• quality of care
• world health organization
• standards of paediatric care

In the last 25 years there has been an increasing recognition of the importance of quality of health services as a public health issue.1 2 Quality in healthcare is now represented in national policies, and demanded by health boards and consumers alike. The drive for quality began with the recognition that hospital-acquired adverse events were frequent, costly and often deadly in high-income countries. Since 2000, in many low-income and middle-income countries, assessments have shown that there was much scope for improving quality in many aspects of paediatric care, especially in district-level and provincial-level hospitals, and experience has grown in how to do this.3–12

Many populations and environments have seen little of the quality of healthcare revolution. This is especially the case in health facilities in low-income and middle-income countries, and particularly in rural and remote settings. Sometimes this has been because of the lack of clear and simple description of how to improve quality in difficult settings, of the standards that need to be achieved to improve health outcomes, and of the contributions that can be made by individuals and nurses and doctors working together.

On April 24 WHO published standards for improving the quality of care in children and young adolescents in healthcare facilities.13 This is very important progress. Developing these standards involved a 20-person technical advisory group, a Delphi review involving over 200 paediatricians, scientists and policy makers from 88 countries, and a large WHO secretariat.

The standards define the priorities for quality improvement in eight domains (box 1). The standards are holistic, and include clinical standards aligned to WHO guidelines,14 but go beyond treatment to require more child-centred and family-centred care, better environments to care for children, and greater attention to prevention and protection of children’s rights.