In today’s increasingly complex health landscape, ensuring access to healthcare is no longer sufficient. It is equally essential to guarantee that services are safe, effective, equitable, efficient, and patient-centered. In many countries, assessing the quality of healthcare remains a significant challenge due to a lack of adequate tools, reliable data, and a culture of rigorous performance monitoring. How can we determine whether a hospital is delivering high-quality care? How can we compare the performance of different facilities or health sectors? The answer lies in establishing a robust monitoring and evaluation (M&E) system grounded in relevant and standardized indicators. This article presents essential healthcare quality indicators and offers guidance on how to effectively integrate them into public health policy and practice.
What is Healthcare quality ?
According to the World Health Organization (WHO), the quality of healthcare is defined as the extent to which health services provided to individuals and populations improve desired health outcomes. Therefore, quality goes beyond clinical interventions to include the appropriateness, safety, timeliness, accessibility, efficiency, and overall experience of care.
The WHO has identified seven core dimensions of healthcare quality that serve as global reference points for evaluation:
- Safety: Minimizing medical errors, healthcare-associated infections, and preventable harm.
- Effectiveness: Ensuring that interventions are evidence-based and clinically appropriate.
- Timeliness: Reducing harmful delays in receiving care.
- Patient-centeredness: Respecting patients’ dignity, rights, and preferences throughout the care process.
- Efficiency: Maximizing the use of available resources and reducing waste.
- Equity: Guaranteeing consistent quality regardless of gender, socioeconomic status, geographic location, or ethnicity.
- Integration: Ensuring continuity of care across life stages and healthcare services.
Understanding these dimensions helps inform the selection of relevant indicators and align national practices with international standards.
Types of indicators for assessing healthcare quality
The evaluation of healthcare quality typically relies on three categories of indicators, based on the Donabedian model—a widely recognized framework in global health evaluation:
Structural indicators
These indicators describe the capacity and organizational setup of a health system to deliver quality services. They include the availability of human resources, infrastructure, equipment, funding, and institutional arrangements.
Examples:
- Availability of essential medicines
- Number of health professionals per 1,000 inhabitants (WHO recommends 4.5 per 1,000)
- Facility opening hours
Structural indicators provide insight into readiness but do not assess how care is delivered.
Process indicators
These indicators assess whether healthcare services are being delivered in accordance with established standards and protocols.
Examples:
- Percentage of pregnant women receiving four recommended antenatal visits
- Rate of reporting adverse drug events
They allow for evaluation of both the technical and interpersonal aspects of care, providing actionable data for quality improvement.
Outcome indicators
Outcome indicators measure the actual results of care on patient and population health. These are often the most telling in terms of system impact.
Examples:
- Neonatal, infant, or maternal mortality rates
- Percentage of patients recovered or clinically improved
- User satisfaction levels
Using all three categories together is essential, as good infrastructure alone does not guarantee good care, and good practices may not always translate into strong outcomes without contextual analysis.
Best practices in selecting and using quality indicators
Selecting the right healthcare quality indicators is essential for sustainable improvement.
In many developing countries, however, indicators are often poorly adapted to local realities.
Here are a few key principles to help you choose indicators that truly make a difference.
Ensure Indicators Are Context-Specific and Relevant
Not all indicators are equally useful in every setting. Effective selection must consider:
- National health priorities (e.g., malaria, HIV, tuberculosis, neonatal mortality)
- Local data collection and analysis capacity
- Level of care (hospital, health center, or community)
Indicators should follow the SMART criteria: Specific, Measurable, Achievable, Relevant, and Time-bound.
Engage all stakeholders
An indicator is only effective if it is understood and accepted by those who collect and use the data. Key stakeholders include:
- Healthcare providers (nurses, doctors)
- Health facility managers
- Local health authorities
- Community representatives or patient groups
Involving stakeholders improves tool acceptance, fosters shared ownership, and promotes a culture of quality.
Ensure data quality and integrity
Indicators are only as good as the data behind them. It is essential to train staff in accurate and consistent data collection. Integrating indicators into standardized tools such as DHIS2, technical forms, and patient registers is strongly recommended.
Regular data reviews, quality audits, and cross-verification mechanisms are also necessary to maintain data integrity.
Analyze and Interpret Results in Context
Indicators are not an end in themselves – they should serve as tools for identifying performance gaps, comparing geographic areas or facilities, and pinpointing bottlenecks in service delivery. Analysis should always consider contextual variables (e.g., stockouts, conflict, natural disasters).
Integrate Indicators into a Dynamic Quality Dashboard
Developing dashboards for each health facility or health zone is an effective way to visualize and track progress.
Recommendations:
- Limit to 10–20 key indicators
- Update data monthly, quarterly, or biannually
- Share findings with frontline teams and decision-makers
Digitizing data collection and dashboarding enhances data availability in real time and facilitates evidence-based decision-making across management levels.
Conclusion
Healthcare quality indicators are more than just numbers—they are strategic tools that guide health policy, improve clinical practice, empower healthcare workers, and ultimately save lives. As a leader in monitoring and evaluation of health programs, Kerus Consulting International supports health authorities in designing and implementing reliable M&E systems tailored to local contexts. These systems foster transparency, improve performance, and ensure impact. Contact us to co-create data-driven, sustainable solutions that strengthen health systems and improve care outcomes.
References
- What Are Healthcare Performance Indicators?
- How to Measure Healthcare Quality
- Healthcare Quality: Criteria, Dimensions, Approaches and Frameworks
- Evaluating Healthcare Quality Using Structure, Process, and Outcome Indicators
