Principles for Developing Clinical Quality Standards in Low and Middle Income Countries: A Guide

Abstract

This guide defines the principles for developing evidence-informed, clinical quality indicators known as quality standards and describes the processes and methods involved. It is designed to help low and middle income countries (LMICs) that are moving to universal health coverage (UHC) develop robust and measurable criteria, derived from evidence-informed guidance, to improve the quality of patient care. This document has been adapted from the National Institute for Care and Excellence (NICE) Quality Standards Process Guide, which details how quality standards are developed for the National Health Service in the UK. The document also draws on examples from our experiences of adapting this NICE model to develop quality standards for improving maternal care in Kerala, India and for stroke care in Vietnam, in partnership with respective policymakers and stakeholders such as clinicians. We recognise that countries have different health systems with different needs, with different political and socio-cultural factors underlying policy and clinical decisions; and decision-makers will need to contextualise the process of quality standards development to their local setting. However we hope this guide provides a useful roadmap for policy makers and others who are responsible for establishing quality improvement programmes and who drive quality initiatives in their locality. The methods for developing Quality Standards are evolving, so this guide is work in progress. It will be reviewed regularly as our experience of developing Quality Standards in LMICs evolves.