Quality Assurance Manual


The Quality Assurance Manual can be used by national, state or local level health institutions to evaluate the quality of health services at service delivery sites, to determine whether they meet predetermined quality standards in order to be accredited.

The Quality Assurance Manual is designed to help assure the delivery of quality health services to clients through a process of continued quality improvement. The tool includes 1) an evaluation and accreditation instruction manual, with an introduction on accreditation and quality improvement and a guide on the use of the instrument; 2) a questionnaire for measuring the quality of health services, in MS Access for easy management, processing, and graphical viewing of the data; 3) a client satisfaction questionnaire; and 4) standards and descriptiors of quality by level.

The accreditation questionnaire, to be completed by an external evaluator in conjunction with the management team of the facility, is structured around 17 standards. Each of these standards focuses on an administrative or management issue fundamental to the appropriate functioning of the polyclinic needed to guarantee positive impacts in the population. Through the use of the questionnaire, the evaluators assess the facility’s infrastructure, information and signage for clients using the clinic, equipment, management and clinic norms and procedures, drugs and supplies, health promotion and prevention activities, etc. Those evaluating the health services rate these components according to three levels of quality, with three being the highest rating. An overall rating is given. Guidance is provided to each department on recommended areas of improvement.

Developed by:
Caja Nacional de Salud (Social Security health institution) of Bolivia and Management Sciences for Health in 1998, with funding from USAID.

Intended Users:
The tool can be used by health service providers and administrators, supervisors and others who evaluate the quality of health services delivered at public and private sector health care institutions at the regional or central level.

The tool was designed for measuring the overall quality of health services at the Bolivian Social security Institute polyclinics, with particular attention paid to reproductive health services. It has been used in all departments of six polyclinics of the Caja Nacional de Salud in Bolivia.

The tool is user-friendly, practical, comprehensive, and covers every department and provides opportunities for problems to be identified and solved. Survey data is saved instantly in an easy to use format. The tool can be customized to local settings.

Some of the indicators may not be applicable to certain types of health services. The accreditation process is labor-intensive, but the use of this tool makes the process more efficient

Recommendations for Users:
In order to support this methodology, there needs to be commitment and support on behalf of the institutional management. The organization should have an assigned team of professionals conduct the evaluation, and another set of people process the data. Users must be familiar with quality improvement and MS Access in order to use the database, but this is not necessary if the hard copy is used as a checklist.

Reports and Publications:

The tool is available in English and Spanish.