This guide provides decision-makers and managers at the country level with a systematic process which will allow them to design and implement effective interventions to promote quality in health systems. Conceived as a capacity-building tool in health-care this guide focuses particular attention on individuals who have a strategic responsibility for quality. It has been designed to assist self-assessment and serve as a discussion guide so that decision-makers and interested parties involved in quality of care can work together to find answers for their own setting. The guide describes an approach for decision-making at country level to make informed strategic interventions for predictable quality improvement. It also describes six generic domains where quality interventions could be made. They are intended to help policy-makers address quality issues at a more strategic level.