with poor and neglected sectors of society. One aspect of Setting this movement was recognition of the need to strengthen the public health sector by improving the quality of health Chile is a geographically and climatically diverse country of care, a widespread concern of both patients and providers. 14.6 million people, located on the southwest side of South Against this backdrop, in March 1991, the MOH began a America. The country is divided into 13 Regions, 51 Provinces national quality improvement initiative with a quality awareand 341 Districts. The vast majority (84.9%) of the population ness seminar conducted by USAID’s Quality Assurance Proresides in urban areas, with 39.7% concentrated in the Santiago ject. As a result of the seminar, an initial plan for a 2-year Metropolitan Region alone. The literacy rate is 94.6%. Altechnical collaboration effort between the Primary Health though Chile’s per capita gross national product of US$4753 Care Department of the MOH and the Quality Assurance ranks it as a middle income country, some 23% of the Project was funded by USAID/Chile as one component of population lives below the poverty line and 15.8% live in a larger effort to strengthen primary care in Chile. The Proyecto extreme poverty [1]. Despite the low income of a significant para la Evaluacion y Mejoramiento de la Calidad or National proportion of the population, health indicators for the country approach those in more developed countries. The infant Project for the Evaluation and Improvement of Quality was mortality rate is 11.1 per 1000 live births, maternal mortality born, known in Chile by its Spanish acronym, EMC. is 2.5 per 10 000 live births, and life expectancy is 75.2 years. Following the initial quality awareness seminar, a small The Chilean health system is comprised of four subsectors: team in the Primary Health Care Department of the MOH public, private, Armed Forces and non-governmental health worked with international consultants to design a national care. All of these subsectors are regulated by the Ministry of quality assurance (QA) programme. Because of the deHealth, whose principal role is to set technical norms and centralized nature of the Chilean health system and the quality standards and monitor their implementation. The geographic diversity of its regions, MOH authorities decided public health subsector serves approximately 60% of the from the outset that the programme should be developed population and is represented by the national system of on a national scale, rather than as a regional pilot project geographically defined health services. The 29 health services with phased introduction to other regions. Participation must are autonomous of the Ministry of Health (MOH) with be voluntary and respect local autonomy, allowing each region, respect to planning, programming and administration of health service and facility to determine the nature, extent and health care delivery. scope of its QA activities, respecting existing technical and administrative lines of authority. Different strategies would be pursued in accordance with particular local needs; together, Origins, objectives and strategies of the these would comprise the national programme. The MOH also made a conscious decision to involve the various key national quality assurance programme actors in the health sector in the QA programme. Representatives of national and regional universities, the private In 1989, Chile held its first democratic elections after 17 sector, non-government organizations, and the medical asyears of military dictatorship. In 1990, the Government of sociations were invited to participate in training activities and the elected President, Patricio Aylwin, defined social policies quality committees. Finally, although the programme began based on principles of equity, social efficiency, social participation, respect for the dignity of individuals, and solidarity in the primary care setting, requests were soon received