70. Improving the Quality of Care in Developing Countries


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Richard Lord, www.rlordphoto.com

Although quantity of health care has historically been the focus in developing countries, ample evidence suggests that quality must be at the center of every discussion about better health. Quality improvement tools and technologies and information on successful quality improvement policies must be consistently shared among developing countries to build local capacity. Funding and incentives to providers also must be consistent with high quality. Finally, there must be a political will to ensure that quality becomes a top priority on the health care reform agenda.

Several studies in developing countries have revealed a failure by practitioners to diagnose or properly treat common diseases and conditions such as pneumonia, malaria, and viral diarrhea. These deficiencies do not reflect a failure of professional compassion or lack of resources. Rather, they result from gaps in knowledge, inappropriate applications of available technology, or the inability to change.

Increasing evidence shows that health care quality can be improved rapidly, if it is defined and measured and if appropriate steps are taken to inform providers and change their practices as needed. Although basing health care decisions on health care outcomes is controversial for valid reasons, such as variations in patient populations, they can help in the search for underlying causes of poor quality. In the United States, for example, the delivery of coronary artery bypass surgery began to shift from low–volume to high–volume facilities after 30–day mortality rates were measured. Outcome data can be used in combination with other information, such as data on patient safety, timeliness, efficiency, and equity, to achieve a more comprehensive evaluation of quality.