Paper short abstract:

Healthcare standards are increasingly used internationally to gather evidence of healthcare quality. We use recent research in the Pakistan health system to explore social, political and other factors influencing the use of standards in providing evidence of healthcare quality.

Paper long abstract:

Healthcare standards are increasingly used internationally to gather evidence of quality of healthcare services and the wider healthcare system. What makes healthcare standards internationally acceptable as a means for this proof? Are there social, political and other factors that influence the use of healthcare standards as a mechanism of proof within a country context, and, if so, is there anything distinctively 'South Asian' about these factors? Our recent research in Pakistan on the introduction of healthcare accreditation identified the codification of the healthcare standards approach through the International Society for Quality in Healthcare (www.isqua.com). Though codified, we found that the production and use of the standards still involves interpretation and negotiation at all levels in the local health system, from policy managers through practicing clinicians to the users of the healthcare services, including negotiation of whether they can be used as proof of a quality service. We use three examples to explore perceptions of proof and the factors influencing the proof. We explore whether: (1) The standards prove that the healthcare service is a quality service; (2) The standards provide evidence for management decisions about individual facilities or health providers; (3) The standards provide evidence for a regulatory mechanism to close unsafe providers. We close by discussing whether there is anything distinctively 'South Asian' about the factors influencing the use of standards as proof of healthcare quality.