Percent of facilities with systems that support quality service delivery (assessed separately for each service)
This composite indicator combines several indicators for support systems required for quality service delivery. It measures the percentage of facilities with each of the following:
- Resources and systems adequate for preventing transmission of infection;
- Service-specific written protocols for service delivery;
- Visual aids for educating clients about the service;
- Service providers with in-service training on a related topic within the prior 12 months;
- Service providers supervised while providing the service within the prior 6 months;
- Information systems providing basic information on clients and services provided;
- Use of individual client records/charts; and
- Systems for monitoring service coverage (where relevant).
Equipment and standard procedures meeting requirements for infection control; relevant infection control supplies in service delivery areas; client information registers/forms and copies of protocols; and information on in-service training and supervision for service delivery staff
Evaluators may use core definitions for “minimum requirement” (based on generally accepted standards) for each of the aspects of quality measured so they can compare system support for quality services among various countries. However, evaluators may augment the essential items and details within each item with country specific standards.
Interviews with staff and with persons in charge of each service; facility inventory and physical verification of equipment and supplies
This indicator provides information on whether a facility has established systems to support and maintain minimum standards of quality. The indicator also assesses how the system functions (e.g., whether staff know the appropriate procedures for disinfection/sterilization; whether staff training is recent). It can identify gaps between planned systems and actual practices. These gaps will most often reflect problems with the support systems, such as the commodities and logistics systems, management and supervision system for the facility, or staff training.
Evaluators can analyze each component of the support system by type of facility, by geographic area, or by sector system (e.g., government, private for profit, private non-profit). Each of these factors may uniquely influence specific items (e.g., availability of items, access for supervision, establishment of acceptable standards) required to support quality of care.
Although this indicator provides information on the existence of systems that should support quality of services, the fact that a facility meets the indicator criteria does not mean that the facility functions to standard and achieves good quality results. For example, although staff may report following appropriate procedures for sterilizing equipment, the service provision assessment (SPA) does not observe the actual sterilization process. Similarly, although the SPA assesses the staff’s level of training, it does not evaluate actual performance and expertise on the job. The assessment of supervision likewise stems from facility reports, not from observation of practice.
health system strengthening (HSS), quality
There are many overlaps between services that are gender sensitive and those that provide high levels of quality of care. The elements of a quality program should include gender equitable treatment by providers, respect for the client’s dignity and attention to the client’s rights to privacy, confidentiality and free and informed choice. If the elements of a gender-equitable program are included in the parameters that measure quality of care, the percentage of facilities that support quality service delivery will also reflect those that give explicit attention to gender.