‘‘QUALITY IMPROVEMENT IN HEALTH CARE IN DEVELOPING COUNTRIES’’  A Term paper submitted to fulfill the partial requirement ...
1. AcknowledgementThe students of Bachelor of Public Health 3rd semester of 2nd year like to express our humblythanks to a...
2. Table of content1.      Acknowledgement ..................................................................................
3. Introduction 3.1 Definition of Quality:Quality is a degree of excellence. In health care, quality is defined in the lig...
Quality of care includes effectiveness, Accessibility, Interpersonal relation, continuity andamenities.Service provider’s ...
4. Objective:4.1 General Objectives:      o   To Study Quality Improvement in Health Care In Developing Countries.4.2   Sp...
5. METHODOLOGYSecondary data                    7
6. Finding and discussion:6.1 Elements of Quality:Quality comprises three elements:• Structure Structure refers to stable,...
6.2 QUALITY OF CARE FRAMEWORK6.3 QUALITY OF CARE IN DEVELOPING COUNTRIES:In the fifteen years since the Alma Ata Declarati...
procedures, to assess performance compared with selected performance standards, and to take tangible stepstoward improving...
7.   ConclusionIn industrialized countries, quality of care is widely debated in the context of health sectorreform. A wea...
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Quality improvement in health care in developing countries

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Quality improvement in health care in developing countries

  1. 1. ‘‘QUALITY IMPROVEMENT IN HEALTH CARE IN DEVELOPING COUNTRIES’’ A Term paper submitted to fulfill the partial requirement of BPH Third semester [TPP 8.1 HEALTH SYSTEM DEVELOPMENT] SUBMITTED TO: DEPARTMENT OF PUBLIC HEALTH, LA GRANDEE INTERNATIONAL COLLEGE, SIMALCHAUR-8, POKHARA 2012 SUBMITTED BY: RAJESH KUMAR YADAV PURNIMA TIMILSINA KALPANA GURUNG SAGUN PAUDEL 1
  2. 2. 1. AcknowledgementThe students of Bachelor of Public Health 3rd semester of 2nd year like to express our humblythanks to all those who have supported and helped us in accomplishing this term paper in thetopic ‘‘QUALITY IMPROVEMENT IN HEALTH CARE IN DEVELOPINGCOUNTRIES’’.We would like to convey our heartfelt thanks to all those who were directly or indirectlyconcerned with this and to all our well-wishers.First of all we would like to thank our respected subject teacher Mr. Hari kafle for giving usopportunity to prepare this term paper. We are fully indebted to our coordinator Mr. Dilip kumarYadav for expert guidance, regular supervision, untiring encouragement, inspiration and valuablesuggestion and full support during preparation of term paper.This term paper is written in simple language, with every bit of necessary information related tothe topic so that studying independently also would not find any difficulties. We think that thiseffort will help every individual to understand about the information of the related topic. 2
  3. 3. 2. Table of content1. Acknowledgement ........................................................................................................................... 22. Table of content .............................................................................................................................. 33. Introduction .................................................................................................................................... 43.1 Definition of Quality: ......................................................................................................................... 4 3.2 Quality of service: .......................................................................................................................... 44. Objective: ........................................................................................................................................ 6 4.1 General Objectives:........................................................................................................................ 65. METHODOLOGY ............................................................................................................................... 76. Finding and discussion: .................................................................................................................... 8 6.1 Elements of Quality:....................................................................................................................... 8 6.2 QUALITY OF CARE FRAMEWORK .................................................................................................... 9 6.3 QUALITY OF CARE IN DEVELOPING COUNTRIES: ............................................................................. 9 6.4 Quality of care in Nepal:............................................................................................................... 107. Conclusion ..................................................................................................................................... 118. References:.................................................................................................................................... 11 3
  4. 4. 3. Introduction 3.1 Definition of Quality:Quality is a degree of excellence. In health care, quality is defined in the light of the provider’stechnical standards and patient’s expectations. Quality is doing right thing in right way. It is acomprehensive and multifaceted concept.3.2 Quality of service:Quality of services refers to what is actually provided at the service delivery point. Quality ofservices is determined by how policy makers and programme managers convert their resources(staff, suppliers and physical locations) into services. The quality of services should be measuredobjectively.William R. finger‘The degree to which health services for individuals and populations increase the likelihood ofdesired health outcomes and are consistent with current professional knowledge’(Institute of Medicine, 2001)Institute of Medicine, 2001: Crossing the Quality Chasm, Washington, DC: National AcademyPressQuality of health care should always fulfill three points which are;  It should fulfill clients or patient’s need and wants.  It should give positive impact on health status.  It should follow scientifically approved methods and techniques.Quality of care is views in 3 perspective;Client/community perspectiveService provider’s perspectiveManager/supervisor’s perspective.Client perspective: 4
  5. 5. Quality of care includes effectiveness, Accessibility, Interpersonal relation, continuity andamenities.Service provider’s perspective:It implies the skills, resources and other conditions necessary to improve health status.Health care manager/ supervisor’s perspective:Involves addressing needs of clients/ service providers through resource allocation, mobilizationetc. 5
  6. 6. 4. Objective:4.1 General Objectives: o To Study Quality Improvement in Health Care In Developing Countries.4.2 Specific Objectives: o To study the elements of quality of health care o To study a framework for quality of care o To study the Policy interventions to improve quality o To study how to Measurement of quality o Analyze the Economic benefits and costs of quality 6
  7. 7. 5. METHODOLOGYSecondary data 7
  8. 8. 6. Finding and discussion:6.1 Elements of Quality:Quality comprises three elements:• Structure Structure refers to stable, material characteristics (infrastructure, tools, technology) and theresources of the organizations that provide care and the financing of care (levels of funding,staffing, payment schemes, and incentives).• ProcessProcess is the interaction between caregivers and patients during which structural inputs fromthe health care system are transformed into health outcomes.• Outcomes Outcome can be measured in terms of health status, deaths, or disability-adjusted life years—ameasure that encompasses the morbidity and mortality of patients or groups of patients.Outcomes also include patient satisfaction or patient responsiveness to the health care system(WHO 2000). 8
  9. 9. 6.2 QUALITY OF CARE FRAMEWORK6.3 QUALITY OF CARE IN DEVELOPING COUNTRIES:In the fifteen years since the Alma Ata Declaration, in which the international community committed itself toproviding primary health care (PHC) for all, major efforts have been made in nearly all developing countries toexpand PHC services. This has been achieved through increased resources allocated by both national andinternational sources, expanded health worker training, and major health system reorganization. Dramaticincreases in outreach and health coverage have been reported by most countries, many of which have postedmodest declines in infant and child mortality and some reductions in selected morbidity. However, the reportedimprovements have not always been commensurate with the resources expended. Furthermore, not enough hasbeen done to assess service quality or to ensure that resources are having an optimal impact. Quality assurance(QA) methods can help health program managers to define clinical guidelines and standard operating 9
  10. 10. procedures, to assess performance compared with selected performance standards, and to take tangible stepstoward improving program performance and effectiveness.The process of providing care in developing countries is often poor and varies widely. A large body ofevidence from industrial countries consistently shows variations in process, and these findings havetransformed how quality of care is perceived (McGlynn and others 2003). A 2002 study found that physicianscomplied with evidence-based guidelines for at least 80 percent of patients in only 8 of 306 U.S. hospitalregions (Wennberg, Fisher, and Skinner 2002). It is important to note that these variations appear to beindependent of access to care or cost of care: Neither greater supply nor higher spending resulted in better careor better survival. Studies from developing countries show similar results. For example, care in tertiary andteaching hospitals and care provided by specialists may be better than care for the same cases in primary carefacilities and by generalists (Walker, Ashley, and Hayes 1988).One explanation for variation and low-quality care in the developing world is lack of resources. Limited dataindicate, however, that high-quality care can be provided even in environments with severely constrainedresources. A study in Jamaica, which used a cross-sectional analysis of government-run primary care clinics,showed that better process alone was linked to significantly greater birthweight (Peabody, Gertler, andLiebowitz 1998). A study in Indonesia attributed 60 percent of all perinatal deaths to poor process and only 37percent to economic constraints (Supratikto and others 2002).Cross-system or cross-national comparisons provide the best examples of the great variation in clinical practicein developing countries. In one seven-country study, researchers directly observing clinical practice found that75 percent of cases were not adequately diagnosed, treated, or monitored and that inappropriate treatment withantibiotics, fluids, feeding, or oxygen occurred in 61 percent of cases (Nolan and others 2001). Another studycompared providers’ knowledge and practice in California and FYR Macedonia, using vignettes to adjust forcase-mix severity. Although the quality of the overall or aggregate process was lower in FYR Macedonia, apoor country, the top 5 percent of Macedonian doctors performed as well as or better than the averageCalifornian doctor (Peabody, Tozija, and others 2004).In a study commissioned for this chapter, an international team measured quality in five developing countries(China,El Salvador, India, Mexico, and the Philippines), using the same clinical vignettes at each site. The teamevaluated the process for common diseases according to international, evidence-based criteria. Quality variedonly slightly among countries. The within-country range of quality of doctors was 10 times as great as thebetween-country range. Such wide variation strongly suggests that efforts to improve health status mustinvolve policies that change the quality of clinical care.6.4 Quality of care in Nepal:In Nepal, there is lack of well trained, qualified, midlevel health care workers (MLHCW) in rural areas. Thelack of poor performance of providers at these health posts results in inadequate preventive and curative healthservices to the poor and geographically isolated population of all ethnic groups. The lack of quality providersis a primary reason for a continued high maternal and neonatal mortality rates as well as general reduction inthe quality of life due to the burden of diseases of the rural population. 10
  11. 11. 7. ConclusionIn industrialized countries, quality of care is widely debated in the context of health sectorreform. A wealth of literature reflects the progress made in developing tools to monitor andimprove the quality of health care. Poor quality health services can violate basic human rights,lead to negative therapeutic outcomes and prevent people from enjoying the highest standard ofphysical and mental health. However, poor quality of care can be substantially redressed throughconcerted and systematic quality improvement strategies. 8. References:  The Quality of Care in Developing Countries, John W. Peabody, Mario M. Taguiwalo, David A. Robalino, and Julio Frenk  Quality Assurance of Health CareIn Developing Countries, Lori DiPreteBrown,Lynne Miller Franco,NadwaRafeh,TheresaHatzell THANKYOU Prepared by: sagun paudel Do not forget to give comment or feedback for me…… mail4sagun@gmail.com  www.facebook.com/publichealthstudents www.facebook.com/sagun.paudel  www.facebook.com/preventionisbest 11

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