Improving Quality of Care in Low- and Middle-Income Countries Workshop Summary (2015) / Chapter Skim
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5 Synthesizing Evidence, Identifying Gaps
5 Synthesizing Evidence, Identifying Gaps
Pages 61-72
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From page 61... ...
Closing this gap probably depends on training and on involving the private sector.
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From page 62... ...
The concept of health as a human right has been central to the recent discussion about universal coverage, and improving quality protects that right. Ruelas took issue with a point in the universal coverage discussion: the policy documents, particularly the ones released by the WHO and the Pan American Health Organization, do not reference quality beyond a cursory mention of "quality services." While considerable attention is paid to questions of access, funding, professional training, and infrastructure, quality of care is neglected.
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From page 63... ...
The national quality strategy came into place in 2000, in part because President Vicente Fox, the former Coca-Cola chairman for Latin America, understood the importance of quality control. Data and political will are important for expanding quality programs, but Ruelas advised that these are not the only factors driving sustainability and scale.
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From page 64... ...
Although un licensed practice is illegal in India, 2011 estimates indicate that it accounted for 70 percent of the first contact with primary care in the country. Research using standardized patients found that about 4 percent of patients get the correct treatment and no incorrect treatment; 40 percent of the time patients get the correct treatment plus another treatment, and 75 percent of the time patients receive at least one incorrect treatment (Das et al., 2012)
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From page 65... ...
FIGURE 5-1 The know-do gap in correct treatment by case among different types of providers in India. NOTE: MBBS = Bachelor of Medicine, Bachelor of Surgery; SP = standardized patient.
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From page 66... ...
In India, private sector clinicians provide 80 to 90 percent of care; some of these providers have long experience and apprenticeship-style training, despite having no 2 These figures come from ongoing work by Das, Jeffrey Hammer, and Aakash Mohpal.
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From page 67... ...
Nynke van den Broek of the Liverpool School of Tropical Medicine then gave a presentation on the quality gaps in maternal and newborn health. Indicators of neonatal and maternal health are the most disparate in the world, making maternal and neonatal health a litmus test for the strength of the health system.
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From page 68... ...
Researchers answer questions such as whether emergency obstetric training is more effective when given alone or in combination with other quality improvement methods. Project staff first defined quality and came to the conclusion that, "Quality of care is the degree to which maternal health services for individuals and populations increase the likelihood of timely and appropriate treatment for the purpose of achieving
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From page 69... ...
He echoed van den Broek's point about the challenges of measuring the effectiveness of bundles of interventions, as well as Ruelas's idea that the momentum for universal coverage will make quality questions even more important. Kelley emphasized the challenge of looking at quality in the context of health systems strengthening.
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From page 70... ...
The majority of public-sector health workers in India earn six times more than their counterparts in the private sector, a fact that is often obscured by high salaries at the top private hospitals.
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From page 71... ...
Some participants saw this as an example of how governments and donors need to look beyond the proximal good when setting policy. The initial effect of reimbursing public providers equally, without regard to the quality of their education, might have been positive, but over time, it has warped the market.
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