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Once TMDLs are implemented, indicators of water quality (chemical/physical and biologic) can be re-assessed to document any changes.
However, often indicators and indices suffer from limitations and it may not be advisable to implement indicators designed for global comparisons at local, regional or even national scales.
Further, we were unable to implement indicators for domain 5 for several reasons.
The present study aimed to select and to implement indicators for a new SSISS in the State.
Local adaptations of this protocol could be used by policy-makers and researchers to empirically test the likely effect of implementing indicators.
This publication is meant to be of use also for others seeking to improve the quality of care in their health systems by implementing indicator-based quality assurance.
Since a business process can only be controlled and managed if it can be measured, organizations need to implement indicators for performance and take preventive and corrective actions when necessary [ 45].
This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out.
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