International Journal for Quality in Health Care 8:131-139 (1996)
© 1996 International Society for Quality in Health Care
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Quality of Primary Health Care in Developing Countries: Recent Experiences and Future Directions
*Harvard School of Public Health Boston, Massachusetts, USA
Harvard Institute for International Development 1 Eliot St., Cambridge, MA 02138, USA
Assessing and improving the quality of health care was, until recently, a low priority, both for policy makers in developing countries, and for technical agencies. The authors review the reasons for this long neglect of quality of care, which include: (i) a perceived priority of extending coverage at the expense of quality; (ii) the view that quality is difficult to assess in the absence of reliable documentation and health information systems; and (iii) the perception that improving quality is tantamount to increasing inputs, thus costly and not affordable for many countries.
The authors strongly suggest that focusing on improving the process of care through quality assurance (QA) is the most promising avenue to improved quality of care in these countries. They review the current state of the art of QA in developing countries and formulate some policy suggestions: they call for a national commitment and leadership that provides a legal and institutional framework for QA and supports QA teams in the areas of setting professional standards, training, supervision, and information. The authors stress that the focus on process should not lead to a neglect of improving inputs.
We conclude by suggesting future research in four broad areas: (i) development, testing and evaluation of new ways to implement QA through operational research; (ii) the links between process as well as inputs and outcomes; (iii) the relationship between quality and other health system variables, such as demand, costs, revenues and equity; and (iv) development of comprehensive quality indicators based on a score of process, input and outcome variables that allow researchers and policy makers to compare quality across time, space and different types of care providers. Copyright © 1996 Elsevier Science Ltd.
Keywords: Primary health care, quality of care, quality assurance, utilization, developing countries
Rainer Sauerborn, Harvard Institute for International Development, 1 Eliot St., Cambridge, MA 02138, USA. Tel. 617 495 3903; Fax 617 495 0527.
Received for publication July 21, 1995. Accepted for publication December 18, 1995.
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