nd th

e sa

fe m

anag

emen

t of

con

cent

rate

d in

ject

able

med

icin

es. I

n ad

ditio

n, m

etho

dolo

gica

l rec

omm

enda

tions

fo

r mea

surin

g pa

tient

safe

ty a

re p

rese

nted

.

Met

hodo

logi

cal

guid

e fo

r dat

a po

or

hosp

itals

(2

010)

Guid

ance

He

alth

car

e ad

min

istra

tors

and

re

gula

tors

, qua

lity

man

ager

s, cl

inic

ians

The

guid

ance

des

crib

es a

set o

f m

etho

dolo

gies

that

can

be

used

ei

ther

to e

stim

ate

the

exte

nt o

f har

m

caus

ed b

y the

del

ivery

of h

ealth

car

e in

a p

artic

ular

hea

lth c

are

faci

lity o

r to

est

ablis

h pr

iorit

y act

ions

aro

und

perc

eive

d pa

tient

safe

ty is

sues

.

The

docu

men

t is c

lose

ly li

nked

with

pat

ient

sa

fety

and

its i

mpl

emen

tatio

n in

hos

pita

ls.

http://apps.who.int/iris/bitstream/10665/70882/1/WHO_IER_PSP_2010.2_eng.pdf?ua=1





http://www.who.int/patientsafety/publications/high5s/en/



http://www.who.int/patientsafety/research/methodological_guide/PSP_MethGuid.pdf?ua=1





6. T

raditional

Compl

emen

tary

and

Integ

rativ

e Med

icin

e

Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ce

Sum

mar

y des

crip

tion

Key l

esso

ns le

arnt

In

terli

nkag

es w

ith o

ther

ar

eas

WHO

Ben

chm

arks

for

train

ing

in:

Ayur

veda

(201

0)

Unan

i Med

icin

e (2

010)

Natu

ropa

thy (

2010

)

Oste

opat

hy (2

010)

Nuad

Tha

i (20

10)

Trad

ition

al C

hine

se

Med

icin

e (2

010)

Tui n

a (2

010)

Trai

ning

/Cap

acity

-bu

ildin

g Ac

adem

ics/

rese

arch

ers,

deve

lopm

ent a

genc

ies,

heal

th w

orke

rs,

nong

over

nmen

tal

orga

niza

tions

, pol

icy-

mak

ers

The

serie

s of b

ench

mar

ks fo

r tra

inin

g re

flect

wh

at th

e co

mm

unity

of p

ract

ition

ers i

n tra

ditio

nal

and

com

plem

enta

ry m

edic

ine

cons

ider

to b

e re

ason

able

pra

ctic

es in

trai

ning

pro

fess

iona

ls

to p

ract

ice

the

disc

iplin

e, co

nsid

erin

g co

nsum

er

prot

ectio

n an

d pa

tient

safe

ty a

s bei

ng c

ore

to

prof

essi

onal

pra

ctic

e. T

he tr

aini

ng to

ols p

rovi

de

a re

fere

nce

poin

t to

whic

h ac

tual

pra

ctic

e ca

n be

com

pare

d an

d ev

alua

ted.

The

doc

umen

ts

desc

ribe

mod

els o

f tra

inin

g fo

r tra

inee

s with

di

ffere

nt p

rofe

ssio

nal b

ackg

roun

ds. T

he li

st,

deve

lope

d by

a c

omm

unity

of p

ract

ition

ers,

aim

s to

pro

mot

e sa

fe p

ract

ice

and

min

imize

the

risk

of

acci

dent

s.

Ther

e is

a n

eed

to u

pdat

e an

d al

ign

the

train

ing

benc

hmar

ks w

ith p

ract

ice

benc

hmar

ks. R

esou

rce

mob

iliza

tion

to su

ppor

t de

velo

pmen

t and

re

finem

ent o

f doc

umen

ts

is ke

y.

The

tool

s ser

ve a

s ref

eren

ce

poin

ts to

whi

ch a

ctua

l pr

actic

e ca

n be

com

pare

d an

d ev

alua

ted.

WHO

Gui

delin

es o

n Ba

sic

Trai

ning

and

Sa

fety

in C

hiro

prac

tic

(200

5)

Trai

ning

/Cap

acity

-bu

ildin

g Ac

adem

ics/

rese

arch

ers,

deve

lopm

ent a

genc

ies,

heal

th w

orke

rs,

nong

over

nmen

tal

orga

niza

tions

, pol

icy-

mak

ers

This

doc

umen

t com

pris

es g

uide

lines

on

basi

c tra

inin

g an

d sa

fety

in c

hiro

prac

tic. A

vaila

ble

in

Engl

ish,

Fre

nch

and

Span

ish.

Regu

lar a

nd ti

mel

y upd

ate

is n

eede

d to

mai

ntai

n th

e re

leva

nce

of th

is re

sour

ce.

A sy

stem

of e

xam

inat

ions

an

d lic

ensi

ng m

ay b

e es

tabl

ishe

d or

ada

pted

on

the

basi

s of t

his t

rain

ing

prog

ram

me,

to e

nsur

e th

e co

mpe

tenc

e of

the

train

ees

and

avoi

d th

e pr

actic

e of

ch

iropr

actic

by u

nqua

lifie

d pe

rson

s.

http://apps.who.int/medicinedocs/documents/s17552en/s17552en.pdf








http://apps.who.int/medicinedocs/en/m/abstract/Js14076e/





Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ce

Sum

mar

y des

crip

tion

Key l

esso

ns le

arnt

In

terli

nkag

es w

ith o

ther

ar

eas

Guid

elin

es o

n Ba

sic

Trai

ning

and

Saf

ety i

n Ac

upun

ctur

e (1

999)

Trai

ning

/Cap

acity

-bu

ildin

g Ac

adem

ics/

rese

arch

ers,

deve

lopm

ent a

genc

ies,

heal

th w

orke

rs,

nong

over

nmen

tal

orga

niza

tions

, pol

icy-

mak

ers

The

guid

elin

es o

n ba

sic

train

ing

cove

r bas

ic

requ

irem

ents

for t

rain

ing

non-

phys

icia

n ac

upun

ctur

ists

and

phy

sici

ans w

ishi

ng to

use

ac

upun

ctur

e in

thei

r clin

ical

wor

k an

d in

clud

es

a co

re sy

llabu

s. T

he g

uide

lines

on

safe

ty in

ac

upun

ctur

e ar

e in

tend

ed fo

r hos

pita

ls, c

linic

s an

d pr

actit

ione

rs a

nd p

rovi

de st

anda

rds f

or

safe

ty in

the

clin

ical

pra

ctic

e of

acu

punc

ture

. Av

aila

ble

in E

nglis

h, F

renc

h an

d Sp

anis

h.

Ther

e is

nee

d to

upd

ate

and

alig

n th

e tra

inin

g be

nchm

arks

with

pra

ctic

e be

nchm

arks

. The

pra

ctic

e be

nchm

arks

are

und

er

deve

lopm

ent.

The

docu

men

t is i

nten

ded

to a

ssis

t nat

iona

l hea

lth

auth

oriti

es in

setti

ng

stan

dard

s and

est

ablis

hing

of

ficia

l exa

min

atio

ns, a

s we

ll as

med

ical

scho

ols

and

inst

itutio

ns w

ishi

ng

to a

rrang

e tra

inin

g pr

ogra

mm

es.

WHO

Gui

delin

es fo

r As

sess

ing

Qual

ity

of H

erba

l Med

icin

es

with

Ref

eren

ce to

Co

ntam

inan

ts a

nd

Resi

dues

(2

007)

Guid

ance

Na

tiona

l /in

tern

atio

nal

drug

regu

lato

ry

agen

cies

, res

earc

hers

, ph

arm

aceu

tical

con

trol

labo

rato

ries,

polic

y-m

aker

s

Thes

e W

HO g

uide

lines

pre

sent

gen

eral

co

nsid

erat

ions

on

pote

ntia

lly h

azar

dous

co

ntam

inan

ts a

nd re

sidu

es in

her

bal m

edic

ines

an

d in

clud

e gu

idin

g pr

inci

ples

for a

sses

sing

the

qual

ity o

f her

bal m

edic

ines

, in te

rms o

f maj

or

cont

amin

ants

and

resi

dues

. It a

lso

reco

mm

ends

an

alyt

ical

met

hods

for q

ualit

ative

and

qu

antit

ative

det

erm

inat

ion

of su

ch c

onta

min

ants

an

d re

sidu

es.

Regu

lar a

nd ti

mel

y upd

ate

is n

eede

d to

mai

ntai

n th

e re

leva

nce

of th

e re

sour

ce.

With

in th

e ov

eral

l con

text

of

qua

lity a

ssur

ance

, the

se

guid

elin

es in

tend

ed to

pr

ovid

e ge

nera

l tec

hnic

al

guid

ance

to M

embe

r Sta

tes

in a

sses

sing

qua

lity r

elat

ing

to th

e sa

fety

of h

erba

l m

ater

ials

and

pro

duct

s cl

assi

fied

as m

edic

ines

, in

rela

tion

to m

ajor

and

co

mm

on c

onta

min

ants

and

re

sidu

es.

Gene

ral G

uide

lines

fo

r Met

hodo

logi

es

on R

esea

rch

and

Eval

uatio

n of

Tr

aditi

onal

Med

icin

e (2

000)

Guid

ance

Ac

adem

ics/

rese

arch

ers,

deve

lopm

ent a

genc

ies,

heal

th w

orke

rs,

nong

over

nmen

tal

orga

niza

tions

, pol

icy-

mak

ers

The

spec

ific

obje

ctive

s of t

he g

uide

lines

are

to

: har

mon

ize th

e us

e of

cer

tain

acc

epte

d an

d im

porta

nt te

rms i

n tra

ditio

nal m

edic

ine;

to

sum

mar

ize ke

y iss

ues f

or d

evel

opin

g m

etho

dolo

gies

for r

esea

rch

and

eval

uatio

n of

tra

ditio

nal m

edic

ine;

and

to im

prov

e th

e qu

ality

an

d va

lue

of re

sear

ch in

trad

ition

al m

edic

ine.

Th

e gu

idel

ines

con

sist

of s

ectio

ns o

n he

rbal

m

edic

ines

, tra

ditio

nal p

roce

dure

-bas

ed th

erap

ies,

clin

ical

rese

arch

, and

rela

ted

issu

es, in

clud

ing

ethi

cs, e

duca

tion

and

train

ing,

as w

ell a

s su

rvei

llanc

e sy

stem

s. A

vaila

ble

in E

nglis

h, F

renc

h an

d Sp

anis

h.

Regu

lar a

nd ti

mel

y upd

ate

is n

eede

d to

mai

ntai

n th

e re

leva

nce

of th

is re

sour

ce.

Reso

urce

cur

rent

ly b

eing

up

date

d.

Prov

ide

appr

opria

te

eval

uatio

n m

etho

ds to

fa

cilit

ate

the

deve

lopm

ent o

f re

gula

tion

and

regi

stra

tion

of

tradi

tiona

l med

icin

e.

http://apps.who.int/medicinedocs/en/d/Jwhozip56e/



http://apps.who.int/medicinedocs/documents/s14878e/s14878e.pdf













Case

stud

y 6: I

ndo-

Swis

s Ayu

rved

a Fo

unda

tion

In 2

009,

Swi

tzer

land

reco

gnize

d tra

ditio

nal a

nd c

ompl

emen

tary

med

icin

e (T

&CM

) in

its p

ublic

hea

lth sy

stem

thro

ugh

a ch

ange

in it

s con

stitu

tion.

Thr

ough

SAM

A’s (S

wiss

Ayu

rved

ic

Med

ical

Aca

dem

y) a

ctive

eng

agem

ent w

ith th

e Sw

iss a

nd In

dian

gov

ernm

ents

, the

Indo

-Swi

ss A

yurv

eda

Foun

datio

n (IS

A), a

non

-for-p

rofit

org

aniza

tion,

was

offi

cial

ly c

reat

ed in

201

3 un

der S

wiss

law.

As a

resu

lt of

the

work

of I

SA, S

witz

erla

nd h

as d

efin

ed th

ree

prof

essi

ons f

or T

&CM

in it

s pub

lic h

ealth

syst

em: (

i) th

e al

lopa

thic

doc

tor w

ith a

com

plem

enta

ry tr

aini

ng in

T&C

M a

nd (

ii)

two

T&CM

pro

fess

ions

with

out p

rior t

rain

ing

in m

edic

ine.

WHO

ben

chm

arks

for t

rain

ing

in A

yurv

eda

defin

e th

e sa

me

thre

e pr

ofes

sion

s as f

ores

een

by th

e Sw

iss r

egul

atio

ns fo

r T&C

M.

The

rele

ase

of W

HO’s

benc

hmar

ks fo

r tra

inin

g in

Ayu

rved

a va

lidat

ed IS

A’s vi

sion

of A

yurv

eda

as a

key p

art o

f the

med

ical

syst

em. S

wiss

aut

horit

ies f

orm

ally

reco

gnize

d Ay

urve

da a

s a

fund

amen

tal t

rain

ing

com

pone

nt fo

r all

thre

e T&

CM-re

late

d pr

ofes

sion

s.

To su

ppor

t im

plem

enta

tion

of A

yurv

eda

into

the

Swis

s hea

lth sy

stem

, a h

igh

stan

dard

trai

ning

pro

gram

me

in A

yurv

eda

med

icin

e, M

edVa

idya

(run

by S

AMA

and

supp

orte

d by

ISA)

was

de

velo

ped.

The

trai

ning

is in

spire

d by

WHO

ben

chm

arks

, Swi

ss re

gula

tions

and

BAM

S co

nten

t (Ba

chel

or o

f Ayu

rved

a M

edic

ine

and

Surg

ery,

Indi

a). T

he o

bjec

tive

of th

e tra

inin

g is

to

train

hig

h-le

vel p

rofe

ssio

nals

to p

ract

ice

Ayur

veda

and

ens

ure

safe

kno

wled

ge tr

ansf

er, a

s wel

l as p

atie

nt sa

fety

. The

WHO

ben

chm

arks

supp

orte

d IS

A in

the

desi

gn o

f the

trai

ning

pr

ogra

mm

e.

Thre

e ke

y les

sons

lear

nt fr

om th

is p

roce

ss in

clud

e:1.

Th

e W

HO b

ench

mar

ks fo

r tra

inin

g in

Ayu

rved

a ha

ve g

iven

the

Swis

s reg

ulat

ory m

odel

for A

yurv

eda

its g

loba

l rel

evan

ce, o

n th

e on

e ha

nd b

y def

inin

g th

e sa

me

thre

e pr

ofes

sion

s fo

r the

dis

cipl

ine

and

on th

e ot

her h

and

by su

ppor

ting

ISA

Foun

datio

n’s vi

sion

of r

espe

ctin

g Ay

urve

da’s

tradi

tiona

l sci

entif

ic re

quire

men

ts a

nd h

igh

prof

essi

onal

stan

dard

s in

the

glob

aliza

tion

proc

ess.

2.

Th

roug

h th

e pr

oces

s of e

ngag

ing

with

the

Swis

s Gov

ernm

ent i

n th

is p

roce

ss, t

he fo

llowi

ng a

reas

of i

mpr

ovem

ent w

ere

note

d fo

r the

Ayu

rved

a gu

idel

ines

:

Mod

ern

teac

hing

met

hodo

logi

es sh

ould

be

intro

duce

d, su

ch a

s int

erac

tive

teac

hing

, gro

up w

ork,

peer

lear

ning

, sup

ervi

sed

pers

onal

trai

ning

out

side

the

clas

sroo

m

E-le

arni

ng a

nd E

-teac

hing

shou

ld b

e co

nsid

ered

as o

ptio

ns fo

r fut

ure

teac

hing

met

hodo

logi

es.

Som

e tra

inin

g co

nten

t is n

o lo

nger

rele

vant

in m

oder

n tim

es fo

r stu

dent

s out

side

Indi

a. S

ome

train

ing

aspe

cts c

an b

e co

nsid

ered

as o

ptio

nal (

redu

ce th

e nu

mbe

r of s

ugge

sted

hou

rs)

like

agad

a ta

ntra

and

rasa

shas

tra.



7. Em

erge

ncy

and

esse

ntia

l su

rger

y

Nam

e of

tool

(yea

r)Ty

pe o

f to

olAu

dien

ce

Sum

mar

y des

crip

tion

Key l

esso

ns

lear

nt

Inte

rlink

ages

wi

th o

ther

are

as

Surg

ical

Car

e Sy

stem

St

reng

then

ing

(201

7)M

anua

l Po

licy-

mak

ers,

gove

rnm

ent

auth

oriti

es,

acad

emic

s and

re

sear

cher

s

This

man

ual p

rovi

des t

he b

asic

s for

dev

elop

ing

a na

tiona

l sur

gica

l, ob

stet

ric a

nd a

naes

thes

ia p

lan.

Incl

uded

are

eig

ht c

ase

stud

ies f

rom

co

untri

es. A

nat

iona

l pla

n wi

ll pr

ovid

e th

e ba

sis f

or b

uild

ing

serv

ice

deliv

ery

capa

city

, incl

udin

g es

tabl

ishi

ng in

form

atio

n m

anag

emen

t with

M&E

.

• Del

ivers

the

build

ing

bloc

ks

for d

evel

opin

g su

rgic

al se

rvic

e de

liver

y• I

mpl

emen

tatio

n is

the

mos

t di

fficu

lt st

ep• H

ealth

Min

istry

bu

y-in

and

le

ader

ship

are

cr

itica

l• A

ll st

akeh

olde

rs’

inpu

t is c

ritic

al

Surg

ical

sub-

spec

ialti

es:

anae

sthe

sia,

obst

etric

s, m

ater

nal a

nd

child

hea

lth,

repr

oduc

tive

heal

th

emer

genc

ies,

nonc

omm

unic

able

di

seas

es, H

IV,

negl

ecte

d tro

pica

l dis

ease

s, m

edic

ines

.

Surg

ical

Site

Infe

ctio

n Gu

idel

ines

(201

7)Gu

idan

cePr

actit

ione

rs,

faci

litie

s,Ch

eckl

ist f

or re

duci

ng su

rgic

al si

te in

fect

ions

to im

prov

e su

rgic

al

outc

omes

.

Patie

nt`s

Com

mun

icat

ion

Tool

fo

r Sur

gica

l Saf

ety (

2015

)Ad

voca

cyPa

tient

s, fa

mili

es

and

care

give

rsTh

is to

ol a

ids p

atie

nt`s

with

a li

st o

f ess

entia

l inf

orm

atio

n th

at th

ey n

eed

to k

now

and

disc

uss w

ith th

eir h

ealth

car

e pr

ovid

er to

ens

ure

safe

r sur

gica

l ca

re b

efor

e an

d af

ter t

he p

roce

dure

.

Surg

ical

Ass

essm

ent

Tool

: fac

ility

and

serv

ice

asse

ssm

ent t

ool, u

sed

for g

ap

anal

ysis

and

bui

ldin

g ca

paci

ty

Guid

ance

Polic

y-m

aker

s, go

vern

men

t au

thor

ities

, ac

adem

ics a

nd

rese

arch

ers

With

out c

ontin

ued

mon

itorin

g an

d ev

alua

tion,

usi

ng re

liabl

e su

rvey

tool

s, th

ere

will

not b

e qu

ality

impr

ovem

ent.

This

tool

pro

vide

s the

mea

ns to

ob

tain

relia

ble

data

from

a fa

cilit

y and

a se

rvic

e de

liver

y per

spec

tive.

Co

mpr

ehen

sive

faci

lity a

nd se

rvic

e de

liver

y ass

essm

ent t

ool o

n su

rgic

al

care

with

sub-

mod

ules

for p

aedi

atric

surg

ery a

nd a

naes

thes

ia c

are.

Re

liabl

e da

ta m

ust b

e av

aila

ble

and

used

to d

rive

stra

tegi

c he

alth

pol

icy.

http://www.who.int/surgery/publications/scss/en/

http://www.who.int/surgery/publications/scss/en/

http://www.who.int/surgery/en/


http://www.who.int/surgery/publications/patients_communication_tool.pdf?ua=1

http://www.who.int/surgery/publications/patients_communication_tool.pdf?ua=1







Case

stud

y 7: S

urgi

cal C

are

Syst

em a

pplic

atio

n in

Zam

bia

In 2

014,

the

Zam

bian

Min

istry

of H

ealth

per

form

ed a

n au

dit r

evea

ling

that

des

pite

sign

ifica

nt im

prov

emen

ts in

man

y hea

lth in

dica

tors

, the

MDG

targ

ets f

or n

eona

tal a

nd m

ater

nal

mor

talit

y wer

e no

t bei

ng m

et. T

here

fore

, a ta

sk fo

rce

was c

reat

ed b

y the

MOH

to id

entif

y som

e of

the

root

cau

ses o

f thi

s gap

. The

prim

ary o

bsta

cle

to a

chie

ving

thes

e ta

rget

s was

a la

ck

of su

rgic

al se

rvic

es, e

spec

ially

the

prov

isio

n of

cae

sare

an se

ctio

ns. F

urth

erm

ore,

a co

untry

-wid

e st

udy r

evea

led

that

74%

of Z

ambi

ans d

id n

ot h

ave

acce

ss to

safe

, tim

ely a

nd a

fford

able

su

rgic

al c

are.

In 2

015,

the

Zam

bian

del

egat

ion

spea

rhea

ded

WHA

reso

lutio

n 68

.15

to d

raw

atte

ntio

n to

the

need

to p

riorit

ize e

mer

genc

y and

ess

entia

l sur

gica

l and

ana

esth

esia

car

e as

par

t of

unive

rsal

hea

lth c

over

age.

Rec

ogni

zing

curre

nt g

aps w

ithin

the

dom

ains

of i

nfra

stru

ctur

e, wo

rkfo

rce,

serv

ice

deliv

ery,

finan

ce, in

form

atio

n m

anag

emen

t, an

d le

ader

ship

and

gov

erna

nce,

the

Zam

bian

Min

istry

of H

ealth

beg

an th

e pr

oces

s of d

evel

opin

g a

Natio

nal S

urgi

cal, O

bste

tric

and

Anae

sthe

sia

Plan

(NSO

AP).

Zam

bia’s

nat

iona

l pla

nnin

g pr

oces

s em

phas

ized

a pr

ovid

er-d

riven

pro

cess

, with

ove

rsig

ht b

y the

Min

istry

of H

ealth

. Thi

s NSO

AP p

roce

ss w

as c

ompo

sed

of th

e fo

llowi

ng p

hase

s:

1.

Base

line

asse

ssm

ent a

nd g

ap a

naly

sis

2.

Stak

ehol

der m

eetin

gs3.

W

ritin

g wo

rksh

op4.

Na

tiona

l Sur

gica

l, Obs

tetri

c an

d An

aest

hesi

a Fo

rum

5.

Cost

ing

work

shop

.In

ear

ly 2

017,

the

NSOA

P wa

s sig

ned

by th

e Za

mbi

an P

erm

anen

t Sec

reta

ry fo

r inc

lusi

on w

ithin

Zam

bia’s

Nat

iona

l Hea

lth S

trate

gic

Plan

for 2

017-

2021

. The

NSO

ASP

incl

udes

a ro

adm

ap

with

con

cret

e m

ilest

ones

and

mon

itorin

g m

echa

nism

s for

surg

ical

scal

e-up

in a

ll cr

itica

l dom

ains

.

8. P

rimary

care

Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y le

sson

s le

arnt

Inte

rlink

ages

with

oth

er a

reas

:

Tech

nica

l ser

ies o

n Sa

fer P

rimar

y Car

e (2

016)

Tech

nica

l re

port

Min

istri

es o

f he

alth

, hea

lth c

are

adm

inis

trato

rs

and

regu

lato

rs,

orga

niza

tions

/in

stitu

tions

Thes

e do

cum

ents

des

crib

e th

e sc

ope,

appr

oach

, pot

entia

l so

lutio

ns, p

ract

ical

nex

t ste

ps, a

nd th

en p

rovi

de li

nks t

o on

line

tool

kits

and

man

uals

to p

rovi

de p

ract

ical

sugg

estio

ns

for c

ount

ries a

nd o

rgan

izatio

ns th

at h

ave

com

mitt

ed to

m

akin

g pr

imar

y car

e sa

fer.

Tech

nica

l are

as c

over

ed in

clud

e:

patie

nt e

ngag

emen

t, ed

ucat

ion

and

train

ing,

hum

an fa

ctor

s, ad

min

istra

tive

erro

rs, d

iagn

ostic

erro

rs, m

edic

atio

n er

rors

, mul

ti-m

orbi

dity

, tra

nsiti

ons o

f car

e an

d el

ectro

nic

tool

s.

No le

sson

s le

arnt

as

yet.

Seen

thro

ugh

a PH

C le

ns, t

hese

mon

ogra

phs

addr

ess a

reas

whi

ch w

ould

be

rele

vant

for

vario

us te

chni

cal a

reas

. For

exa

mpl

e, th

e m

onog

raph

on

elec

troni

c to

ols w

ould

be

of in

tere

st to

the

eHea

lth u

nit w

ithin

WHO

he

adqu

arte

rs a

s wel

l as t

he G

uide

lines

Re

view

Com

mitt

ee.

http://www.who.int/patientsafety/topics/primary-care/technical_series/en/

http://www.who.int/patientsafety/topics/primary-care/technical_series/en/



Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y le

sson

s le

arnt

Inte

rlink

ages

with

oth

er a

reas

:

Met

hods

and

m

easu

res u

sed

in

prim

ary c

are

patie

nt

safe

ty re

sear

ch:

resu

lts o

f a li

tera

ture

re

view

(200

8)

Rese

arch

Re

sear

cher

s, qu

ality

man

ager

s, cl

inic

ians

This

doc

umen

t loo

ks a

t the

met

hods

use

d to

rese

arch

pat

ient

sa

fety

in p

rimar

y car

e an

d th

e m

etric

s thi

s res

earc

h us

es a

nd

prod

uces

.

No le

sson

s le

arnt

as

yet.

Give

n th

e se

arch

crit

eria

incl

uded

rese

arch

ab

out c

omm

unity

-bas

ed c

ompl

emen

tary

or

alte

rnat

ive m

edic

ine,

it al

so in

form

s co

mm

unity

out

reac

h pr

ogra

mm

es, a

s wel

l as

tradi

tiona

l med

icin

e pr

ogra

mm

es.

9. B

lood

safe

ty

Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lean

ed

Inte

rlink

ages

with

ot

her a

reas

:

Aide

-Mem

oire

: Qu

ality

Sys

tem

s for

Bl

ood

Safe

ty

(200

2)

Advo

cacy

Po

licy-

mak

ers,

natio

nal b

lood

pr

ogra

mm

e m

anag

er

An e

ffect

ive q

ualit

y sys

tem

pro

vide

s a fr

amew

ork

with

in w

hich

ac

tiviti

es a

re e

stab

lishe

d, p

erfo

rmed

in a

qua

lity-

focu

sed

way a

nd

cont

inuo

usly

mon

itore

d to

impr

ove

outc

omes

. A q

ualit

y sys

tem

sh

ould

cov

er a

ll as

pect

s of i

ts a

ctiv

ities

and

ens

ure

trace

abili

ty,

from

the

recr

uitm

ent a

nd se

lect

ion

of b

lood

don

ors t

o th

e tra

nsfu

sion

of b

lood

and

blo

od p

rodu

cts t

o pa

tient

s. It

shou

ld

also

refle

ct th

e st

ruct

ure,

need

s and

cap

abili

ties o

f the

blo

od

trans

fusi

on se

rvic

e, as

wel

l as t

he n

eeds

of t

he h

ospi

tals

and

pa

tient

s tha

t it s

erve

s.

1. T

he b

lood

tran

sfus

ion

serv

ice

is a

n im

porta

nt c

ompo

nent

of

a st

rong

hea

lth sy

stem

. A

syst

ems a

ppro

ach

is c

ruci

al

in d

evel

opin

g a

natio

nal b

lood

se

rvic

e to

ens

ure

unive

rsal

ac

cess

to sa

fe a

nd q

ualit

y bl

ood

trans

fusi

on.

Link

s with

nat

iona

l qu

ality

pol

icy a

nd

stra

tegy

, prim

ary

care

and

hos

pita

l m

anag

emen

t

http://www.who.int/patientsafety/research/methods_measures/makeham_dovey_full.pdf?ua=1






http://www.who.int/bloodsafety/quality/en/AM_quality_system.pdf?ua=1





Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lean

ed

Inte

rlink

ages

with

ot

her a

reas

:

Qual

ity m

anag

emen

t tra

inin

g fo

r blo

od

trans

fusi

on se

rvic

esFa

cilit

ator

s’ to

olki

t

Trai

ning

m

anua

l and

to

olki

ts

Natio

nal b

lood

pr

ogra

mm

e m

anag

er,

qual

ity

man

ager

of

bloo

d se

rvic

e,

educ

atio

nal

and

train

ing

inst

itute

s, he

alth

wor

kers

Qual

ity M

anag

emen

t Tra

inin

g (Q

MT)

: thi

s fac

ilita

tor’s

tool

kit i

s a

com

preh

ensi

ve se

t of t

each

ing

mat

eria

ls to

supp

ort a

n 18

-day

tra

inin

g co

urse

for q

ualit

y man

ager

s in

bloo

d tra

nsfu

sion

serv

ices

. It

cont

ains

gui

danc

e fo

r QM

T fa

cilit

ator

s, a

cour

se c

urric

ulum

, Po

werP

oint

pre

sent

atio

ns, a

ctiv

ities

, pre

sent

atio

n no

tes,

reso

urce

m

ater

ials

and

glo

ssar

y. Fa

cilit

ator

s are

enc

oura

ged

to a

dd lo

cal

reso

urce

mat

eria

ls, s

uch

as n

atio

nal s

tand

ards

and

exa

mpl

es o

f do

cum

enta

tion.

Par

t 1 o

f the

cou

rse

intro

duce

s gen

eral

con

cept

s of

qua

lity a

nd P

art 2

focu

ses o

n qu

ality

in th

e sp

ecifi

c co

ntex

t of

bloo

d tra

nsfu

sion

, fro

m b

lood

don

or re

crui

tmen

t to

the

trans

fusi

on

of b

lood

and

blo

od p

rodu

cts t

o th

e pa

tient

. The

cou

rse

cons

ists

of

15 m

odul

es c

onta

inin

g 57

pre

sent

atio

ns a

nd 6

9 ac

tiviti

es.

2. A

pre

-requ

isite

to im

plem

ent

a qu

ality

syst

em in

all

the

aspe

cts o

f blo

od tr

ansf

usio

n ch

ain,

from

don

or re

crui

tmen

t to

pat

ient

tran

sfus

ion,

is th

e es

tabl

ishm

ent o

f nat

iona

lly

coor

dina

ted

bloo

d tra

nsfu

sion

se

rvic

es.

3. T

he e

stab

lishm

ent a

nd

mai

nten

ance

of a

n ef

fect

ive

and

sust

aina

ble

qual

ity

man

agem

ent s

yste

m in

blo

od

trans

fusi

on se

rvic

es re

quire

s le

ader

ship

com

mitm

ent,

a st

rong

qua

lity c

ultu

re

and

a su

stai

nabl

e ex

tern

al

asse

ssm

ent p

rogr

amm

e to

dr

ive th

e sy

stem

con

tinua

lly to

im

prov

e.

Link

s with

nat

iona

l qu

ality

pol

icy a

nd

stra

tegy

, prim

ary

care

and

hos

pita

l m

anag

emen

t

Esta

blis

hing

Ext

erna

l Qu

ality

Ass

essm

ent

Prog

ram

mes

fo

r Scr

eeni

ng o

f Do

nate

d Bl

ood

for T

rans

fusi

on-

Tran

smis

sibl

e In

fect

ions

Impl

emen

tatio

n Gu

ide

Guid

ance

Na

tiona

l blo

od

prog

ram

me

man

ager

, qu

ality

m

anag

er o

f bl

ood

serv

ice,

QC p

erso

nnel

An e

xter

nal q

ualit

y ass

essm

ent (

EQA)

is a

n im

porta

nt c

ompo

nent

of

qua

lity s

yste

ms f

or b

lood

tran

sfus

ion

serv

ices

. Est

ablis

hing

ex

tern

al q

ualit

y ass

essm

ent p

rogr

amm

es fo

r the

scre

enin

g of

do

nate

d bl

ood

for t

rans

fusi

on-tr

ansm

issi

ble

infe

ctio

ns (T

TI):

this

impl

emen

tatio

n gu

ide

aim

s to

supp

ort W

HO M

embe

r Sta

tes

in e

stab

lishi

ng a

nd o

pera

ting

EQA

prog

ram

mes

for s

cree

ning

do

nate

d bl

ood

for T

TI. T

he g

uide

has

bee

n de

sign

ed fo

r use

by

natio

nal h

ealth

aut

horit

ies a

nd E

QA o

rgan

izing

inst

itutio

ns in

the

deve

lopm

ent o

f EQA

pro

gram

mes

. It w

ill a

lso

give

par

ticip

atin

g la

bora

torie

s ins

ight

s int

o th

e or

gani

zatio

n of

EQA

pro

gram

mes

fo

r TTI

scre

enin

g an

d an

und

erst

andi

ng o

f the

ben

efits

of

parti

cipa

tion

in th

is.

Link

s with

in vi

tro

diag

nost

ics a

nd

labo

rato

ry te

chno

logy

: ht

tp://

www.

who.

int/

diag

nost

ics_

labo

rato

ry/

en/

http://www.who.int/bloodsafety/publications/qmp_toolkit/en/




http://apps.who.int/iris/bitstream/handle/10665/246169/9789241510431-eng.pdf;jsessionid=469D4C439D57F5C85DF9429C8C06486A?sequence=1










http://www.who.int/diagnostics_laboratory/en/





Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lean

ed

Inte

rlink

ages

with

ot

her a

reas

:

Aide

-Mém

oire

fo

r Min

istry

of

Heal

th: N

atio

nal

Haem

ovig

ilanc

e Sy

stem

Advo

cacy

Polic

y-m

aker

s, na

tiona

l blo

od

prog

ram

me

man

ager

The

orga

niza

tion

of a

hae

mov

igila

nce

syst

em is

larg

ely d

eter

min

ed

by th

e st

ruct

ure

of th

e ex

istin

g na

tiona

l blo

od sy

stem

and

wid

er

heal

th sy

stem

. A sy

stem

of h

aem

ovig

ilanc

e is

dep

ende

nt o

n th

e tra

ceab

ility

of b

lood

and

blo

od p

rodu

cts f

rom

don

ors t

o re

cipi

ents

an

d vi

ce ve

rsa,

and

on th

e m

onito

ring,

repo

rting

, inve

stig

atio

n an

d an

alys

is o

f adv

erse

eve

nts.

The

rigo

rous

man

agem

ent o

f in

form

atio

n ge

nera

ted

thro

ugh

this

syst

em is

key t

o in

trodu

cing

am

endm

ents

in b

lood

pol

icie

s and

gui

delin

es th

at le

ad to

cha

nges

in

pro

cess

es a

nd p

ract

ices

in d

onat

ion

and

trans

fusi

on.

Sam

e le

sson

lear

nt a

s bef

ore

Link

s with

nat

iona

l qu

ality

pol

icy a

nd

stra

tegy

, prim

ary

care

and

hos

pita

l m

anag

emen

t.

A gu

ide

to

esta

blis

hing

a

natio

nal

haem

ovig

ilanc

e sy

stem

Guid

ance

Polic

y-m

aker

s, na

tiona

l blo

od

prog

ram

me

man

ager

, cl

inic

ians

and

tra

nsfu

sion

m

edic

ine

spec

ialis

t

Haem

ovig

ilanc

e in

clud

es th

e m

onito

ring,

repo

rting

, inve

stig

atio

n an

d an

alys

is o

f adv

erse

eve

nts r

elat

ed to

the

dona

tion,

pro

cess

ing

and

trans

fusi

on o

f blo

od, a

nd ta

king

act

ion

to p

reve

nt th

eir

occu

rrenc

e or

recu

rrenc

e. T

his g

uida

nce

aim

s to

supp

ort c

ount

ries

in e

stab

lishi

ng e

ffect

ive n

atio

nal s

yste

ms f

or h

aem

ovig

ilanc

e th

roug

hout

the

trans

fusi

on c

hain

. It p

rovi

des p

olic

y gui

danc

e on

es

tabl

ishi

ng a

hae

mov

igila

nce

syst

em a

s par

t of n

atio

nal b

lood

an

d he

alth

syst

ems,

and

incl

udes

tech

nica

l inf

orm

atio

n an

d gu

idan

ce o

n th

e sp

ecifi

c m

easu

res a

nd a

ctio

ns w

hich

nee

d to

be

take

n to

impl

emen

t a su

cces

sful

hae

mov

igila

nce

syst

em.

Link

s with

repo

rting

fo

r pat

ient

safe

ty:

http

://ww

w.wh

o.in

t/pat

ient

safe

ty/

impl

emen

tatio

n/re

porti

ng_a

nd_le

arni

ng/

en/

http://www.who.int/bloodsafety/am_National_Haemovigilance_System.pdf?ua=1





http://apps.who.int/iris/bitstream/handle/10665/250233/9789241549844-eng.pdf?sequence=1





http://www.who.int/patientsafety/implementation/reporting_and_learning/en/







Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lean

ed

Inte

rlink

ages

with

ot

her a

reas

:

Clin

ical

tran

sfus

ion

proc

ess a

nd p

atie

nt

safe

ty (A

ide-

mém

oire

for N

atio

nal

Heal

th A

utho

ritie

s an

d Ho

spita

l M

anag

emen

t)

Advo

cacy

Polic

y-m

aker

s, na

tiona

l blo

od

prog

ram

me

man

ager

, cl

inic

ians

and

tra

nsfu

sion

m

edic

ine

An a

ppro

pria

te a

nd c

orre

ct c

linic

al tr

ansf

usio

n pr

oces

s ens

ures

pa

tient

safe

ty a

nd c

ontri

bute

s to

impr

oved

hea

lth a

nd su

rviva

l. Ho

weve

r, tra

nsfu

sion

car

ries t

he ri

sk o

f adv

erse

eve

nts i

nclu

ding

er

rors

, tra

nsfu

sion

reac

tions

and

tran

smis

sion

of i

nfec

tions

. Er

rors

dur

ing

the

clin

ical

tran

sfus

ion

proc

ess c

an b

e pr

even

ted

by

the

stre

ngth

enin

g of

hos

pita

l sys

tem

s and

pro

cess

es fo

r clin

ical

tra

nsfu

sion

, the

trai

ning

of h

ospi

tal s

taff

and

the

impl

emen

tatio

n of

stan

dard

ized

proc

edur

es th

roug

hout

the

clin

ical

tran

sfus

ion

proc

ess.

Link

s with

nat

iona

l qu

ality

pol

icy a

nd

stra

tegy

, prim

ary

care

and

hos

pita

l m

anag

emen

t

The

clin

ical

use

of

bloo

d in

obs

tetri

cs,

paed

iatri

cs, s

urge

ry

and

anae

sthe

sia,

traum

a an

d bu

rns

Trai

ning

M

anua

l Na

tiona

l blo

od

prog

ram

me

man

ager

, cl

inic

ians

and

tra

nsfu

sion

m

edic

ine

The

Clin

ical

use

of b

lood

aim

s to

show

how

blo

od a

nd b

lood

pr

oduc

ts c

an b

e us

ed a

ppro

pria

tely

at a

ll le

vels

of t

he h

ealth

ca

re sy

stem

in a

ny c

ount

ry, w

ithou

t com

prom

isin

g st

anda

rds o

f qu

ality

and

safe

ty. I

t pro

vide

s a c

ompr

ehen

sive

gui

de to

the

use

of b

lood

and

blo

od p

rodu

cts a

nd, in

par

ticul

ar, w

ays o

f min

imizi

ng

unne

cess

ary t

rans

fusi

on.

Prim

ary c

are,

hosp

ital

man

agem

ent,

infe

ctio

n pr

even

tion

and

cont

rol

http://www.who.int/bloodsafety/clinical_use/who_eht_10_05_en.pdf?ua=1







http://www.who.int/bloodsafety/clinical_use/en/Manual_EN.pdf?ua=1







Nam

e of

tool

Type

of

tool

Audi

ence

Su

mm

ary d

escr

iptio

nKe

y les

sons

lean

ed

Inte

rlink

ages

with

ot

her a

reas

:

Glob

al S

tatu

s Rep

ort

on B

lood

Saf

ety a

nd

Avai

labi

lity 2

016

Repo

rtPo

licy-

mak

ers,

natio

nal b

lood

pr

ogra

mm

e m

anag

ers

The

Wor

ld H

ealth

Org

aniza

tion

Glob

al D

atab

ase

on B

lood

Saf

ety

(GDB

S) w

as e

stab

lishe

d in

199

8 to

add

ress

glo

bal c

once

rns a

bout

th

e av

aila

bilit

y, sa

fety

and

acc

essi

bilit

y of b

lood

for t

rans

fusi

on.

The

obje

ctive

of t

his a

ctiv

ity is

to c

olle

ct a

nd a

naly

se d

ata

from

al

l cou

ntrie

s on

bloo

d an

d bl

ood

prod

uct s

afet

y as t

he b

asis

for

effe

ctive

act

ion

to im

prov

e bl

ood

trans

fusi

on se

rvic

es g

loba

lly.

The

2016

repo

rt, w

hich

is b

ased

on

the

late

st G

DBS

data

, pro

vide

s in

form

atio

n on

the

curre

nt st

atus

of b

lood

tran

sfus

ion

serv

ices

.

Link

s with

nat

iona

l qu

ality

pol

icy a

nd

stra

tegy

, prim

ary

care

and

hos

pita

l m

anag

emen

t

Case

stud

y 8: S

treng

then

ing

the

Natio

nal B

lood

Sys

tem

in B

huta

n to

ens

ure

equi

tabl

e ac

cess

to sa

fe b

lood

tran

sfus

ion

In 2

010,

Bhu

tan

beca

me

a be

nefic

iary

of t

he W

HO/O

FID

join

t pro

ject

(pha

se I:

201

0-20

13 a

nd p

hase

II: 2

015-

2017

). Th

e ov

eral

l pro

ject

goa

l has

bee

n to

pre

vent

med

ical

tran

smis

sion

of

infe

ctio

us d

isea

ses s

uch

as H

IV, h

epat

itis B

and

C th

roug

h tra

nsfu

sion

of b

lood

and

its a

ssoc

iate

d pr

oduc

ts. T

hrou

gh th

e pr

ojec

t, su

ppor

t in

polic

y gui

danc

e, ad

voca

cy, t

echn

ical

and

ca

paci

ty-b

uild

ing

were

pro

vide

d by

WHO

. An

adap

ted

vers

ion

of th

e W

HO to

ol w

as u

sed

to id

entif

y exi

stin

g co

nstra

ints

and

gap

s in

natio

nal b

lood

ava

ilabi

lity a

nd sa

fety

. Pro

ject

act

ivity

pl

ans w

ere

deve

lope

d wi

th th

e ob

ject

ives t

o st

anda

rdize

the

bloo

d sc

reen

ing

proc

ess w

ith a

focu

s on

stre

ngth

enin

g la

bora

tory

faci

litie

s, im

plem

entin

g go

od la

bora

tory

pra

ctic

es a

s wel

l as

stre

ngth

enin

g th

e na

tiona

l blo

od sy

stem

to im

prov

e ac

cess

to sa

fe, q

ualit

y and

ade

quat

e bl

ood

supp

lies.

The

key e

lem

ents

are

out

lined

in th

e Ai

de-M

emoi

re o

n Qu

ality

syst

ems a

s bui

ldin

g bl

ocks

to in

itiat

e th

e pr

oces

s of q

ualit

y man

agem

ent.

In 2

013,

the

Natio

nal S

tand

ards

for B

TS

were

dev

elop

ed a

nd la

ter i

ncor

pora

ted

into

the

regu

lato

ry fr

amew

ork

for i

mpr

oved

com

plia

nce.

WHO

tool

s wer

e us

ed a

s ref

eren

ce m

ater

ials

dur

ing

the

cons

ulta

tive

and

draf

ting

stag

es fo

r the

dev

elop

men

t of n

atio

nal g

uide

lines

such

as b

lood

don

or m

otiva

tion

and

recr

uitm

ent s

trate

gies

, blo

od d

onor

ass

essm

ent a

nd se

lect

ion,

qua

lity a

ssur

ed sc

reen

ing

of

trans

fusi

on-tr

ansm

issi

ble

infe

ctio

ns, n

atio

nal e

xter

nal q

ualit

y ass

essm

ent s

chem

es (N

EQAS

) in

bloo

d gr

oup

sero

logy

and

tran

sfus

ion-

trans

mis

sibl

e in

fect

ions

. A

guid

ance

doc

umen

t on

hae

mov

igila

nce

in B

huta

n ha

s now

bee

n pu

blis

hed

and

is in

use

acr

oss t

he c

ount

ry. Q

ualit

y man

agem

ent t

rain

ings

bas

ed o

n W

HO Q

ualit

y Man

agem

ent T

rain

ing

(QM

T) m

odul

es

were

con

duct

ed a

s par

t of c

apac

ity-b

uild

ing

of B

TS p

erso

nnel

and

a c

ore

grou

p of

qua

lity m

anag

ers i

nvol

ved

in w

ritin

g th

e Qu

ality

Man

ual, s

tand

ard

oper

atin

g pr

oced

ures

and

wor

k in

stru

ctio

ns. D

ata

repo

rting

and

info

rmat

ion

man

agem

ent o

n bl

ood

safe

ty h

as b

een

stre

ngth

ened

and

rece

ntly

a st

atus

repo

rt on

blo

od sa

fety

and

ava

ilabi

lity i

n Bh

utan

was

rele

ased

us

ing

findi

ngs o

f the

GDB

S re

port

of 2

016.

The

imm

edia

te im

pact

has

bee

n on

the

gene

ral p

ublic

bei

ng m

ore

awar

e of

the

impo

rtanc

e of

blo

od d

onat

ion,

beh

avio

ur c

hang

e an

d po

sitiv

e re

spon

se o

bser

ved

when

ask

ed to

don

ate

bloo

d vo

lunt

arily

. The

tim

ely a

vaila

bilit

y of b

lood

at t

he g

rass

root

leve

l, has

save

d liv

es o

f man

y Bhu

tane

se, e

spec

ially

pre

vent

ing

mat

erna

l dea

ths d

ue to

blo

od lo

ss, w

ith n

ewbo

rns,

infa

nts a

nd o

ther

chr

onic

ally

ill i

ndiv

idua

ls b

eing

oth

er b

enef

icia

ries.

No

HIV

or h

epat

itis t

rans

mis

sion

thro

ugh

bloo

d ha

s bee

n re

porte

d by

resp

ectiv

e pr

ogra

mm

es. P

erfo

rman

ce o

f bl

ood

bank

s has

esc

alat

ed in

pas

t yea

rs a

nd b

ette

r com

plia

nce

amon

g nu

rses

to u

se S

OPs a

nd re

port

adve

rse

reac

tions

to b

lood

. Ke

y les

sons

lear

nt1.

Bl

ood

syst

em m

ust b

e in

corp

orat

ed in

any

nat

iona

l hea

lth sy

stem

WHO

doc

umen

ts (i

n pa

rticu

lar t

he o

ne-p

age

Aide

Mem

oire

) are

the

appr

opria

te a

dvoc

acy t

ools

for g

aini

ng

polit

ical

com

mitm

ent a

nd su

ppor

t. 2.

A

syst

em a

ppro

ach

and

the

impl

emen

tatio

n of

a c

ompr

ehen

sive

stra

tegi

c pl

an is

cru

cial

for a

chie

ving

pro

visi

on o

f tim

ely a

nd u

nive

rsal

acc

ess t

o sa

fe a

nd q

ualit

y blo

od

trans

fusi

on se

rvic

es a

nd p

rodu

cts.

3.

Perfo

rman

ce o

f nat

iona

l blo

od se

rvic

e ca

n be

ben

chm

arke

d an

d co

ntin

ually

impr

oved

thro

ugh

the

repo

rting

and

ana

lysi

s of g

loba

l/reg

iona

l KPI

s of d

ata.

4.

Futu

re su

ppor

t sho

uld

be o

n es

tabl

ishi

ng p

rogr

amm

e an

d ca

paci

ty fo

r the

sele

ctio

n of

in-v

itro

diag

nost

ic k

its fo

r blo

od sc

reen

ing,

pro

mot

ing

evi

denc

e-ba

sed

clin

ical

tran

sfus

ion

prac

tices

and

impl

emen

ting

patie

nt b

lood

man

agem

ent g

uide

lines

.






10. In

fect

ion p

reven

tion a

nd

contro

l

Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y les

sons

lear

ntIn

terli

nkag

es w

ith o

ther

ar

eas

WHO

gui

delin

es o

n co

re c

ompo

nent

s fo

r IPC

(2

016)

Guid

elin

ePo

licy-

mak

ers

(nat

iona

l lev

el)

and

faci

lity l

evel

ad

min

istra

tors

(fa

cilit

y lev

el)

The

guid

elin

es su

mm

arize

eig

ht fa

cilit

y-le

vel

and

six n

atio

nal-l

evel

reco

mm

enda

tions

on

IPC,

add

ress

ing

prog

ram

mes

, gui

delin

es,

educ

atio

n an

d tra

inin

g, su

rvei

llanc

e, m

ultim

odal

stra

tegi

es, m

onito

ring,

aud

it an

d fe

edba

ck, a

n en

ablin

g en

viro

nmen

t in

clud

ing

work

load

, sta

ffing

and

bed

oc

cupa

ncy a

nd th

e bu

ilt e

nviro

nmen

t, m

ater

ials

and

equ

ipm

ent.

For m

ore

info

rmat

ion:

http

://ww

w.wh

o.in

t/inf

ectio

n-pr

even

tion/

publ

icat

ions

/cor

e-co

mpo

nent

s/en

/

The

guid

elin

es a

re b

eing

use

d in

a n

umbe

r of c

ount

ries t

o dr

ive n

atio

nal a

nd fa

cilit

y lev

el

impr

ovem

ent i

n IP

C, su

ppor

ted

by re

leva

nt a

sses

smen

t too

ls.

In so

me

regi

ons t

he g

uide

lines

an

d as

soci

ated

ass

essm

ent a

nd

impl

emen

tatio

n to

ols a

re se

rvin

g as

the

foun

datio

n fo

r nat

iona

l IPC

gu

idel

ines

and

/or b

eing

pos

ition

ed

as p

art o

f the

AM

R ag

enda

.

Wat

er, s

anita

tion

and

hygi

ene

(WAS

H), q

ualit

y, pa

tient

safe

ty, a

ntim

icro

bial

st

ewar

dshi

p ac

cred

itatio

n/re

gula

tion,

pub

lic h

ealth

/di

seas

e co

ntro

l, occ

upat

iona

l he

alth

WHO

Cor

e co

mpo

nent

s nat

iona

l im

plem

enta

tion

m

anua

l (2

017)

Impl

emen

tatio

n m

anua

lPo

licy-

mak

ers

and

impl

emen

ters

re

spon

sibl

e fo

r IPC

(in

clud

ing

IHR)

and

AM

R

This

pra

ctic

al m

anua

l is d

esig

ned

to su

ppor

t im

plem

enta

tion

of th

e W

HO G

uide

lines

on

core

com

pone

nts o

f inf

ectio

n pr

even

tion

and

cont

rol p

rogr

amm

es a

t the

nat

iona

l le

vel, w

ith sp

ecia

l foc

us o

n co

untri

es w

ith

limite

d re

sour

ces.

Thi

s pra

ctic

al m

anua

l ou

tline

s how

to d

o th

is, t

hat i

s, ho

w to

im

plem

ent t

he G

uide

lines

. It f

ocus

es o

n th

e de

velo

pmen

t of a

sust

aina

ble

actio

n pl

an

info

rmed

by t

he lo

cal c

onte

xt to

put

into

op

erat

ion

the

Guid

elin

e re

com

men

datio

ns.

For m

ore

info

rmat

ion:

ht

tp://

www.

who.

int/i

nfec

tion-

prev

entio

n/to

ols/

core

-com

pone

nts/

en/

Thi

s man

ual o

utlin

es fi

ve st

eps

for i

mpl

emen

ting

IPC

prog

ram

mes

to

max

imize

the

likel

ihoo

d of

su

cces

s and

ove

rcom

e so

me

of

the

com

plex

ity in

the

proc

ess.

Th

e em

phas

is w

ithin

eac

h st

ep

is o

n lo

cal a

dapt

atio

n. H

owev

er,

depe

ndin

g on

the

loca

l situ

atio

n,

som

e st

eps m

ay a

lread

y hav

e be

en a

chie

ved,

whi

le o

ther

s may

ne

ed g

radu

al d

evel

opm

ent o

r to

be re

visi

ted

as n

ew c

halle

nges

or

chan

ges w

ithin

the

heal

th c

are

syst

em a

rise.

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

http://www.who.int/infection-prevention/publications/core-components/en/






http://www.who.int/infection-prevention/tools/core-components/en/








Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y les

sons

lear

ntIn

terli

nkag

es w

ith o

ther

ar

eas

WHO

Cor

e co

mpo

nent

s nat

iona

l as

sess

men

t too

l (IP

CAT2

) (2

017)

Asse

ssm

ent t

ool

Polic

y-m

aker

s an

d im

plem

ente

rs

resp

onsi

ble

for I

PC

(incl

udin

g IH

R) a

nd

AMR

IPCA

T2 w

ill a

ssis

t cou

ntrie

s to

dete

rmin

e th

e co

re c

ompo

nent

s alre

ady i

n pl

ace,

that

is, n

atio

nal e

xist

ing

stre

ngth

s, an

d to

iden

tify g

aps o

r wea

knes

ses t

o gu

ide

actio

n pl

anni

ng. I

PCAT

2 co

rresp

onds

to

the

six c

ore

com

pone

nt re

com

men

datio

ns

of th

e gu

idel

ines

targ

eted

at t

he n

atio

nal

leve

l. Fo

r mor

e in

form

atio

n: h

ttp://

www.

who.

int/i

nfec

tion-

prev

entio

n/to

ols/

core

-co

mpo

nent

s/en

/

It is

very

impo

rtant

to u

nder

stan

d th

at IP

CAT2

is n

ot in

tend

ed to

be

used

as a

n au

dit t

ool.

Its p

urpo

se

is to

hel

p as

sess

, pla

n, o

rgan

ize

and

impl

emen

t a n

atio

nal I

PC

prog

ram

me.

The

tool

pro

vide

s a

gene

ral o

verv

iew

of th

e st

atus

of

IPC

activ

ities

acc

ordi

ng to

the

guid

elin

e re

com

men

datio

ns, r

athe

r th

an fo

cusi

ng o

n sp

ecifi

c IP

C pr

actic

es/ri

sk fa

ctor

s rel

ated

to

indi

vidu

al p

atie

nts.

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

WHO

Cor

e co

mpo

nent

s he

alth

car

e fa

cilit

y im

plem

enta

tion

man

ual (

2018

)

Impl

emen

tatio

n m

anua

lIP

C le

ads/

foca

l pe

rson

s and

team

s in

acu

te h

ealth

car

e fa

cilit

ies r

espo

nsib

le

for i

mpl

emen

ting

IPC,

incl

udin

g he

alth

car

e fa

cilit

y m

anag

ers

This

man

ual o

ffers

pra

ctic

al g

uida

nce,

tips,

reso

urce

s and

exa

mpl

es fr

om a

roun

d th

e wo

rld to

supp

ort g

uide

line

impl

emen

tatio

n. It

als

o fo

cuse

s on

the

deve

lopm

ent o

f a su

stai

nabl

e ac

tion

plan

that

shou

ld b

e in

form

ed b

y the

loca

l co

ntex

t to

put i

nto

oper

atio

n th

e gu

idel

ine

reco

mm

enda

tions

. Fin

ally,

the

man

ual

focu

ses o

n in

tegr

atin

g an

d em

bedd

ing

IPC

with

in th

e da

y-to

-day

stru

ctur

e an

d ac

tiviti

es o

f a h

ealth

car

e fa

cilit

y. Fo

r mor

e in

form

atio

n: h

ttp://

www.

who.

int/i

nfec

tion-

prev

entio

n/to

ols/

core

-com

pone

nts/

en/

Only

rece

ntly

laun

ched

. No

less

ons

lear

nt a

s yet

. W

ASH,

qua

lity,

patie

nt sa

fety

, an

timic

robi

al st

ewar

dshi

p ac

cred

itatio

n/re

gula

tion,

pu

blic

hea

lth/d

isea

se c

ontro

l, oc

cupa

tiona

l hea

lth.

WHO

Cor

e co

mpo

nent

s he

alth

car

e fa

cilit

y as

sess

men

t fra

mew

ork

(IPCA

F)

(201

8)

Asse

ssm

ent t

ool

IPC

lead

s/fo

cal

pers

ons a

nd te

ams

in a

cute

hea

lth c

are

faci

litie

s res

pons

ible

fo

r im

plem

entin

g IP

C, in

clud

ing

heal

th c

are

faci

lity

man

ager

s

The

IPCA

F is

a st

ruct

ured

, clo

sed-

form

atte

d qu

estio

nnai

re w

ith a

n as

soci

ated

scor

ing

syst

em. I

t is p

rimar

ily in

tend

ed to

be

self-

adm

inis

tere

d bu

t it c

an a

lso

be u

sed

for

join

t ass

essm

ents

with

ext

erna

l ass

esso

rs

(for e

xam

ple,

from

the

min

istry

of h

ealth

, W

HO o

r oth

er st

akeh

olde

rs) a

nd fa

cilit

y st

aff.

For m

ore

info

rmat

ion:

http

://ww

w.wh

o.in

t/inf

ectio

n-pr

even

tion/

tool

s/co

re-

com

pone

nts/

en/

Only

rece

ntly

laun

ched

. No

less

ons

lear

nt a

s yet

.W

ASH,

qua

lity,

patie

nt sa

fety

, an

timic

robi

al st

ewar

dshi

p ac

cred

itatio

n/re

gula

tion,

pu

blic

hea

lth/d

isea

se c

ontro

l, oc

cupa

tiona

l hea

lth.

























Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y les

sons

lear

ntIn

terli

nkag

es w

ith o

ther

ar

eas

WHO

gui

delin

es o

n th

e pr

even

tion

of

surg

ical

site

infe

ctio

n (2

016)

Guid

elin

eSu

rgic

al te

ams,

(sur

geon

s, nu

rses

, te

chni

cal s

uppo

rt st

aff,

anae

sthe

tists

) an

d an

y pr

ofes

sion

als d

irect

ly

prov

idin

g su

rgic

al

care

The

aim

of t

hese

gui

delin

es is

to p

rovi

de

a co

mpr

ehen

sive

rang

e of

evi

denc

e-ba

sed

reco

mm

enda

tions

for i

nter

vent

ions

to

be a

pplie

d du

ring

the

pre-

, intra

- and

po

stop

erat

ive p

erio

ds, f

or th

e pr

even

tion

of S

SI, w

hile

als

o co

nsid

erin

g, a

spec

ts

rela

ted

to re

sour

ce a

vaila

bilit

y and

valu

es

and

pref

eren

ces.

For

mor

e in

form

atio

n:

http

://ww

w.wh

o.in

t/inf

ectio

n-pr

even

tion/

publ

icat

ions

/ssi

-gui

delin

es/e

n/

Thes

e gu

idel

ines

hav

e ga

ined

at

tent

ion

in a

rang

e of

setti

ngs

sinc

e th

eir l

aunc

h, in

clud

ing

thro

ugh

lette

rs a

nd re

spon

ses

with

in sc

ient

ific

jour

nals

, and

are

al

read

y inf

orm

ing

an im

prov

emen

t to

ol k

it.

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

WHO

gui

delin

es

on h

and

hygi

ene

in

heal

th c

are

(200

9)

Guid

elin

ePo

licy-

mak

ers

and

impl

emen

ters

re

spon

sibl

e fo

r IP

C (in

clud

ing

Inte

rnat

iona

l Hea

lth

Regu

latio

ns (I

HR))

and

Antim

icro

bial

Re

sist

ance

(AM

R),

IPC

lead

s/fo

cal

pers

ons a

nd te

ams

in a

cute

hea

lth c

are

faci

litie

s res

pons

ible

fo

r im

plem

entin

g IP

C, in

clud

ing

heal

th c

are

faci

lity

man

ager

s

Guid

elin

es o

n ha

nd h

ygie

ne in

hea

lth

care

with

a re

view

of t

he e

vide

nce

on

hand

hyg

iene

in h

ealth

car

e an

d sp

ecifi

c re

com

men

datio

ns to

impr

ove

prac

tices

an

d re

duce

tran

smis

sion

of p

atho

geni

c m

icro

orga

nism

s to

patie

nts a

nd H

CWs.

The

gu

idel

ines

are

to b

e im

plem

ente

d in

any

si

tuat

ion

in w

hich

hea

lth c

are

is d

elive

red

eith

er to

a p

atie

nt o

r to

a sp

ecifi

c gr

oup

in a

pop

ulat

ion.

For

mor

e in

form

atio

n,

http

://ww

w.wh

o.in

t/inf

ectio

n-pr

even

tion/

publ

icat

ions

/han

d-hy

gien

e-20

09/e

n/

The

guid

elin

es h

ave

drive

n aw

aren

ess a

nd a

ctio

n si

nce

thei

r la

unch

in 2

009

and

have

bee

n th

e im

petu

s for

com

mitm

ent b

y co

untri

es (i

nclu

ding

num

erou

s m

inis

teria

l ple

dges

) and

hea

lth

faci

litie

s (in

clud

ing

regi

stra

tion

for

WHO

’s ha

nd h

ygie

ne c

ampa

ign)

, le

adin

g to

use

of t

he W

HO

impr

ovem

ent s

trate

gy/to

olki

t.

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

http://www.who.int/infection-prevention/publications/ssi-guidelines/en/





http://www.who.int/infection-prevention/publications/hand-hygiene-2009/en/







Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y les

sons

lear

ntIn

terli

nkag

es w

ith o

ther

ar

eas

WHO

han

d hy

gien

e se

lf-as

sess

men

t fra

mew

ork

(HHS

AF)

(201

0)

Asse

ssm

ent t

ool

Polic

y-m

aker

s an

d im

plem

ente

rs

resp

onsi

ble

for I

PC

(incl

udin

g IH

R) a

nd

AMR,

IPC

lead

s/fo

cal

pers

ons a

nd te

ams

in a

cute

hea

lth c

are

faci

litie

s res

pons

ible

fo

r im

plem

entin

g IP

C, in

clud

ing

heal

th c

are

faci

lity

man

ager

s

A sy

stem

atic

tool

with

whi

ch to

obt

ain

a si

tuat

ion

anal

ysis

of h

and

hygi

ene

prom

otio

n an

d pr

actic

es w

ithin

an

indi

vidu

al

heal

th c

are

faci

lity.

For m

ore

info

rmat

ion:

ht

tp://

www.

who.

int/g

psc/

coun

try_w

ork/

hhsa

_fra

mew

ork_

Octo

ber_

2010

.pdf

?ua=

1

This

tool

is u

sed

wide

ly in

man

y co

untri

es a

s dem

onst

rate

d th

roug

h tw

o W

HO g

loba

l sur

vey r

epor

ts

and

form

s par

t of a

hos

pita

l ex

celle

nce

awar

d in

four

WHO

re

gion

s. It

has

bee

n ad

opte

d by

m

any o

rgan

izatio

ns in

clud

ing

thos

e fo

cuse

d on

qua

lity a

nd sa

fety

, to

prom

ote

impr

ovem

ent i

n he

alth

fa

cilit

ies.

For

mor

e in

form

atio

n on

the

surv

ey re

port,

visi

t: ht

tp://

www.

who.

int/i

nfec

tion-

prev

entio

n/pu

blic

atio

ns/re

late

d-do

cum

ents

/en

/),

Addi

tiona

l les

sons

lear

nt a

re

capt

ured

in:

Alle

gran

zi B,

Con

way

L, La

rson

E e

t al.

Stat

us o

f the

im

plem

enta

tion

of th

e W

orld

Hea

lth

Orga

niza

tion

mul

timod

al h

and

hygi

ene

stra

tegy

in U

nite

d St

ates

of

Am

eric

a he

alth

car

e fa

cilit

ies.

Am

eric

an J

ourn

al o

f Inf

ectio

n Co

ntro

l 201

4; 4

2(3)

: 224

-230

ht

tps:

//www

.ncb

i.nlm

.nih

.gov

/pu

bmed

/245

8101

1?do

pt=A

bstra

ct

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

http://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf?ua=1





http://www.who.int/infection-prevention/publications/related-documents/en/




https://www.ncbi.nlm.nih.gov/pubmed/24581011?dopt=Abstract

https://www.ncbi.nlm.nih.gov/pubmed/24581011?dopt=Abstract

41

Nam

e of

tool

(yea

r)Ty

pe o

f too

lAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y les

sons

lear

ntIn

terli

nkag

es w

ith o

ther

ar

eas

WHO

han

d hy

gien

e gu

ide

to

impl

emen

tatio

n an

d as

soci

ated

reso

urce

s

Impl

emen

tatio

n m

anua

l and

as

soci

ated

re

sour

ces

Polic

y-m

aker

s an

d im

plem

ente

rs

resp

onsi

ble

for I

PC

(incl

udin

g IH

R) a

nd

AMR,

IPC

lead

s/fo

cal

pers

ons a

nd te

ams

in a

cute

hea

lth c

are

faci

litie

s res

pons

ible

fo

r im

plem

entin

g IP

C, in

clud

ing

heal

th c

are

faci

lity

man

ager

s

A su

ite o

f too

ls fo

r im

plem

entin

g W

HO

guid

ance

on

hand

hyg

iene

. For

mor

e in

form

atio

n: h

ttp://

www.

who.

int/i

nfec

tion-

prev

entio

n/to

ols/

hand

-hyg

iene

/en/

The

focu

s of a

num

ber o

f sci

entif

ic

publ

icat

ions

, the

mul

timod

al

impr

ovem

ent t

oolk

it is

wid

ely u

sed

in m

ost c

ount

ries a

roun

d th

e wo

rld.

WHO

web

stat

istic

s als

o co

nfirm

th

e po

pula

rity o

f man

y of t

he to

ols,

espe

cial

ly a

s the

y are

targ

eted

at

both

hig

h- a

nd lo

w-m

iddl

e in

com

e co

untri

es. A

key p

ublic

atio

n su

mm

arize

s the

impr

ovem

ent

stra

tegy

’s su

cces

s whi

ch th

eref

ore

refle

cts t

he u

sefu

lnes

s of t

he

tool

kit.

http

s://w

ww.b

mj.c

om/

cont

ent/3

51/b

mj.h

3728

/

WAS

H, q

ualit

y, pa

tient

safe

ty,

antim

icro

bial

stew

ards

hip

accr

edita

tion/

regu

latio

n,

publ

ic h

ealth

/dis

ease

con

trol,

occu

patio

nal h

ealth

.

WHO

gui

delin

es

for t

he p

reve

ntio

n an

d co

ntro

l of

carb

apen

em-re

sist

ant

Ente

roba

cter

iace

ae,

Acin

etob

acte

r ba

uman

nii a

nd

Pseu

dom

onas

ae

rugi

nosa

in h

ealth

ca

re fa

cilit

ies

(201

7)

Guid

elin

eIP

C le

ads/

foca

l pe

rson

s and

team

sPr

ovid

es e

vide

nce-

base

d re

com

men

datio

ns

on th

e ea

rly re

cogn

ition

and

spec

ific

requ

ired

IPC

prac

tices

and

pro

cedu

res t

o ef

fect

ively

pre

vent

the

occu

rrenc

e an

d co

ntro

l the

spre

ad o

f CRE

-CRA

B-CR

PsA

colo

niza

tion

and/

or in

fect

ion

in a

cute

he

alth

car

e fa

cilit

ies.

An

evid

ence

-bas

ed

fram

ewor

k to

hel

p in

form

the

deve

lopm

ent

and/

or st

reng

then

ing

of n

atio

nal a

nd

faci

lity I

PC p

olic

ies a

nd p

rogr

amm

es to

co

ntro

l the

tran

smis

sion

of C

RE-C

RAB-

CRPs

A in

a va

riety

of h

ealth

car

e se

tting

s is

als

o pr

esen

ted.

For

mor

e in

form

atio

n:

http

://ww

w.wh

o.in

t/inf

ectio

n-pr

even

tion/

publ

icat

ions

/gui

delin

es-c

re/e

n/

Man

y cou

ntrie

s hav

e de

velo

ped

natio

nal i

mpl

emen

tatio

n st

rate

gies

or

faci

lity l

evel

impl

emen

tatio

n to

ols b

ut th

ere

is a

nee

d fo

r WHO

to

crea

te a

n in

vent

ory o

f the

se to

ols

(on

prog

ress

as o

f Jun

e 20

18) a

nd

then

to id

entif

y and

dev

elop

whi

ch

WHO

tool

s are

nec

essa

ry to

supp

ort

impl

emen

tatio

n.

Antim

icro

bial

resi

stan

ce,

WAS

H.

Tools and resources for improving the


http://www.who.int/infection-prevention/tools/hand-hygiene/en/






https://www.bmj.com/content/351/bmj.h3728/

https://www.bmj.com/content/351/bmj.h3728/

http://www.who.int/infection-prevention/publications/guidelines-cre/en/














Case

stud

y 9: N

atio

nal I

PC p

rogr

amm

e im

plem

enta

tion

in Q

atar

The

natio

nal I

PC p

rogr

amm

e in

Qat

ar w

ent t

hrou

gh a

n ex

tern

al c

onsu

ltatio

n us

ing

the

WHO

cor

e co

mpo

nent

s nat

iona

l im

plem

enta

tion

man

ual a

nd a

ssoc

iate

d na

tiona

l ass

essm

ent

tool

(IPC

AT2)

. Thi

s was

don

e as

par

t of t

he J

oint

Pro

gram

Pla

nnin

g/Re

view

Mis

sion

(JPR

M) a

nd th

e Co

untry

Coo

pera

tion

Stra

tegy

for E

MRO

and

the

Stat

e of

Qat

ar. T

he m

ain

aim

of

this

mis

sion

was

to a

sses

s the

nat

iona

l IPC

pro

gram

me

agai

nst t

he W

HO st

anda

rd a

nd in

doi

ng so

, to

prov

ide

evid

ence

-bas

ed g

uida

nce

(incl

udin

g pr

iorit

izatio

n an

d to

ols)

for s

tepw

ise

impl

emen

tatio

n of

the

core

com

pone

nts o

f IPC

pro

gram

mes

that

are

requ

ired

to b

e in

pla

ce a

t the

nat

iona

l lev

el.

The

Min

istry

of P

ublic

Hea

lth (M

OPH)

of Q

atar

use

d th

e IP

CAT2

to se

lf-as

sess

the

stat

us o

f the

ir na

tiona

l IPC

pro

gram

me

agai

nst t

he si

x cor

e co

mpo

nent

s to

iden

tifyi

ng th

e le

vel o

f pr

ogre

ss a

nd st

reng

ths a

nd w

eakn

esse

s. T

hese

resu

lts w

ere

then

use

d in

con

junc

tion

with

the

man

ual (

whic

h ou

tline

s the

‘how

’ of i

mpl

emen

tatio

n) to

dev

elop

a st

epwi

se, s

usta

inab

le

actio

n pl

an a

imed

at a

chie

ving

ove

rall

com

plia

nce

with

the

requ

irem

ents

out

lined

in th

e W

HO c

ore

com

pone

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uide

lines

. Det

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d te

chni

cal f

indi

ngs a

re n

ot re

porte

d he

re b

ut th

e ov

eral

l lev

el o

f com

plia

nce

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d wi

dely

acr

oss t

he si

x cor

e co

mpo

nent

s and

the

resu

lts w

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usef

ul in

hel

ping

to p

riorit

ize in

whi

ch a

reas

(cor

e co

mpo

nent

) act

ion

was m

ost n

eede

d.

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wor

k al

so h

ighl

ight

ed th

e ne

cess

ity o

f im

prov

ing

both

inte

rlink

ages

bet

ween

the

IPC

prog

ram

me

and

othe

r pro

gram

mes

, and

com

mun

icat

ion/

colla

bora

tion

betw

een

the

MoH

and

ot

her k

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akeh

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rs. T

he e

xerc

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resu

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in a

n im

prov

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spon

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tiviti

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ch a

s out

brea

ks a

nd

data

repo

rting

.

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n le

sson

s lea

rnt

• Th

e co

mbi

natio

n of

an

inte

r-rel

ated

ass

essm

ent t

ool (

IPCA

T2),

“how

to d

o” m

anua

l (na

tiona

l lev

el IP

C m

anua

l) an

d no

rmat

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uida

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(IPC

core

com

pone

nts)

pro

vide

s a st

rong

ba

sis f

or a

sses

sing

the

stat

us o

f nat

iona

l IPC

pro

gram

mes

and

mak

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deta

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and

real

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pla

ns.

• Th

e to

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re st

rong

eno

ugh

to g

ener

ate

impr

ovem

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lans

eve

n wi

th se

lf-as

sess

men

t is u

sed.

• It

is n

eces

sary

to in

ter-r

elat

e na

tiona

l IPC

pro

gram

mes

with

oth

er h

ealth

inte

rven

tion

prog

ram

mes

, and

acr

oss s

take

hold

ers,

to e

nsur

e su

cces

s. H

ow th

is is

ach

ieve

d wi

ll va

ry

acro

ss c

ount

ries,

but i

t alw

ays r

equi

res d

ialo

gue

acro

ss st

akeh

olde

rs.

43

11. Pe

ople

-cen

tre

d ca

re

Nam

e of

tool

(yea

r)Ty

pe o

f to

olAu

dien

ceSu

mm

ary d

escr

iptio

nKe

y le

sson

s le

arnt

Inte

rlink

ages

wi

th o

ther

ar

eas

Cont

inui

ty a

nd c

oord

inat

ion

of c

are.

A p

ract

ice

brie

f to

supp

ort i

mpl

emen

tatio

n of

the

WHO

Fra

mew

ork

on in

tegr

ated

pe

ople

-cen

tred

heal

th se

rvic

es

(201

8)

Prac

tice

brie

fHe

alth

m

anag

ers a

nd

prac

titio

ners

This

pra

ctic

e br

ief o

n th

e co

ntin

uity

and

coo

rdin

atio

n of

car

e ad

dres

ses t

he c

ondi

tions

an

d on

goin

g re

latio

nshi

ps n

eede

d to

supp

ort s

eam

less

inte

ract

ions

am

ong

mul

tiple

pr

ovid

ers w

ithin

inte

rdis

cipl

inar

y tea

ms a

nd/o

r acr

oss c

are

setti

ngs a

nd/o

r sec

tors

. It

is p

art o

f a su

ite o

f WHO

reso

urce

s to

supp

ort i

mpl

emen

tatio

n of

the

Fram

ewor

k on

in

tegr

ated

peo

ple-

cent

red

heal

th se

rvic

es (I

PCHS

). It

high

light

s the

bro

ad a

nd o

verla

ppin

g na

ture

of t

he tw

o in

terre

late

d co

ncep

ts, c

ontin

uity

and

coo

rdin

atio

n, th

at c

an im

prov

e th

e ex

perie

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of p

eopl

e wi

th c

hron

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and

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show

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atio

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ttp://

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Nam

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tool

Type

of

tool

Audi

ence

Su

mm

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lliat

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are

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ntex

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ary h

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car

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sson

s lea

rnt a

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e do

cum

ents

are

rela

ted

to

a nu

mbe

r of a

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g em

erge

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gs a

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ary h

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https://www.who.int/palliativecare/en/






Nam

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http://apps.who.int/iris/bitstream/handle/10665/250584/9789241565417-eng.pdf;jsessionid=B03AA330D606CCA264F54172725297C6?sequence=1





45Quality improvement resources in development

Part II. Technical area Tools and resources in development: structure

Name of tool Type of tool Audience Summary description Interlinkages with other areas

1. Cross-cutting tools and resources

Name of tool Type of tool

Audience Summary description Interlinkages with other areas

Global Efforts Measuring Quality of Care(GEMQoC) (2018)

Technical report

Policy-makers and academic researchers

The report provides a compendium of resources for countries working to improve the quality of health services, based on evidence and objective analysis. This report classified 29 efforts according to the types of resources, domains of health care performance, foundation of quality and health care needs.

The technical report presents 29 existing global efforts to measure quality of care or quality related health systems components. http://www.who.int/servicedeliverysafety/measurement/en

Towards a common mapping tool for measurement in health service delivery (2018)

Conceptual framework

Policy-makers, academic/researchers and technical partners

This conceptual framework has been developed to meet the global gap that currently exists on service delivery measurement and associated quality. The concept note presents a mapping tool for health service delivery measurement, lists pre-existing monitoring and evaluation, and a plan for analysing the gap and capacity-building in measurement.

The document links with various aspects of service delivery and safety.http://www.who.int/servicedeliverysafety/measurement/en

Quality improvement

resources in development

http://apps.who.int/iris/bitstream/handle/10665/260544/WHO-HIS-SDS-2018.1-eng.pdf?ua=1
















Evidence brief for policy on innovation in healthcare

Technical report

Policy-makers The current situation regarding technological and social innovations in health care. Formulation of policy options to have an integrated, people-centred approach to innovation in health care. For more information visit: http://www.who.int/servicedeliverysafety/en/

Innovation is a cross-cutting endeavour within service delivery. Innovative approaches need to be assessed to understand the drivers or barriers for successful uptake in multiple contexts.

Evidence brief for policy on engagement (2019)

Technical report

Policy-makers A look at the current situation of engagement from citizens, patients, families to the wider community. Documents different models and drivers of engagement. Formulation of policy options to have a systematic way of build better engagement.

Engagement is a cross-cutting endeavour within service delivery and key driver of UHC. Engagement strategies and practices need to be assessed to understand the drivers or barriers for successful uptake in multiple contexts.

2. Community engagement

Name of tool Type of tool Audience Summary description Interlinkages with other areas:

A suite of programme-specific and generic tools and resources are being developed to adapt and apply the CEQ framework.

Implementation package

Administrators, front-line staff, programme and health facility managers, policy-makers, researchers

The CEQ implementation package will help countries, researchers and partners wishing to improve the quality of engagement between health service providers and service users. It will contain a.) programme-specific and generic assessment tools and interventions to ready and prepare services and programmes to engage; b.) a menu of engagement interventions with evidence to enable countries to select appropriate and relevant interventions; c.) a selection of indicators and measurement tools; and d.) case studies showing where they have been applied and their impact.

For more information visit: http://www.who.int/servicedeliverysafety/areas/qhc/community-engagement/en/

The document will be co-developed with countries. This is an important and emerging area in QI that has the potential to significantly impact country level quality improvement efforts across entire health systems.

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


http://www.who.int/servicedeliverysafety/areas/qhc/community-engagement/en/



47

3. Patient safety



WHO mother-baby 7 day mCheck tool

Guidance Mothers and children

This tool instructs the user to recognize the danger signs in mother and baby during the first week after birth so appropriate health care can be sought.

Clear links with all technical programmes. For example ,maternal and child health and water, sanitation and hygiene.

Technical reports on Medication safety (polypharmacy, high-risk situations, transitions of care)

Technical reports

Policy-makers, health care administrators and regulators, organizations/institutions

These three technical reports outline the problem, current situation and recommended future approach to reducing medication-associated harm in polypharmacy, high-risk situations and transitions in care.

Closely related to all aspects of service delivery.

Framework on patient and family engagement

Guidance Policy-makers, health care providers

This document is an action framework that aims to support WHO Member States to nurture an enabling environment where patients, families and communities partner with providers and leaders at all system levels to improve patient safety, quality and health outcomes.

Linked to the WHO global strategy on people-centred and integrated health services.

Also to health promotion and health literacy.

4. Traditional, complementary and integrative medicine

Name of tool (year)

Type of tool Audience Summary description Interlinkages with other areas

WHO Benchmarks for training in:

• Yoga

• Anthroposophic Medicine

Training/

Capacity-building

Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers

The series of benchmarks for training reflect what the community of practitioners in traditional and complementary medicine (TCM) consider to be reasonable practice in training professionals to practice the discipline, considering consumer protection and patient safety as core to professional practice. The training tool provides a reference point to which actual practice can be compared and evaluated. The document describes models of training for trainees with different professional backgrounds. The list, developed by a community of practitioners, aims to promote safe practice and minimize the risk of accidents.

The tool serves as a reference point to which actual practice can be compared and evaluated.

Quality improvement resources in development



Name of tool (year)


Technical document on clinical research in traditional and complementary medicine (tentative title)

Guidance Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers

The specific objectives of this guideline are to review the major challenges of clinical research in TCM and to clarify the aspects of clinical research that are unique to TCM. This document will present important and relevant guiding principles and key recommendations on research methods.

This document aims to provide appropriate methodologies and approaches to guide and conduct clinical research and evaluation of TCM; to promote and enhance the quality of clinical research addressing TCM; to facilitate the establishment of national regulations around TCM products and practices and enhance the quality of TCM practice in order to benefit patients.

WHO benchmarks for practice in:

• Ayurveda

• Panchakarma

• Unani medicine

Guidance Academics/researchers, development agencies, health workers, nongovernmental organizations, policy-makers

Benchmarks can help assist in the development of approaches and frameworks and evaluate how existing systems can be improved.

These benchmarks for practice could be used in evaluating individual therapies, identifying trends in utilization, developing payment structures for service models, establishing regulatory frameworks for traditional and complementary medicine products and practice, providing oversight of providers, including accreditation and remuneration and determining how a service is delivered within a national health care system.

WHO benchmarks for training in Tibetan medicine

Guidance Government authorities and regulatory agencies, health care providers including traditional and complementary practitioners, academics and researchers, communities and the general public, NGOs and other related stakeholders.

The document intends to present what professional experts and health regulators consider to be adequate training levels and appropriate learning modules for trainees with different backgrounds. It will not only serve as a reference tool of quality evaluation and improvement for relevant stakeholders, but also contribute to the formulation of a traditional and complementary medicine service mode in the context of integrated, people-centred health care.

Will serves as a reference tool of quality evaluation and improvement for relevant stakeholders.

49

Name of tool (year)


WHO benchmarks for practice in:

• Acupuncture

• Tui na

• Cupping

Guidance Government authorities and regulatory agencies, health care providers including traditional and complementary practitioners, academics and researchers, communities and the general public, NGOs and other related stakeholders.

The document intends to present what professional experts and health regulators consider to be standard procedures of reasonable practice for providers with different backgrounds. It will not only serve as a reference tool of quality evaluation and improvement for relevant stakeholders, but also contribute to the formulation of traditional and complementary medicine service mode in the context of integrated, people-centred health care.

Serves as a reference tool of quality evaluation and improvement for relevant stakeholders.

5. People-centred care



Participatory assessment and planning toolkit to support implementation of the Framework on integrated people-centred health services at the sub-national level

Capacity-building

Sub-national health authorities

The Participatory Assessment and Planning (PAP) toolkit will contribute to building capacity of sub-national (district) authorities to steer local health systems towards IPHCS. It encompasses assessing performance, setting priorities and preparing strategic action plans. More specifically, the PAP toolkit aims to support sub-national health authorities to identify opportunities for the delivery of integrated people-centred health services based on a comprehensive and shared diagnosis of current health structures, processes, activities and outcomes. It is based on the five interdependent strategies defined in the Framework on IPCHS and covers a defined territory/population catchment area, including all levels and settings of care, disease-specific programmes and coordination with other relevant sectors (social, education, transport, etc.). The application of PAP toolkit with sub-national governance structures will be a critical element of the Framework’s implementation success by helping to bring integrated people-centred health services higher up on the policy agenda and building a vision for advancement of the model(s) of care

The PAP toolkit will incorporate a score card made up of 20-30 indicators for monitoring and evaluation of IPCHS progress at the sub-national level.




6. Emergency and essential surgery



Manual on optimal resources for children’s surgery

Guidance Policy-makers, government authorities, academics and researchers

Describes the optimal resources that should be available to enable safe paediatric surgery service delivery, including equipment and supplies, essential medicines, trained health workforce, infrastructure needs, etc. The document provides a reliable benchmark for paediatric surgery service delivery.

Maternal and child health, essential medicines

National surgical, obstetric and anaesthesia plan development manual

Manual Policy-makers, government authorities, academics and researchers

This document aims to enable health ministries and governments to implement optimal surgical, obstetric and anaesthesia care delivery. A national plan will provide the basis for building service delivery capacity, including establishing information management with M&E.

Surgical sub-specialties:anaesthesia,obstetrics, maternal and child health, reproductive health emergencies, non-communicable diseases, HIV, neglected tropical diseases, medicines

Emergency surgery on sepsis

Guidance Health workers Possible checklist and algorithm for the optimal prevention and treatment of sepsis.

Infection prevention and control plays a critical role in sepsis and hospital acquired infections.

Anaesthesia guidelines Guidance Policy-makers, government authorities, academics and researchers

Safe standards for anaesthesia care delivery under a range of conditions and settings, including equipment and supplies, essential medicines, trained health workforce, infrastructure needs, etc. The document is aimed at improving surgical and anaesthesia outcomes.

Surgical sub-specialties:anaesthesia,obstetrics, maternal and child health, reproductive health emergencies, non-communicable diseases, HIV, neglected tropical diseases, medicines

Surgical safety checklist Guidance Health professionals, policy-makers, government authorities, academics and researchers

This document incorporates three “time out” periods before, during and after surgery to reduce the risk of complications that may arise from multiple system failures within the operating theatre.

Surgical subspecialties,Anaesthesia,Obstetrics, VIP, maternal adolescent and child health, reproductive health, emergencies, non-communicable diseases, HIV, neglected tropical diseases.

Ebola and Marburg Virus guidelines for surgical teams

Guidance Health professionals, policy-makers, government authorities, academics and researchers

These are the guidelines to help reduce the risk of EVD transmission to surgical, obstetric and anaesthesia health care workers and all operating room team members.

Surgical subspecialties,Anaesthesia,Obstetrics, VIP, maternal adolescent and child health, reproductive health, emergencies, non-communicable diseases, HIV, neglected tropical diseases.

51



Surgical Treatment of Hydroceles secondary to Lymphatic Filariasis

Guidance Health professionals, policy-makers, government authorities, academics and researchers

This document provides guidance on the surgical treatment of hydroceles secondary to Lymphatic Filariasis for surgeons and other health care providers in endemic areas.

Surgical subspecialties,neglected tropical diseases.

7. Hospital management



Hospital transformations towards integrated and people-centred health services for universal health coverage

Guidance Policy-makers, academics/researchers, international partners

This document is part of a suite of WHO resources to support implementation of the Framework on Integrated People-centred Health Services (IPCHS). It sets out a vision for hospitals to take on population-based responsibilities and actively implement integrated and people centred health services, on the way to towards UHC. It highlights pressure points for hospital sector transformation and calls for reassessing the role of hospitals and their position in the health system and for strengthening their organization and internal operations. It then suggests a series of policy orientations at the system level and at the organizational level to enable and sustain a paradigm shift from “hospitals operating in isolation as individual entities” to “hospitals fully embedded in the local service delivery architecture and its community”.

It is primarily aimed at decision-makers at the national and sub-national level to accompany them in thinking about health system transformations and more specifically about hospital planning and management within the wider health system architecture. It also offers the international community a renewed agenda on hospitals and seeks to generate a constructive dialogue towards a shared vision of how hospitals will function in the future.

8. Infection prevention and control


Surgical site infection implementation tools

A range of tools encompassing the WHO multimodal improvement strategy

Policy-makers and implementers responsible for IPC and AMR, IPC leads/focal persons and teams, and surgical teams, in acute health care facilities responsible for implementing safe surgery, including health care facility managers

Tools include those to monitor processes and outcome related to surgical site infection prevention, raise awareness and address the safety culture in a facility related to safe surgery. A publication has already informed this toolkit as well as the WHO SSI guidelines. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30107-5/fulltext

WASH, quality, patient safety, antimicrobial stewardship accreditation/regulation, public health/disease control, occupational health.


https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30107-5/fulltext





Published literature on quality improvement demonstrate its benefits in a variety of settings, particularly those with limited resources (4,5,6). The science of improvement has evolved over time. The well-known Donabedian (7) model describes three parameters for quality of care: structure (or input), process and outcomes. This can be a useful approach to conceptualize the wide range of potential improvement methods and interventions. Structures, or inputs, refers to the setting in which care is delivered, for example the health facility and the human and financial resources underpinning it; process relates to the provision of care

4 Singh, Kavita et al. Can a Quality Improvement Project Impact Maternal and Child Health Outcomes at Scale in Northern Ghana? Health Research Policy and Systems 14 (2016): 45. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910198/ , assessed 20 August 2018).

5 Sheila Leatherman et al. The role of quality improvement in strengthening health systems in developing countries, International Journal for Quality in Health Care, Volume 22, Issue 4, 1 August 2010, Pages 237–243, (https://doi.org/10.1093/intqhc/mzq028 assessed 20 August 2018 )

6 Franco LM, Marquez L Effectiveness of collaborative improvement: evidence from 27 applica-tions in 12 less-developed and middle-income countries BMJ Quality & Safety 2011;20:658-665.( http://qualitysafety.bmj.com/content/20/8/658.long , assessed 20 August 2018)

7 Donabedian A. The quality of care. How can it be assessed? J Am Med Assoc 1988;260:1743–8.

itself, including all aspects of the transaction between the receivers and providers of care; and outcome is the measurable effect on health status, which may be affected by a wide range of factors. Inputs, process indicators and output measures act as key drivers for achieving improved quality of care, person satisfaction, positive experience and desired health outcomes.

A commonly cited concept in health care improvement efforts is the Juran Trilogy. The Juran Trilogy comprises three separate but related approaches that must all be considered when thinking through efforts to enhance

Annex 1: Rapid mapping

of quality improvement

definitions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910198/

https://doi.org/10.1093/intqhc/mzq028

http://qualitysafety.bmj.com/content/20/8/658.long

53 Annex 1: rapid mapping of quality


quality: quality planning, quality control, and quality improvement. This can be a useful structure to conceptualize the different domains that can be addressed when selecting quality interventions. The approach highlights how the deliberate efforts by all stakeholders through the design and implementation phase of an intervention can improve health services and lead to improved outcomes. Quality planning includes the involvement of all stakeholders in the design phase of an intervention. It is

at this stage that aims, processes and goals are developed. Quality control includes the monitoring of established processes to ensure their functionality. Quality improvement is a disciplined approach that improves the level of performance of a process. These same principles are echoed by Edward Deming who proposed that by focussing on management, organizations can improve productivity, quality and efficiency.

Table 1: Rapid mapping of quality improvement definitions

Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvements in health care services and the health status of targeted patient groups

Institute of Medicine https://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

Quality Improvement is the attainment, or process of attaining, a new level of performance or quality that is superior to any previous level of quality.

Joint Commission on Economic and Technological Cooperation

Continuous quality improvement is a management approach involving the continuous study and improvement of the processes of providing health care services to always better meet the needs of patients and other persons.

Joint Commission on Economic and Technological Cooperation

Quality improvement / continuous quality improvement is the sum of all the activities which create the desired change in quality. In the health care setting, quality improvement requires a feedback loop which involves the identification of patterns of the care of individuals (or of the performance of other systems involved in care), the analysis of those patterns in order to identify opportunities for improvement (or instances of departure from standards of care), and then action to improve the quality of care for future patients. An effective quality improvement system results in step-by-step increases in quality of care.

WHO Kobe Center http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf

QI is an approach to the improvement of service systems and processes through the routine use of health and programme data to meet patient and programme needs.

WHO, 2008 http://www.who.int/hiv/pub/imai/om_11_quality_improvement.pdf

Quality Improvement entails understanding the complex health care environment; applying a systematic approach; designing, testing, and implementing changes using real-time measurement for improvement, in order to make a difference to patients by improving safety, effectiveness and experience of care.

Academy of Medical Royal Colleges, 2016

http://aomrc.org.uk/wp-content/uploads/2016/06/Quality_improvement_key_findings_140316-2.pdf

https://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/



http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf

http://www.who.int/kobe_centre/ageing/ahp_vol5_glossary.pdf

http://www.who.int/hiv/pub/imai/om_11_quality_improvement.pdf

http://www.who.int/hiv/pub/imai/om_11_quality_improvement.pdf







A quality improvement effort aims at making changes in the health care system that address the causes of poor quality. To do so requires implementing an improvement strategy with three phases:

• Identify issues and effective solutions through a small-scale pilot improvement project;

• Replicate effective changes/interventions and the QI process to the entire health care system

• Institutionalize an improvement dynamic throughout.

Abt Associates http://www.abtassociates.com/reports/0847_Intro_Field_Qual_Improv_Hlth_Care_0206.pdf

QI is an organizational strategy that formally involves the analysis of process and outcomes data and the application of systematic efforts to improve performance

Agency for healthcare research and quality, 2010

https://ahrq-ehc-application.s3.amazonaws.com/media/pdf/disparities-quality-improvement_research-protocol.pdf

Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

Department of Health and Human Services, 2011

https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf

Theoretical findings

Quality improvement denotes both a philosophy (the pursuit of continuous performance improvement) and a family of discrete technical and managerial methods.

Leatherman et al https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzq028

Improving health care processes, drawing on a number of disciplines. Heiby, 2014 https://academic.oup.com/intqhc/article/26/2/117/1802645/The-use-of-modern-quality-improvement-approaches

Quality improvement can be defined as the combined and unceasing efforts of everyone —health care professionals, patients and their families, researchers, payers, planners and educators— to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.

Batalden & Davidoff, 2007

http://qualitysafety.bmj.com/content/16/1/2.short

Continuous quality improvement is embedded within five main components:

1. Improvement of organizational processes;2. Use of structured problem-solving processes incorporating

statistical methods and measurement to diagnose problems and monitor progress;

3. Use of teams, including employees from multiple departments and from different organizational levels, as a mechanism for introducing improvements in organizational processes;

4. Empowering employees to identify quality problems and improvement opportunities and to take action on these problems and opportunities; and

5. An explicit focus on “customers”- both external and internal.

Brennan et al 2009 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003319.pub2/full

http://www.abtassociates.com/reports/0847_Intro_Field_Qual_Improv_Hlth_Care_0206.pdf







https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzq028



https://academic.oup.com/intqhc/article/26/2/117/1802645/The-use-of-modern-quality-improvement-approaches






55Annex 1: rapid mapping of quality


Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality in services or processes which achieve equity and improve the health of the community.

Beitsch et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/25494050

Quality improvement processes use systems thinking, data analysis and teams of professionals to bring about better outcomes for patients and improved clinical processes.

Plsek,1999 http://acmd615.pbworks.com/w/file/fetch/46352558/QIMethodsInClinicalPractice.pdf

The term CQI can be defined briefly as a comprehensive management philosophy that focuses on continuous improvement by applying scientific methods to gaining knowledge and control over various work processes.

Kahan & Goodstadt 1999

http://idmbestpractices.ca/pdf/CQI.pdf

Health care delivery requires structure (eg. people, equipment, education, prospective registry data collection) and process (eg. policies, protocols, procedures), which, when integrated, produce a system (eg. programmes, organizations, cultures) leading to certain outcomes such as patient safety, quality, satisfaction.

Kronick et al 2015 http://circ.ahajournals.org/content/132/18_suppl_2/S397.long

Continuous quality improvement (CQI) is a management approach or set of principles that aims to constantly increase the efficiency and effectiveness of organizational systems to better meet the needs and expectations of patients and other stakeholders. These principles include a positive focus on creating better functioning organizational systems rather than isolated issues or personal blame, and organization-wide involvement to foster ownership and build quality improvement capacity.

Gibson-Helm et al 2016

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0892-1

Continuous quality improvement can be defined as a planned approach to transform organizations by evaluating and improving systems to achieve better outcomes.

Colton, 2000 https://www.ncbi.nlm.nih.gov/pubmed/10787951

Quality improvement in health care is the structured analysis of a health care system with a view to improving its performance.

Arasaratnam, 2012 https://www.ncbi.nlm.nih.gov/pubmed/22585323

Activities intended to close the gap between desired processes and outcomes of care and what is actually delivered.

Ferris et al 2001 https://www.ncbi.nlm.nih.gov/pubmed/11134448

Quality improvement is a distinct management process and set of tools and techniques that are coordinated to ensure that departments consistently meet the health needs of their communities.

Riley et al 2010 http://journals.lww.com/jphmp/Abstract/2010/01000/Defining_Quality_Improvement_in_Public_Health.3.aspx

http://acmd615.pbworks.com/w/file/fetch/46352558/QIMethodsInClinicalPractice.pdf








https://www.ncbi.nlm.nih.gov/pubmed/10787951






http://journals.lww.com/jphmp/Abstract/2010/01000/Defining_Quality_Improvement_in_Public_Health.3.aspx






Continuous quality improvement is a movement from the standard definitions of quality, which looked back at work already done, to a method of prevention. This involves defining and meeting customers’ needs, leading to exemplary service.

Foreman, 1993 https://www.ncbi.nlm.nih.gov/pubmed/10129027

Quality improvement and continuous quality improvement focus on proactively improving and continually enhancing the quality of care and services by combining professional knowledge with knowledge about making improvements (14,15). Their philosophy is focused on continuous improvement of processes associated with services that meet or exceed the expectations of the patient or referring clinician. For quality improvement and continuous quality improvement, clear standards should be identified for every activity or process in an imaging facility. These standards should be measurable to allow processes to be continually improved.

Kelly & Cronin, 2015 http://pubs.rsna.org/doi/10.1148/rg.2015150057?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&



http://pubs.rsna.org/doi/10.1148/rg.2015150057?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&




57Annex 2: further information

Annex 2: Further information

Related organizational links

• Service Delivery and Safety – webpage with links to a range of service delivery areas to support countries http://www.who.int/servicedeliverysafety/en/

• Quality improvement and hospitals: http://www.who.int/hospitals/en/

• External Web pages showcasing the application of modern quality improvement approaches in a range of technical areas:

• Institute for Healthcare Improvement: http://www.ihi.org/Pages/default.aspx

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

• Jhpiego: https://www.jhpiego.org/

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

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

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



http://www.who.int/hospitals/en/

http://www.who.int/hospitals/en/

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



https://isqua.org

https://www.jhpiego.org/

https://www.jhpiego.org/

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




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



https://www.usaidassist.org/

https://www.usaidassist.org/



annex 3: Process note – WHO

SDS improvement cross-cut

Three interdependent cross-cutting areas of work – measurement, engagement and improvement – were established in the Service Delivery and Safety department at WHO headquarters, to

maximize the effectiveness of all technical work and to ensure timely response on quality improvement matters to WHO regional and country offices.

The SDS improvement cross-cut was activated in August 2017 to bring coherence on quality improvement within service delivery and to enhance

support to Member States. To achieve this, specific objectives include:

1. to outline existing quality improvement approaches in service delivery in support of Member States;

2. to explore the relationship between quality improvement and service delivery;

3. to outline a number of practical case studies that ground the application of the identified tools and resource.

Sep 20176 grounding themes developed and agreed upon

Nov 2017Mapping exercise for SDS tools and resourcesinitiated

Jan 2018QI and measurement linkage identified and tools and resources narrowed to focus on QI

April 2018Phase II prioritization exercise to cull focussing on country application

July 2018Agreed definition of Ql. Quality improvement is the action of every person working to implement iterative measurable changes to make health services more effective, safe and people-centred.

Oct 2017Strategic direction from Director to focus on quality improvement

Aug 2017Improvement cross-cutactivated by SDS

Dec 2017Check-in with members to ensure that cross-cut is on the right track

March 2018Draft v0 of Compendium with input from across SDS

June 2018Prioritizationexercise to cull focusing on country application

August 2018Final draft compendium of "Improving the quality of health services: tools and resources"

Figure 1: development of the QI compendium

59 annex 3: Process note – WHO SDS

improvement cross-cut

The cross-cut solicited representation from each of the units within the SDS department. WHO/SDS technical units involved in this compendium included those working on engagement; infection prevention and control; innovation in service delivery; knowledge management; measurement; patient safety and risk management; quality systems and resilience; services organization and clinical interventions; and traditional, complementary and integrative medicine.

A structured and collaborative approach was employed which resulted in input from across SDS. Cross-cut members, serving in liaison roles, were asked to feed back from cross-cut meetings and report back from their respective units. Monthly meetings (see Figure 1) were held to agree on direction and continued sustained development. Consensus-building was used to arrive at strategic decision points and inputs fed into the final compendium.

A conductive listening and engaging environment was created to ensure that everyone’s perspective was reflected in the final products.

The work of the improvement cross-cut is grounded in three core principles. It is:

• country-focused, ensuring that SDS is well positioned technically to respond to emerging needs from Member States on quality improvement;

• evidence-based, grounding the work in practical and tested front-line quality improvement approaches to improve overall health care outcomes;

• service-oriented, focusing on service delivery.

The work of the improvement cross-cut was informed by the draft thirteenth general programme of work, 2019−20238. The three strategic priorities articulated by the GPW, namely achieving UHC, addressing health emergencies and promoting healthier populations, are strongly linked with quality improvement. In order to move forward on UHC, quality improvement approaches need to be placed within the grasp of health systems designers and implementers.

In addressing health emergencies, quality improvement approaches can support preparedness and response efforts as well. Finally, in promoting healthier populations, improvement approaches can support multiple proposed flagship efforts, for example, care for mothers and newborns. Quality improvement approaches must be incorporated into all technical programmes as a means of strengthening health systems.

8 Draft thirteenth general programme of work 2019 – 2023. World Health Organization (http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_R2-en.pdf?ua=1 , assessed 20 August 2018)

http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_R2-en.pdf?ua=1

http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_R2-en.pdf?ua=1

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