Quality Assurance

Many countries have made considerable efforts to improve access to health services. However, public health resources have been so stretched that the quality of services has declined markedly over the last decade. Policy makers have realised that health services of inferior quality do not promote equity or maximise health gain.  As a result of this, the public is becoming attracted more to private providers than to public health clinics and hospitals. For many reasons, such as low staff morale and reduced income, this has led to further declines in the quality and efficiency of public sector health services.  It remains a challenge to find innovative approaches that improve the quality of health service delivery. National QA Programmes are one way to improve standards, but strategies to implement QA at district and sub-district level are sometimes ill conceived or may not exist at all. This is surprising in view of the fact that health sector reform policies usually include quality as an explicit priority. Whilst greater decentralisation of responsibility and resources might allow enthusiastic districts to remedy this situation, staff need models of good practice to bolster morale and, indeed, improve their quality of care.