Skip main navigation

Examining the WHO standards for improving quality of maternal and newborn care in health facilities

What are the WHO’s Standards for Improving Quality of Maternal and Newborn Care in Health Facilities and why were they so urgently needed?
A newly refurbished labour room in a rural health facility Nepal, clean, well equipped and able to provide privacy for women
© Nossal Institute for Global Health at the University of Melbourne

In 2016, the World Health Organization (WHO) published the Standards for Improving Quality of Maternal and Newborn Care in Health Facilities and we encourage you to read the executive summary.

WHO define quality of care as:

“…the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.” (Standards for Improving Quality of Maternal and Newborn Care in Health Facilities, p.14).

Standards of care and measures of quality around the time of birth were prioritised, because a document review found that was no substantive guidance available for ensuring quality of care during childbirth.

WHO envisage that the framework can be used:

  • To help prepare national standards of care
  • To help prepare measures for improving, assessing and monitoring the quality of care provided to mothers and newborns in health facilities in different countries around the world
  • As a basis for new quality improvement strategies and activities
  • To incorporate quality into existing national programs in different countries.

And that it could be used by policy-makers; program managers; health planners at any level; maternal and new-born health care professionals and professional bodies; or technical partners involved in quality of care and which advise ministries of health.

Outline of the framework

The WHO framework sets out eight domains in which good quality of care is needed. These are referred to as standards. Each standard has one or more quality statement(s), with 31 in total. These are requirements to achieve compliance with the standard. Each quality statement has a number of quality measures, being the evidence that can be used to objectively decide if the standard has been met.

Structure of standards

Image source: Fig 2 in WHO. Standards for improving quality of maternal and newborncare in health facilities. 2016. []

To objectively measure quality, WHO defines inputs (what must be in place to practically achieve the standard), outputs (measures to assess the actual care provided) and outcome (on health of women and infants). The result is more than 300 distinct measures of quality!

To conclude, the focus of these standards is on clearly setting out expectations for services around birth; determining the clinical and health system requirements for achieving those standards (inputs); and transparently measuring performance in the form of outputs and outcomes.

This means that quality becomes auditable. If external, independent auditors visited a facility to check the quality of service, they could do so by looking for the physical existence of various documents, materials such as equipment or medical supplies or data collection and analysis systems as set out in the inputs, outputs and outcomes.

We will now explore each standard in turn.

Pick one of the eight standards and review one of the quality statements and the corresponding quality measures. As you did for the previous step, consider whether these are feasible measures in your setting and what would be required to be able to measure them.

World Health Organization, 2016, Standards for improving quality of maternal and newborn care in health facilities.
© Nossal Institute for Global Health at the University of Melbourne
This article is from the free online

Health Systems Strengthening

Created by
FutureLearn - Learning For Life

Our purpose is to transform access to education.

We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.

We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.

Learn more about how FutureLearn is transforming access to education