Measuring quality of health-care services: what is known and where are the gaps?

Abstract

The United Nations sustainable development goal (SDG) 3 seeks ensure healthy lives and promote well-being for all and at all ages. (1) To build healthcare systems that were able to progress towards the millennium development goals, many countries had to extend delivery systems to increase coverage. They also greatly improved measurement of people's contacts with the health system. However, with the reduction in disease burden due to specific infectious diseases and childhood illnesses, people tend to live longer, have multiple noncommunicable diseases and require more complex services. The focus on measuring access is not sufficient to capture whether people receive effective care; hence this month's papers on measurement of quality of care in low- and middle-income countries. In papers published online and in this issue, Akachi et al. explain why the quality of health-care services in low-and middle-income countries has been largely overlooked as an important contributor to health outcomes. (2) Sharma et al. observe the management of childbirth at public and private hospitals in Uttar Pradesh, India and conclude that care provided to women and their newborns is of poor quality. (3) Brenner et al. study the effects of a results-based financing scheme in Malawi and find improved equipment and supplies at health facilities but minimal effects on clinical performance. (4) In Ethiopia, Canavan et al. measure the quality of intrapartum care in hospitals using data from medical chart reviews and direct observations. (5) Knowlton et al. do a multinational survey of 120 hospitals and find that many lack the basic infrastructure needed to provide essential surgical care on a consistent basis. (6) Lazzerini et al. find that in Kyrgyzstan--a setting with high rates of hospitalization, over-diagnosis and over-treatment--brief training and supportive supervision by paediatricians improve quality of paediatric care in hospitals. (7) Examining variation in quality is one way to diagnose drivers of good or poor performance. Kruk et al. find that the quality of antenatal and paediatric care in seven African countries varies greatly and that this variation may result from the different approaches governments take in training providers and funding and organizing their health systems. (8) Other articles in this issue present innovations in measures and instruments to assess quality of health-care services. Bedoya et al. document compliance with infection prevention and control measures during outpatient visits in Kenya. (9) Wang et al. show how medical malpractice litigation records can be used as a source of data to assess patients' experience and their health outcomes in China. (10) Madaj et al. assess the validity of the World Health Organization's indicators for quality of care around the time of birth. (11) Despite the wide range of research presented in this issue, several aspects of health-care quality are not addressed. …