Presentation

1. Quality of Care
A process for making
strategic choices in
health systems

2. Introduction
 A wealth of knowledge and experience in
enhancing the quality of health care has
accumulated globally over many decades.
 In spite of this wealth of experience, the
problem frequently faced by policy-makers at
country level in both high- and low-middle-
income countries is to know which quality
strategies – complemented by and integrated
with existent strategic initiatives – would
have the greatest impact on the outcomes
delivered by their health systems.

3. Quality
Quality consists of the degree to which health
services for individuals and populations
increase the likelihood of desired health
outcomes (quality principles), are consistent
with current professional knowledge
(practitioner skill), and meet the expectations
of healthcare consumers (the marketplace).

4. Health system should seek to make
improvements in six areas or dimensions of
quality, which are named and described
below. These dimensions require that health
care be:
1. effective, delivering health care that is
adherent to an evidence base and results in
improved health outcomes for individuals
and communities, based on need;

5. 2. efficient, delivering health care in a manner
which maximizes resource use and avoids
waste;
3. accessible, delivering health care that is
timely, geographically reasonable, and
provided in a setting where skills and
resources are appropriate to medical need;
4. acceptable/patient-centred, delivering health
care which takes into account the preferences
and aspirations of individual service users
and the cultures of their communities;

6. 5. equitable, delivering health care which does
not vary in quality because of personal
characteristics such as gender, race, ethnicity,
geographical location, or socioeconomic
status;
6. safe, delivering health care which minimizes
risks and harm to service users.

7. Roles and responsibilities in quality improvement
 Policy and strategy development: The main concerns of
decision-makers will be to keep the performance of the
whole system under review, and to develop strategies for
improving quality outcomes which apply across the whole
system.
 Health-service providers: Their main concern will be to
ensure that the services they provide are of the highest
possible standard and meet the needs of individual service
users, their families, and communities.
 Communities and service users: These are the co-producers
of health. They have critical roles and responsibilities in
identifying their own needs and preferences, and in managing
their own health with appropriate support from health-service
providers.