2. STANDARDS
• A Standard is a statement of expected level of
quality.
• It states clearly the inputs required to deliver a
service, how things should be done (process) and
what the output or outcome should be.
• When we compare what is expected in the standards
to what we do, we shall be able to identify any
quality gaps and then make plans to improve upon it.
3. • Standards can be set for any level of the healthcare
system i.e. national, regional, district, sub-district.
• There are also international standards e.g. those
developed by the WHO that can be adapted to that
of the country.
• They can be developed for use in public health,
clinical care and support services
4. Types of Standard
• Input Standards- Input or structure standards define
the resources that must be supplied for the activities
to be carried out.
• Process Standards -Process standards describe the
tasks or steps that must be carried out until the
activity is completed.
• Output/ Outcome Standards -Output/ Outcome
standards describe the outputs or results of the
activities carried out.
5. Input standards for antenatal Clinic
Physical structure Equipment and supplies Staff
- A reception and
waiting area with
adequate seating for
women.
-A separate
examination room for
history and
examination
- Standing scale with Height measure
- Shygmomanometer
- Maternal health records
- Fetoscope
- Dipstick for urinalysis
- Measuring tape
- Examination table
- Immunization equipments
- Laboratory for basic tests
- Drugs- Folic acid, Iron,
anti-malarials
Qualified nurse
midwife(s)
Support staff
6. Process standards
• National Reproductive Health Policy
• Standards and Protocols
• Laboratory standard operating procedures; and
• Medical records procedures.
7. Output/ Outcome standards
• Pregnant women will attend at least four times
during pregnancy.
• Ninety percent (90%) of women attending antenatal
clinic will report satisfaction with care given (client
survey).
8. Types of Standards
• Mandatory standards:
– Health & hospital legislation
– Corporate & employee legislation
– Regulatory agencies standards
– Regulations of professional colleges
• Prescriptive standards:
– Manufacturer’s advice
– Insurance company advice
– Standards of accreditation councils
– Standards of professional associations
9. • Adoptive standards, (in house):
– Hospital mission statement
– Facilities long term plan
– Management by objective statement
– Annual budgets
– Administrative and personnel policy
– Union collective agreement
– Job description
– Technical and clinical procedure manuals
(Dr. Jung B. Thapa,)
10. Uses of Standards
Standards are used to:
• Define quality
• Determine, inputs, processes and outcomes, and
• Develop indicators to monitor quality.
11. How Do Staff Get To Know About
Standards?
• There are several methods that can be used
depending on what has been developed. They
include:
• Training of health workers (in service and on the job
training)
• Launching of the standard
• Seminars/ conferences
• Developing job aids
• Support supervision.
12. Quality of Care for EHCS in Nepal
• Improving quality and integration of services at the point of
delivery are critical strategic areas for capacity development,
and will bring together efforts to improve outcomes within
the broader EHCS spectrum supported by NHSP-2.
• The recently developed guidelines for Health Facility Quality
Management (QM), Performance Based Management
System and Integrated Supervision are quality standards
approved by the MoHP and can be seen as a general District
QM system.
13. • Management Division (MD) is responsible for Quality
Management in general, but other divisions and centers are
responsible for quality of care in their programme areas.
• The focal person within MD is responsible for orienting
districts on the quality of care guideline and the formation
of new quality management committees at district and
facility level.
• While orientation on these guidelines will be important, this
alone is not sufficient, as improved responsiveness within
the wider health system is fundamental. Coordination of
supply side inputs is an important aspect of quality.
14. Policies, strategies and guidelines related to Maternal
Newborn Health and other EHCS
• Safe Motherhood Policy 1998
• Safe Motherhood and Newborn health Long Term Plan 2006-
2017, Safe Abortion
• Policy and strategy 2003, Medical Abortion Strategy,2007
• National Skilled Birth Attendance Policy 1998
• National In-service training Strategy for Skilled Birth
Attendant, 2006-12
• National Blood transfusion Policy 2006 and National Guideline
for Blood transfusion Service 2008,
• National Adolescent Health and Development Strategy 2000
• National Neonatal Health Strategy 2004,
15. • Community Based Newborn Package 2007,
• National Essential Maternal and Neonatal Health care Package
2006
• National Family Planning Policy,
• Remote Area Guideline 2009,
• National Reproductive Health Strategy 1998,
• Misoprostal policy
• Guideline for Management of Prolapse Uterus
• Nepal Health Sector Programme II 2010
Nutrition:
• National Nutrition Policy and strategy 2004
• National Nutrition Guidelines 2000
• Five year Plan of Action for control of Anemia among women
and children 2005/06- 2009/11
16. Policy and strategy related to Service
Strengthening
• Strategic Plan for Human Resource 2003-2017
• Human Resource Strategy Options for Safe Delivery 2009
• Job description of Health workers under Department of
Health Service 2054
• Job description of Nurses
• Local Health Management orientation Guideline 2006
• Five year Plan of Action for control of Anemia among women
and children 2005/06-2009/11
• Remote Area Guideline 2009
• National In-service training Strategy for Skilled Birth attendant
2006-2012
17. • Medical Abortion Strategy 2009,
• Guideline for Prevention of Postpartum hemorrhage through
community based
• misoprostal use.
• National Guideline for Blood transfusion Service 2008
• Five Year National Strategic Plan-National Blood Programme
2009
• Infrastructure Information System
• Standards of infrastructure for CEOC,BEOC and birthing center
• Standard Package of Equipment for CEOC, and birthing center
• Policy on quality of Health Services 2007
• Health care waste Management Guideline 2065
18. • Mental health service in integrated Primary Health care
Center Service2064
• Health care Technology Policy 2006
• Orientation book for Local Health service Management 2065
• Aama Guideline for safe motherhood service 2066
• Free Health Programme Guideline 2064
• National Medical Standards for Reproductive Health volume I-
III
• National RH Clinical Protocol for different level of health
workers.
19. • Guideline and standards for establishing Private and NGO
Health Institutions 2061
• Vulnerable Community Development Plan for Nepal Health
Sector Programme
• Implementation Plan 2004/5-2008/9
• Health Sector Gender Equality and Social Inclusion Strategy
• Governance and Accountability Action Plan
20. • Mental Health
• National mental Health Policy (1996)
• Child Health
• Technical guidelines on the control of acute respiratory
infections (1994)
• Operational guidelines for the community based integrated
management of childhood illness (CB-IMCI) program (2007)
• Zinc policy
• National policy for the elimination of Vitamin A Deficiency in
Nepal
21. • Adolescents Health
• Adolescent Health Strategy (2000)
• Guideline for implementation of adolescent friendly services
(internal document
• only, not published yet)
• FCHV
• National Female Community Health Volunteer Program
Strategy (2067)
• Guideline for FCHV endowment fund utilization
• Quality of Care
• Policy on quality health services (2007)
• Health care waste management guideline
22. • HIV/AIDS
• National AIDS policy (1995)
• HIV/AIDS Strategy 2006-11
• National advocacy plan on HIV/AIDS 2008-11
• National HIV/AIDS action plan 2008-11
• National guidelines for management of HIV and AIDS in
children (2008)
• National guidelines on STI case management (2006)
• Monitoring and evaluation guidelines for HIV and AIDS in
Nepal (2006)
• National guidelines for voluntary HIV counseling and testing
(2003)
• Strengthening HIV second general surveillance in Nepal
• National VCT guidelines
