Quality assurance of health care in developing countries.

Abstract

The Quality Assurance (QA) Project originates sustainable approaches to improve the quality of health care in developing countries. Few sustained QA efforts have existed in developing countries. Program evaluations tend to measure changes in mortality morbidity and coverage rates rather than quality of services and the process of service delivery. Evaluation findings on the delivery process are rarely used to systematically improve quality. WHOs Diarrheal Disease Control Program the Primary Health Care Operations Research Project and the CDC Combatting Communicable Childhood Diseases Project are the few groups that have examined service quality. Improving quality of primary health care programs is cost-effective and essential to their success. Improvement can be achieved without extra supplies logistical support or financial and human resources. Generally recognized distinct dimensions of quality relevant to developing country settings include technical competence access to service effectiveness interpersonal relations efficiency continuity safety and amenities. They apply to clinical care as well as to management services that support service delivery. Not all dimensions have equal weight in every program. It is important to realize that QAs definition depends on who is defining it: the client the community the health service provider and the health care manager. There are 4 basic tenets of QA: meeting the needs and expectations of the client and community systems and processes use of data of analyze service delivery processes and team approach to problem solving and quality improvement. The 10-step QA process begins with planning and ends with implementing and evaluating quality improvement efforts. The 10 chief activities in developing a QA program range from fostering commitment to quality to assigning responsibility for QA to managing change.