National Level

Dissemination of approved national standards (to the regional/provincial levels)

In WHO's experience with countries, the development and official approval of national standards is in and of itself not sufficient to ensure wide scale implementation. Responsible officers at state/region/province and district levels, who are responsible - in many countries - for planning and allocating budgets need to be aware of the standards, understand how they can be implemented and have access to the tools need to implement and monitor them.

That this can take considerable time is shown in an examples from Malawi and Tanzania.  5 years after the AFHS standards were adopted in Tanzania and "widely circulated" a survey in 2009 revealed that only 19% of health workers in the sample districts had ever seen the standards document. A monitoring report from Malawi (2009) indicated that in only 55% of facilities copies of the standards were available
The purpose and importance of this step therefore resides in ensuring that the approved national standards reach all the key stakeholders at the national and sub-national levels. Countries use various ways to inform these stakeholders. For example at national meetings for state, regional or district programme managers, or during dedicated orientation workshops at the regional level for regional and district staff responsible for developing plans and budgets.

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WHO/CAH publication
WHO/CAH publication on the 4-S framework and systematic process


WHO/CAH case study
WHO/CAH case studies

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