Research on health-care quality improvement in low- and middle-income countries: is it a worthy investment?

Abstract

This special issue offers an opportunity to reflect on the status of quality improvement research in low- and middle-income countries (LMICs). Quality improvement is difficult to achieve in any setting where busy health professionals are dedicating their full effort to delivering care. Research on quality improvement may be an even lower priority when resources are scarce. In low-income countries, where it is difficult to marshal resources to support quality improvement, supporting evaluation and research may especially daunting. In LMICs, local context can dominate research on quality improvement in ways that researchers in high-income countries may find difficult to appreciate. Research teams with needed capabilities may not be readily available. Secondary data sources that support evaluation in high-income countries may not exist. Primary collection of reliable and valid research data is difficult. Funding to support research and evaluation may be scarce, especially if donors are attempting to spread interventions that they already believe to be effective. Given the odds against research in such settings, the papers in this special issue represent important triumphs. Several authors have overcome key barriers, demonstrating that improvement, learning and research are possible in challenging settings where diverse populations are served. The papers address initiatives by governments, health centers, hospitals and local communities. They include populations such as maternal, neonatal and pediatric groups as well as adults with chronic conditions. The work comes from many continents and examines health-care quality from the level of the patient to the level of the policies that shape entire health systems. The papers reveal that the interventions and tools that best fit the lower-income country context are still a work in progress. They highlight how much …