Improving Quality Of Care In Low And Middle Income Countries

Quality of care is a priority for U.S. Agency for International Development (USAID). The agency's missions abroad and their host country partners work in quality improvement, but a lack of evidence about the best ways to facilitate such improvements has constrained their informed selection of interventions. Six different methods - accreditation, COPE, improvement collaborative, standards-based management and recognitions (SBM-R), supervision, and clinical in-service training - currently make up the majority of this investment for USAID missions. As their already substantial investment in quality grows, there is demand for more scientific evidence on how to reliably improve quality of care in poor countries. USAID missions, and many other organizations spending on quality improvement, would welcome more information about how different strategies work to improve quality, when and where certain tools are most effective, and the best ways to measure success and shortcomings. To gain a better understanding of the evidence supporting different quality improvement tools and clarity on how they would help advance the global quality improvement agenda, the Institute of Medicine convened a 2-day workshop in January 2015. The workshop's goal was to illuminate these different methods, discussing their pros and cons. This workshop summary is a description of the presentations and discussions.

This open access book is a collection of 12 case studies capturing decades of experience improving health care and outcomes in low- and middle-income countries. Each case study is written by healthcare managers and providers who have implemented health improvement projects using quality improvement methodology, with analysis from global health experts on the practical application of improvement methods. The book shows how frontline providers in health and social services can identify gaps in care, propose changes to address those gaps, and test the effectiveness of their changes in order to improve health processes and outcomes. The chapters feature cases that provide real-life examples of the challenges, solutions, and benefits of improving healthcare quality and clearly demonstrate for readers what quality improvement looks like in practice:Addressing Behavior Change in Maternal, Neonatal, and Child Health with Quality Improvement and Collaborative Learning Methods in GuatemalaHaiti’s National HIV Quality Management Program and the Implementation of an Electronic Medical Record to Drive Improvement in Patient CareScaling Up a Quality Improvement Initiative: Lessons from Chamba District, IndiaPromoting Rational Use of Antibiotics in the Kyrgyz RepublicStrengthening Services for Most Vulnerable Children through Quality Improvement Approaches in a Community Setting: The Case of Bagamoyo District, TanzaniaImproving HIV Counselling and Testing in Tuberculosis Service Delivery in Ukraine: Profile of a Pilot Quality Improvement Team and Its Scale‐Up JourneyImproving Health Care in Low- and Middle-Income Countries: A Case Book will find an engaged audience among healthcare providers and administrators implementing and managing improvement projects at Ministries of Health in low- to middle-income countries. The book also aims to be a useful reference for government donor agencies, their implementing partners, and other high-level decision makers, and can be used as a course text in schools of public health, public policy, medicine, and development. ACKNOWLEDGMENT:This work was conducted under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAID Award No. AID-OAA-A-12-00101, which is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). DISCLAIMER:The contents of this book are the sole responsibility of the Editor(s) and do not necessarily reflect the views of USAID or the United States Government. div=""^

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

This open access book is a collection of 12 case studies capturing decades of experience improving health care and outcomes in low- and middle-income countries. Each case study is written by healthcare managers and providers who have implemented health improvement projects using quality improvement methodology, with analysis from global health experts on the practical application of improvement methods. The book shows how frontline providers in health and social services can identify gaps in care, propose changes to address those gaps, and test the effectiveness of their changes in order to improve health processes and outcomes. The chapters feature cases that provide real-life examples of the challenges, solutions, and benefits of improving healthcare quality and clearly demonstrate for readers what quality improvement looks like in practice: Addressing Behavior Change in Maternal, Neonatal, and Child Health with Quality Improvement and Collaborative Learning Methods in Guatemala Haiti's National HIV Quality Management Program and the Implementation of an Electronic Medical Record to Drive Improvement in Patient Care Scaling Up a Quality Improvement Initiative: Lessons from Chamba District, India Promoting Rational Use of Antibiotics in the Kyrgyz Republic Strengthening Services for Most Vulnerable Children through Quality Improvement Approaches in a Community Setting: The Case of Bagamoyo District, Tanzania Improving HIV Counselling and Testing in Tuberculosis Service Delivery in Ukraine: Profile of a Pilot Quality Improvement Team and Its Scale‐Up Journey Improving Health Care in Low- and Middle-Income Countries: A Case Book will find an engaged audience among healthcare providers and administrators implementing and managing improvement projects at Ministries of Health in low- to middle-income countries. The book also aims to be a useful reference for government donor agencies, their implementing partners, and other high-level decision makers, and can be used as a course text in schools of public health, public policy, medicine, and development. ACKNOWLEDGMENT: This work was conducted under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, USAID Award No. AID-OAA-A-12-00101, which is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). DISCLAIMER: The contents of this book are the sole responsibility of the Editor(s) and do not necessarily reflect the views of USAID or the United States Government. Presents real-life case studies, from all levels of the healthcare system and addressing a wide range of health topics, to teach readers about using quality improvement methodology to strengthen health care in lower- and middle-income countries Teaches readers about the process of designing improvement efforts, choosing priorities, carrying out activities, understanding results, building health worker capacity to improve care, engaging leadership, and applying lessons learned from improvement to spread and scale-up initiatives Provides rich detail on how improvement work is applied in practice rather than focusing on methodologies and theory Includes expert commentaries and analysis to guide the reader in understanding results on key issues and themes in designing, supporting, and scaling up improvement Open access This work was published by Saint Philip Street Press pursuant to a Creative Commons license permitting commercial use. All rights not granted by the work's license are retained by the author or authors.

Based on careful analysis of burden of disease and the costs ofinterventions, this second edition of 'Disease Control Priorities in Developing Countries, 2nd edition' highlights achievable priorities; measures progresstoward providing efficient, equitable care; promotes cost-effectiveinterventions to targeted populations; and encourages integrated effortsto optimize health. Nearly 500 experts - scientists, epidemiologists, health economists,academicians, and public health practitioners - from around the worldcontributed to the data sources and methodologies, and identifiedchallenges and priorities, resulting in this integrated, comprehensivereference volume on the state of health in developing countries.

As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a "highest-priority" essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.

Patient safety and quality improvement in health care remain a global priority. Subpar performance in health care, however, is still common more than a decade after the christening of patient safety in Africa. The core principle of safety and quality improvement systems is to identify and assess the root cause of failures in order to learn from them and devise a means to improve and to avoid recurrence. This book is designed to encourage, facilitate and empower healthcare workers in the development and implementation of strategically driven patient safety and quality improvement initiatives for safer healthcare systems and healthcare facilities in low- and middle-income countries (LMICs) of Africa. It also highlights some of the profound challenges and barriers to designing and implementing patient safety and quality improvement interventions or programmes in the region and reiterates the need to remain focused and determined to work out solutions with confidence and overcome these barriers. In the book, chapters highlight six essential components crucial for achieving evolutionary progress in safety and quality improvement in a healthcare system: Standard operating procedure Audit Research Safety management Quality management Evaluation Practical steps in planning and conducting these six essential components are outlined with some specific features to aid learning and facilitate their implementation. The authors have experience and expertise in the medical practice gained in Africa and a decade of knowledge and experience from consultancy work in safety and quality improvement in health care within and outside the region. Essentials for Quality and Safety Improvement in Health Care: A Resource for Developing Countries is authored for both medical professionals and those from other professions who are interested in and enthusiastic about patient safety and healthcare quality and therefore willing to build a career in this field. It is relevant to all health institutions, health and non-health workers, and can be used as a checklist while rendering quality and safe health care.

This policy brief aims to provide guidance for policy-makers in low- and middle-income countries (LMICs) in the Asia Pacific region on actions that governments can take to improve and regulate quality of care in ambulatory care services. There is increasing evidence of the very poor quality of ambulatory care in LMICs. Current strategies to address quality of care in these countries such as accreditation have tended to focus on hospitals. But ambulatory care accounts for the largest share of out-of-pocket expenses in LMICs and is key to addressing the double burden of communicable and noncommunicable disease.