Quality Assurance

This review of experience in accreditation and external quality assessment systems was produced at the request of the UK Department for International Development in India. The purpose of this review is to describe where External Quality Assessment fits in the broader set of levers that exist for engaging with health care providers and organisations in developing countries in order to improve quality and affordability of care. This information is partially based on theory, but primarily presents lessons learned and experience with accreditation and other assessment methods in both OECD and developing countries.

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

A central part of the World Federation for Medical Education strategy is to give priority to specification of international standards and guidelines for medical education, comprising both institutions and their educational programmes. Adoption of international standards will constitute a new framework for medical schools to measure themselves. Furthermore, internationally accepted standards could be used as a basis for national and regional recognition and accreditation of medical schools’ educational programs. [from introduction]

This report provides inforation on the potential establishment of regulatory bodies for allied health professionals in the ECSA region. It introduces the concept of regulation and the traditional methods of regulation, discusses the contextual issues, outlines five possible regulatory models, provides some draft model legislative provisions to regulate AHPs, and describes how to establish and implement a regional body. [adapted from author]

The standards provide a new framework against which individual doctors and the medical profession can assess themselves in a voluntary self-evaluation and self-improvement process. The standards should form the basis for continuted professional development (CPD) providers in designing CPD activities. Depending on local needs and traditions, the standards can also be used by national or regional agencies engaged in monitoring, recognition, and accreditation of CPD. [from introduction]

Credentialing is a means of assuring quality and protecting the public by confirming that individuals, programmes, institutions or products meet agreed standards. Credentialing is becoming increasingly important as health systems strive to address issues of public safety and quality services. [author’s description]

This study reviews the healthcare literature that examines the effect of financial incentives on the behaviour of healthcare organisations and individuals with respect to the quality of care they deliver to consumers. Its purpose is to provide guidance to policy-makers in government and decision-makers in the private sector in their efforts to improve quality of care through payment reforms. [adapted from summary]

Costa Rica has taken the search for improvement of quality health care seriously, and has initiated several activities in that area. The Quality Assurance Project… has provided technical assistance to introduce continuous quality improvement methodology in seven hospitals and clinics in the South Central Health Region. This intervention was expected to result in concrete improvements for specific problems in each of these health facilities, and to serve as a model to be duplicated in health facilities elsewhere in the country. [author’s description]

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams. The report details the impact of each intervention, noting that sustaining performance is problematical under any intervention. The cost of IIMCI training was four times that of performance feedback. [publisher’s description]

This paper describes strategies for improving the performance of health care workers. Many factors interact to affect the quality of health care. The structure of the health care system, educational opportunities for health practitioners, the administrative system, the pace of change, economic conditions and the technology available may influence the ability of the existing workforce to acquire new skills and implement them in practice. Thus, a comprehensive strategy is needed if the quality of the overall system is to improve, including the development of indicators to measure progress. [author’s description]

This presentation was part of the ECSA 38th Regional Health Ministers’ Conference. It discusses the purpose of regulation , the responsibilities of self-regulation, implementing a framework for professional regulation, and the challenges involved.


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This presentation was part of the ECSA 38th Regional Health Ministers’ Conference. It discusses the health sector vision, the role of the Department of Standards and Regulatory Services, the Nursing Council of Kenya, strategies to improve quality, the Kenya Quality Model, lessons learned and challenges.

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This report analytically and comparatively reviews international models and experiences in the development and implementation of health care regulations. The study commences with an introduction to the concept of health care regulations, and then describes the most universally common approaches for putting them into practice: licensing, accreditation, and certification. Depending on the country and its economic and political structures, different governmental and voluntary regulations over health services have evolved. Traditionally, in most countries, official licensure of health personnel has been the favored approach.

This article provides an historical overview of the three major ways that nursing regulates the profession, its members, and their performance, i.e., licensure, certification, and accreditation. Each type of regulation mechanism is described and differences between them are explained. Current issues related to accreditation of schools of nursing are outlined. [abstract]

This paper focuses on lessons learned about building quality improvement into service delivery programs. Addressed to the program leaders and donor agencies that allocate resources for service delivery programs, the paper offers guidance on the actions that must take place to improve the quality of reproductive health and child survival programs. This guidance is based on the field experiences of members of the Management and Supervision Subcommittee of the MAQ Initiative. [publisher’s description]

This document aims to facilitate the development of quality-oriented health sector reforms by providing a clear conceptual framework that can serve as a roadmap for policymakers and senior managers. By taking advantage of opportunities to integrate quality assurance activities into health sector reforms, healthcare leaders can maximize the effectiveness of reform and move toward optimizing health outcomes for the citizens of Latin America and the Caribbean. [author’s description]

Written for midlevel managers in charge of improving the quality of care at the level of primary care facilities, this guide explains how to establish monitoring systems to assess the quality of primary care by measuring the performance of providers and how facilities comply with standards of care. The guide describes a three-step quality monitoring approach to assess the quality of patient care…[author’s description]

India has traditionally had a bureaucratic approach to regulating its health service. Research suggests that this approach has failed to protect the interests of poor and vulnerable groups and has not gained the trust of providers or the public. So are there any other ways to make India’s health systems more accountable? [from author]

Knowing that quality is never an accident, always the result of high intention, sincere effort, intelligent direction and skilfull execution, and that it represents the wise choice of many alternatives, this abbreviated version of the Policy attempts to provide the strategic direction health facilities and officials need to follow to assure quality in health care and continuous improvement in the care that is being provided. Health care personnel are encouraged to use this copy of the Policy to focus their intentions and guide their efforts. [from foreword].


Section 2 directly addresses

The World Federation for Medical Education (WFME) Working Party applied the principles which were developed regarding basic medical education to postgraduate medical education. Attention was focused on the general application of guidelines in quality development of medical education. WFME holds that the set of international standards presented can be used globally as a tool for quality assurance and development of postgraduate medical education. [from introduction]

PROQUALI is a comprehensive, coordinated and innovative reproductive health (RH) service performance and quality improvement accreditation model funded by USAID. PROQUALI was developed to improve performance and quality and increase access to RH services at the primary healthcare level in northeastern Brazil. The training and technical assistance activities of the three previously independent CAs were integrated and applied during PROQUALI to help demonstration sites achieve state-approved RH service quality standards and accreditation. During the pilot demonstration phase, Phase I, the accreditation model was developed and field-tested in five primary health clinics in the states of Bahia and Cear

In addition to QA and performance improvement, this issue focuses on accreditation in South Africa, QI teams in Guatemala, identifying root causes, increasing compliance with standards, and community-based problem solving. [publisher’s description]

This monograph provides an introductory overview of QA for developing countries. It will be of interest to policy makers, upper-level ministry of health (MOH) officials, and district-level health service managers. Part I describes how quality assessment and improvement have been carried out in less developed countries (LDCs). Part II discusses the feasibility and rationale for applying QA in the developing world. Part III proposes some definitions and dimensions of quality. Part IV reviews the definition and basic tenets of QA. Part V presents a simple framework for the QA process, and Part VI discusses the challenges of building a QA program within a health care organization. [author’s description]

This fact sheet highlights approaches to improving quality of care that can be rapidly implemented, over months rather than years, without great cost. The author writes that better quality can improve health much quicker than other drivers of health, such as economic growth, educational advancement, or new technology. [adapted from introduction]

We are immersed in a global nursing workforce crisis – one marked by a critical shortage of nurses. The reasons for the shortage are varied and complex, but key among them are unhealthy work environments that weaken performance or alienate nurses and, too often, drive them away ? from specific work settings or from the nursing profession itself. This kit is designed to provide data on positive practice environments to all health stakeholders who are interested in improving the delivery of quality services. [from introduction]

This presentation discusses quality issues in private practice in developing countries, how the government can make licensing and regulation more effective, shifting the quality distribution and the use of accreditation. [adapted from author]

This brief report describes four different accreditation programs in South Africa: one is nationwide and addresses hospitals; the second accredits privately financed healthcare programs; the third is a provincial program accrediting all public healthcare facilities, and the fourth assesses clinics providing adolescent reproductive health. This operations research study interviewed stakeholders of the South Africa healthcare system to elicit their views of the best possible options for South Africa and of the strengths and weaknesses of the four existing programs. [author’s description]

The death of hundreds of thousands of women due to pregnancy-related complications casts a shadow over the modern obstetrical world. This paper examines the potential roles and responsibilities of professional obstetrical and midwifery associations in addressing this tolerated tragedy of maternal deaths. We examine the successes and challenges of obstetrical and midwifery associations and encourage the growth and development of active associations to address maternal mortality within their own borders. Professional associations can play a vital role in the reduction of maternal mortality worldwide.

This Self-Assessment Inventory outlines the major areas of competence an effective supervisor must have. The competency areas are sub-divided into categories which correspond to the major functions supervisors perform. Its primary use is as a self-assessment tool. Individuals are encouraged to use it to assess their competence and performance as supervisors and use the results to develop a plan for improvement. This Inventory can also be used as a guide to curriculum development for Supervisory Training, using the components as the basis for a needs assessment exercise. [purpose]

This monograph presents a conceptual framework to help healthcare systems and organizations analyze, plan, build and sustain efforts to produce quality healthcare. The framework synthesizes more than ten years of QA Project experience assisting in the design and implementation of QA activities and programs in over 25 countries. [author’s description]