Medair and the ISO 9001 quality standard
by David Verboom April 2002

There is growing interest in the humanitarian sector in techniques and approaches aimed at ensuring the quality of products, services and organisations – a process characterised by some as the ‘quality revolution’.

The NGO Medair applied for and was recently awarded the ISO 9001 Certificate for its humanitarian work. The ISO 9001 is part of a family of quality management standards and guidelines. It looks at the overall learning process within an organisation, rather than the rigid and specific implementation of certain guidelines or procedures. In Medair’s case, the ISO 9001 standard required the following main steps:

  • setting up a quality policy in line with the organisation’s humanitarian mandate;
  • drafting and maintaining manuals describing the way the organisation works; and
  • setting up and maintaining a feedback and improvement cycle to involve beneficiaries, national and expatriate staff, donors, authorities and other stakeholders in the quality improvement process.

Why apply ISO 9001?

Medair sees ISO 9001 as an additional tool, rather than as the answer to all our problems. The main reasons for us to apply for the ISO 9001 standard were:

  • Accountability. We feel that we are accountable to the people we serve, our donors, our supporters, our national and expatriate staff and host and supporting governments. We have been entrusted with financial and human resources to achieve certain objectives in accordance with certain quality standards. We want to take this responsibility seriously by inviting external auditors to evaluate our work against internationally respected ISO 9001 quality standards.
  • Learning. Because the environment of humanitarian aid is enormously complex and constantly changing, humanitarian organisations have to change and improve to remain relevant, effective and appropriate. Because the ISO 9001 standard places emphasis on the improvement cycle, it has helped Medair to strengthen its capacity as a learning organisation.
  • Efficiency and effectiveness. ISO 9001 not only evaluates whether activities are in line with the main organisational objectives, it also evaluates the effectiveness of the organisation in achieving its goals. Because this evaluation uses the organisational manuals as a reference, ISO 9001 basically assesses if the organisation practices what it preaches.
  • The involvement and participation of beneficiaries. ISO 9001 evaluates ‘customer satisfaction’ – in humanitarian terms, whether the needs of the beneficiaries are being met. In its operations, Medair emphasises ‘downward’ accountability (to the people we serve), rather than ‘upward’ accountability (to donors, for instance). This is exactly what the ISO 9001 standard will assess.
  • Standardisation. Medair as an organisation found itself in the mid-1990s moving from the pioneering to the expansion phase. In order to improve structures, procedures and standards, it started to define all of its operational and administrative processes. ISO 9001 helped to draft a Quality Manual that is lean, simple, to the point, easily accessible and user-friendly for all Medair staff.
  • Institutional knowledge. Due to the high turnover of staff and the need to constantly adapt to new emergencies, gaining and maintaining institutional knowledge is critically important to relief agencies. ISO 9001 has helped Medair to improve its institutional knowledge-base in the form of the Quality Manual. This manual has also greatly improved the induction of new staff into the organisation.

Because the advantages of ISO 9001 apply to field as well as head office operations, we found that, despite the initial reservations of our staff, they all started to embrace the ISO 9001 change process. They became supporters when they saw the benefits materialising before their very eyes. Involving all staff also helped us to strip the change process of any hidden agendas or motives. We had to collectively re-emphasise that the only goal of the ISO 9001 process is to improve our performance and quality; it is not to be used as a marketing tool or to raise more funding, and it is definitely not to be used as a top-down control mechanism for management.

Medair’s quality system

Medair’s quality system is set up around three major improvement cycles at three levels. Starting with the improvement cycle that is as close as possible to the beneficiary, we can differentiate between the following cycles:

  1. Project Cycle at field level.
  2. Country Strategy Cycle at country level.
  3. Three-year Strategy Cycle at organisational level.

The Project Cycle describes Medair’s core process, namely the implementation of relief and rehabilitation projects at field level. This cycle consists of six project phases (research, survey, proposal, implementation, evaluation, exit), linked together by six decisions (research, survey, Go/No Go, implementation, evaluation and exit). Medair has chosen the Project Cycle method to increase transparency, efficiency and coordination when initiating, implementing and tracking our projects. Every time a project moves from one phase to the next, a transparent, collective and coordinated decision is taken with the involvement of key field and headquarters staff. Each project in each country incorporates beneficiary involvement and participation, so as to receive regular feedback and input from the communities we are serving. This feedback is taken into account in the evaluation phase, and helps us to design and implement the next project or phase in a more appropriate manner. An example of the Project Cycle at work can be taken from our country programme in south Sudan. A non-food distribution project was thought by some staff to be very successful. But when talking to the families during household visits we found that the impregnated mosquito nets that were distributed were used for clothing and blankets. In response, we used the Project Cycle to design a new project phase focusing on preventive health education and clothing distribution.

The Country Strategy Cycle operates at country programme level, and normally encompasses a number of different projects. The Country Cycle helps Medair to improve its work in a given country, taking into account long-term impact and sustainability. This is especially useful in countries like Afghanistan, Congo, Angola and Sudan, where complex crises have raged for decades. Only by focusing on rehabilitation and training, not just relief, can people develop self-determination, self-reliance and mitigation.

The organisation-wide Three-year Strategy Cycle helps Medair to be a learning organisation in all its departments, sectors, countries and programmes. It sets out strategies to address organisational weaknesses and exploit organisational strengths. On a three-year basis, feedback and evaluation is incorporated in the Strategy so as to work on major improvement processes for the organisation. In fact, it was at one of these Strategy evaluations, with all key field leaders present, that Medair decided to launch the ISO 9001 change process.

When talking about the ‘how’ of quality improvement, we should not forget the importance of the Quality Manual. This describes the quality system and all Medair’s operations. It explains all aspects of Medair’s work, both in the field and at headquarters, from the overall Three-Year Strategy to detailed radio operating instructions. The Manual is available to all staff in the form of an internet-based resource centre, installed on all Medair computers. By using state-of-the-art internet technology, the Manual is made extremely user-friendly, quick and accessible. The result is a manual that provides easy access to frequently required information, is used as a training resource for new staff, increases efficiency by saving time and sharing knowledge, and improves transparency.

The ISO 9001 quality improvement process has been very beneficial for Medair, for its programmes, for its staff and most importantly for its beneficiaries. It has not solved all our problems at field level, nor has it solved all our performance problems, but it has helped us to improve our internal quality, reinforce our accountability to our stakeholders, increase our efficiency and effectiveness and, most importantly, increase our impact for the people we are serving.

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David Verboom is Operations Director and Quality Manager at Medair’s head office in Switzerland. His e-mail address is: