IMPROVING QUALITY OF
CARE IN LOW- AND MIDDLE-
INCOME COUNTRIES
WORKSHOP SUMMARY
Gillian J. Buckley and Rachel E. Pittluck, Rapporteurs
Board on Global Health
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
Washington, DC
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract/Grant No. APC-GM-0002 between the National Academy of Sciences and JSI Research and Training Institute/U.S. Agency for International Development. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-37342-5
International Standard Book Number-10: 0-309-37342-5
DOI: 10.17226/21736
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2015 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Improving quality of care in low- and middle-income countries: Workshop summary. Washington, DC: The National Academies Press.
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PLANNING COMMITTEE FOR THE WORKSHOP
ON IMPROVING QUALITY OF CARE IN LOW-
AND MIDDLE-INCOME COUNTRIES1
SHEILA LEATHERMAN (Chair), Research Professor of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
RIFAT ATUN, Professor of Global Health Systems; Head, Global Health Systems Cluster, Harvard T.H. Chan School of Public Health
KEDAR MATE, Senior Vice President for Innovation, Institute for Healthcare Improvement; Assistant Professor of Medicine, Weill Cornell Medical College
IOM Staff
GILLIAN J. BUCKLEY, Program Officer
RACHEL E. PITTLUCK, Research Associate
DAVID T. GARRISON, Senior Program Assistant (from June 2015)
FAYE HILLMAN, Financial Associate
PATRICK W. KELLEY, Director, Board on Global Health
_________________
1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
A. Mushtaque R. Chowdhury, BRAC, Bangladesh; Columbia University Mailman School of Public Health
Corine Karema, Ministry of Health, Rwanda
Nachiket Mor, CARE India; Reserve Bank of India; CRISIL
Edward B. Perrin, University of Washington
Alexander Rowe, Centers for Disease Control and Prevention
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Robert S. Lawrence, Professor of Environmental Health Sciences, Health Policy, and International Health, and Director, Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health. He was responsible for making certain that an independent examination
of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.
Acknowledgments
This report is the product of the cooperation and contributions of numerous people. The planning committee and project staff are especially grateful to the presenters and moderators who participated in this workshop, lending their time and expertise to make the event a success. These individuals are listed in the workshop agenda in Appendix A. We would also like to thank the many participants who attended the workshop, both in person and via the live webcast.
Many staff of the Institute of Medicine and the National Academies of Sciences, Engineering, and Medicine have supported this activity from its inception to the workshop itself and through the publication of this workshop summary report. In particular, we wish to acknowledge the efforts of Daniel Bearss, Marton Cavani, Chelsea Frakes, Greta Gorman, Faye Hillman, Sarah Kelley, Ellen Kimmel, Rebecca Morgan, and Jose Portillo.
The planning committee and staff thank the U.S. Agency for International Development (USAID) for generously funding this activity.
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Boxes, Figures, and Tables
BOXES
1-1 Six Quality Improvement Strategies Commonly Used in USAID Missions
6-1 Main Points of Practice Discussion
6-2 Main Points of Policy Discussion
6-3 Main Points of Research Discussion
FIGURES
3-1 All three elements of the Juran trilogy are needed to improve outcomes
3-2 Putting the six methods on a continuum from quality assurance (QA) to quality improvement (QI)
3-4 The processes and tools in COPE®
3-6 The logic model through which COPE® changes behavior and improves quality at the facility
3-7 The modified plan-do-study-act cycle that forms the basis of SBM-R
3-8 An SBM-R standard for antenatal care
3-12 The capability, opportunity, motivation model of behavior change
4-1 Breakdown of the strategy studies by region
4-3 The timeline for developing the iSanté electronic medical records (EMRs) system
4-4 The OECD health system performance assessment framework
4-7 General structure of economic evaluations
5-1 The know-do gap in correct treatment by case among different types of providers in India
6-1 Tradeoffs in improving quality
6-2 Combining three key questions with a plan-do-study-act cycle is a model for improvement
TABLES
3-1 Differences Between Quality Assurance and Quality Improvement Methods
3-2 The Accreditation Process, Including the Typical Timeline in Developed Countries
4-3 Breakdown of the Risk of Bias in the Strategy Studies
4-4 Breakdown of the Strategy Comparisons by Study Design
4-5 Breakdown of the Strategy Studies by Setting
4-6 Breakdown of the Strategy Studies by Health Care Provider Type
4-7 Breakdown of the Strategy Studies by Health Condition
4-8 Breakdown of the Strategy Studies by Method of Data Collection
4-10 Types of OECD Health Systems Indicators
5-1 Variability in Key Health Indicators by World Bank Income Group in 2013
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AIDS | acquired immune deficiency syndrome |
AMTSL | active management of the third stage of labor |
ART | antiretroviral therapy |
ASSIST | Applying Science to Strengthen and Improve Systems |
CDC | Centers for Disease Control and Prevention |
COPE® | client-oriented, provider-efficient services |
DALY | disability-adjusted life year |
DHS | Demographic and Health Survey |
Global Fund | Global Fund to Fight AIDS, Tuberculosis and Malaria |
HIV | human immunodeficiency virus |
IOM | Institute of Medicine |
IQR | interquartile range |
MES | median effect size(s) |
MESI | Monitoring, Evaluation and Surveillance Interface |
OECD | Organisation for Economic Co-operation and Development |
PEPFAR | The President’s Emergency Plan for AIDS Relief |
SBM-R | Standards-Based Management and Recognition |
URC | University Research Co., LLC |
USAID | U.S. Agency for International Development |
WHO | World Health Organization |