Quality improvement initiatives in Brazil: a progress report.
BACKGROUND
In 1994 Brazil's Ministry of Health (MOH) introduced a program to provide a supporting environment for quality improvement (QI) initiatives. Yet the five-track QI strategy, which included moving toward outcome indicators, establishing a national accreditation program, emphasizing QI tools, establishing basic clinical guidelines, and enhancing community control, was discontinued in 1998, following the dismissal of the minister of health. The QI program retained only its accreditation activities.
The Consortium for Brazilian Accreditation (CBA) began in 1994 to establish an accreditation process compatible with international initiatives. Both the MOH and the CBA have developed standards for hospitals. The Brazilian Manual for the Accreditation of Hospitals is available on the Internet. The CBA has developed a set of standards by adapting the 1996 hospital standards from the Joint Commission on Accreditation of Healthcare Organizations. To developing CBA's role as an accrediting organization, administrative and technical supporting structures were created within the Cesgranrio Foundation and a Joint Commission for Accreditation was established.
A growing number of hospitals, clinical laboratories, blood banks, health plans, and other health care services and organizations are seeking International Organization for Standardization (Geneva) certification. Consulting firms in the field of quality management continue to increase the number of their clients in the health sector.


CONCLUSIONS
Current QI initiatives represent only a minority of health care services and organizations in the country. Strong efforts need to be made by both the private and public sectors to expand such initiatives throughout Brazil.
de Noronha
J C
JC
Institute of Social Medicine, State University of Rio de Janeiro, Brazil. jnoronha@uol.com.br
Travassos
C M
CM
Rosa
M L
ML
D000068:Accreditation / Q000458:organization & administration; D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008428:Maternal Mortality; D017063:Outcome Assessment, Health Care; D011635:Public Health Administration; D011785:Quality Assurance, Health Care; D017749:Total Quality Management