1. Quality Improvement In Health Care In
Developing Countries
PRESENTED BY
ROLL NO
PURNIMA TIMILSINA
16
RAJESH KUMAR YADAV
19
SAGUN PAUDEL
22

2. Introduction
Definition of Quality:
Quality is a degree of excellence. In health care, quality
is defined in the light of the provider’s technical
standards and patient’s expectations. Quality is doing
right thing in right way. It is a comprehensive and
multifaceted concept.
Quality of service:
Quality of services refers to what is actually provided at
the service delivery point. Quality of services 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 measured objectively.
William R. finger

3. Quality 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 perspective
 Service provider’s perspective
 Manager/supervisor’s perspective.

4.  Client perspective:
Quality of care includes effectiveness, Accessibility,
Interpersonal relation, continuity and amenities.
 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,
mobilization etc.

5. Objective:
General Objectives:
 To Study Quality Improvement in Health Care in
Developing Countries.
Specific Objectives:
 To study the elements of quality of health care
 To study a framework for quality of care
 To study the Policy interventions to improve
quality
 To study how to Measurement of quality
 Analyze the Economic benefits and costs of
quality

6. Cont……..
 Poor quality mental health services can violate basic
human rights, lead to negative therapeutic outcomes
and prevent people from enjoying the highest standard
of physical and mental health.
 However, poor quality of care can be substantially
redressed through concerted and systematic quality
improvement strategies.
 While prescribing methods for improving the quality of
mental health services is challenging, not least because
there is tremendous variation in the availability of
financial and human resources in different countries,
providing guidance to countries to assist them to attain

7.  Inadequate resources are a major reason for poor
quality mental health care, especially in low- and
middle-income countries .
 This needs to be rectified through additional
allocation of resources, advocacy, training and
other mechanisms.

8. ‘The degree to which health services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge’
(Institute of Medicine, 2001)

9. METHODOLOGY
Secondary data

10. Finding and discussion:
 Elements of Quality:
Quality comprises three elements:
• Structure refers to stable, material characteristics
(infrastructure, tools, technology) and the
resources of the organizations that provide care
and the financing of care (levels of funding,
staffing, payment schemes, and incentives).
• Process is the interaction between caregivers
and patients during which structural inputs from
the health care system are transformed into
health outcomes.

11. Outcomes:
can be measured in terms of health status, deaths,
or disability-adjusted life years—a measure 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).

12. Quality of health Care Framework
Political Institutional
Factors factors
Demographic Health
Structure Process outcome
/socioecono care
mic factors access
The Quality of Care
Cultural Social Factors
Factors

13. QUALITY OF CARE IN
DEVELOPING COUNTRIES :
In the fifteen years since the Alma Ata Declaration,
in which the international community committed
itself to providing primary health care (PHC) for
all, major efforts have been made in nearly all
developing countries to expand PHC services.

14. This has been achieved through increased
resources allocated by both national and
international sources, expanded health worker
training, and major health system reorganization.
Dramatic increases in outreach and health
coverage have been reported by most countries,
many of which have posted modest declines in
infant and child mortality and some reductions in
selected morbidity.

15. The process of providing care in developing
countries is often poor and varies widely. A large
body of evidence from industrial countries
consistently shows variations in process, and
these findings have transformed how quality of
care is perceived.
(McGlynn and others 2003).

16. One explanation for variation and low-quality care
in the developing world is lack of resources.
Limited data indicate, however, that high-quality
care can be provided even in environments with
severely constrained resources. 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, and Liebowitz
1998).

17. Quality of care in Nepal:
In Nepal, there is lack of well trained, qualified,
midlevel health care workers (MLHCW) in rural
areas. The lack of poor performance of providers
at these health posts results in inadequate
preventive and curative health services to the
poor and geographically isolated population of all
ethnic groups..

18. The lack of quality providers is a primary reason for
a continued high maternal and neonatal mortality
rates as well as general reduction in the quality of
life due to the burden of diseases of the rural
population.

19. Economic Benefits
 Individual:
 Physical, emotional and mental health
 Increased productivity (higher capacity to generate
income, other things being equal)
 Higher quality prenatal and post natal care
decreases mortality and improves subsequent
school performance (labour productivity)
(Van der Gag, 2000)

20.  Social:
 Greater capacity to generate wealth
 Reduces premature death and disability (labour
force and productivity up)
 Lower costs for providers and health insurers (lower
public expenditure and possibly lower premiums)

21. References:
• Google.com
• 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