Focus on:
Standards-Based Management
and Recognition
Country Success Stories
Since 1997, Jhpiego has been using the Standards-Based Management and Recognition
(SBM-R) process to improve the quality of health services in many of the countries where we work. We
initially used SBM-R to improve reproductive health care, but have now expanded its application to
maternal and neonatal health care, infection prevention and control, voluntary counseling and testing
for HIV, antiretroviral therapy for HIV, midwifery education, family planning and prevention of
mother-to-child transmission of HIV. Our successes in 11 countries to date have demonstrated that
SBM-R can produce sustainable results and be scaled up at the national level at manageable cost.
Afghanistan: Enhancing Midwifery Education
[ Read Case Study ]
To address the severe shortage of trained midwives in Afghanistan, Jhpiego adapted
SBM-R to a process for defining and achieving high-quality midwifery education. The Ministry of
Public Health, Jhpiego and partners developed 59 educational standards and supported the establishment
of a Midwifery Education Accreditation Board. The schools used the explicitly detailed standards
to evaluate their performance, define their needs and mark their progress. The Board continues
to oversee external evaluations and formal accreditation. Thus far, 14 of Afghanistan's 23
midwifery schools have achieved accreditation, and the remainder are continuing their process
of performance improvement and anticipate accreditation soon. This program clearly demonstrated
that SBM-R has the potential to substantially improve the quality and uniformity of midwifery
education and is also applicable to the education of other health professionals.
Brazil: SBM-R's Debut a Success
Starting in 1997, Jhpiego conducted the PROQUALI project in Bahia and Ceará, two
states in northeast Brazil, in collaboration with the Johns Hopkins Bloomberg School of Public
Health Center for Communication Programs and Management Sciences for Health. The aim of PROQUALI
was to improve the quality, performance and utilization of family planning and selected reproductive
health services (and later primary health care services) by actively involving clients and providers
in achieving compliance with standards. The project began in five public sector clinics and
eventually expanded to 29 health centers. When they were judged by a multidisplinary assessment
team to have achieved 90% of more of the pre-established performance standards, the health centers
received recognition in the form of positive feedback and public ceremonies where "quality symbol"
plaques, T-shirts, certificates and other rewards were presented to the staff.
Ethiopia: Strengthening PMTCT Services
Improvement in the quality and utilization of services for the prevention of
mother-to-child transmission of HIV (PMTCT) has been the focus of our SBM-R work in Ethiopia.
Starting in 2005, we have worked with the Ministry of Health to institute SBM-R in public sector
hospitals nationwide, using a three-phase approach that has reached 25, 30 and 33 hospitals
respectively.
Guatemala: Improving Maternal and Neonatal Health Care Services
[ Read Case Study ]
In collaboration with the Johns Hopkins Bloomberg School of Public Health Center
for Communication Programs, Jhpiego instituted the CALIRED program in Guatemala in 2000. The
purpose of the program was to improve the quality, performance and utilization of maternal and
neonatal health services, including normal care and management of complications, provided by
skilled providers in a network of health facilities. The program covered eight Ministry of
Health areas and 30 municipalities, starting in 154 facilities and eventually expanding to
222 facilities. The multidisciplinary assessment team was composed of representatives from
the Ministry of Health, professionals associations, civil society and universities. When the
health care facilities met 70% of the performance standards, they received recognition in the
form of ceremonies, plaques and letters of commendation. The opportunity for "cross-visits"
to other, already accredited sites was an additional incentive. When they met 85% of standards,
the facilities received accreditation.
Honduras: Ministry of Health Lauds Achievement
In Honduras, the SBM-R process was started in 2001 in order to improve the quality,
performance and utilization of maternal and neonatal health services provided by skilled providers
in hospitals. The initiative covered six public sector (regional and district) hospitals in two
health regions. The Ministry of Health assessed achievement of the standards and rewarded
compliance through internal recognition activities at the hospitals.
Jamaica: SBM-R Applied to HIV Services
In Jamaica, Jhpiego introduced SBM-R in 2002 to improve the quality and utilization
of voluntary counseling and testing (VCT) services for HIV. Initially applied in 15 public and
private sector clinics in the country’s four health regions, the initiative was successful and
ultimately was expanded nationwide. The Ministry of Health has served as the recognition body
to assess and reward achievement of the standards.
Madagascar: SBM-R for Reproductive Health Services
The Madagascar SBM-R initiative was started to improve quality and utilization
of services for family planning, malaria in pregnancy and sexually transmitted infections. The
work has been carried out in public sector hospitals and health centers, beginning in 2005 with
11 training sites for nursing and medical schools in selected provinces. The Ministry of Health
functions as the recognition body to assess the facilities and reward their achievement of the
standards.
Malawi: "Hygiene is Life"
[ Read Case Study ]
In collaboration with the Ministry of Health, Jhpiego has applied SBM-R to
infection prevention and control practices in Malawi, with the goal of protecting clients
and health workers from acquiring infections, especially blood-borne infections and TB.
First implemented at seven hospitals in three regions in 2001, the initiative, called Ukhondo
Ndi Moyo (“Hygiene Is Life”), has now been expanded to 35 hospitals nationwide. To date,
seven hospitals have been recognized for meeting 80% of the performance standards and achieving
excellence. Local media have publicized these accomplishments, which has helped to generate
demand for the initiative at hospitals in others areas of the country and has elicited interest
from local leaders, providers and community members.
Mozambique: Nationwide Scale-Up
In Mozambique, SBM-R was used to improve the quality of infection prevention
and control practices that protect clients and health care workers from acquiring infections,
especially blood-borne infections and TB. The focus of the initial program in 2004 was six
general and provincial hospitals across six provinces, and addressed all infection prevention
practices, both direct services to clients and support functions. Based on the success of the
program, it was scaled up to 23 hospitals nationwide. The Ministry of Health is responsible for
recognizing institutions that meet the standards.
Pakistan: Promoting Client-Focused Family Planning
SBM-R began in Pakistan in 2005 under the Key Social Marketing Program in
collaboration with Constella Futures. The initiative has promoted a client-focused, quality
improvement model for private sector family planning providers in 12 cities. Quality is
judged by an external, multi-institutional assessment team, and performance incentives
include accreditation and certification.
South Africa: Improving and Expanding Antiretroviral Therapy
In South Africa, SBM-R is being used to develop standards and conduct baseline assessments of
antiretroviral therapy (ART) services for HIV. ART services for both adults and children in
public and private hospitals and health centers have been the focus of this nationwide
program, which began in 2005. The Foundation for Professional Development and the Department
of Health are serving as the coordinating body to measure progress and reward achievement.
More Information
Additional information about Jhpiego's work in standards-based
management and recognition is available on under
What We Do and Media Center.
For additional resources on SBM-R, browse the
Human Resources for Health
and Information Sheets
sections of our Publications Catalog, or
contact us.
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