Quality improvement and the hierarchy of needs in low resource settings: perspective of a district health officer.
District services in developing countries are afflicted with frequent system breakdowns, caused by a combination of resource constraints, limitations of the health workforce, and poorly developed management systems. Narrowly focused, outcome-oriented quality improvement initiatives and sporadic accreditation visits fail to address the most pressing need of district health services- to improve manageability. To improve quality at the district level, attention should be directed first toward this need- by building widely focused systems for ongoing, operational monitoring and response.
Durand
A Mark
AM
Quality Assurance Initiative, Pacific Islands Health Officers Association, 1109 Melvin Ave, Maryville, TN, USA. durand@pihoa.org
D003153:Community Health Services / Q000458:organization & administration; D003906:Developing Countries; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D011787:Quality of Health Care / Q000458:organization & administration*; D018511:Systems Integration