title: Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study.
abstract: OBJECTIVE
  The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival.
  
  
  METHODS
  Web-based questionnaire survey.
  
  
  METHODS
  National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey.
  
  
  METHODS
  Income distinctions, accreditation programme features, organizational attributes and cross-national divergence.
  
  
  RESULTS
  Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the divergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, diverse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery.
  
  
  CONCLUSIONS
  Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.
authors.affiliation: Faculty of Medicine, Centre for Clinical Governance Research, University of New South Wales, Sydney, NSW 2052, Australia. j.braithwaite@unsw.edu.au
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.forename: Charles D
authors.initials: CD
authors.lastname: Shaw
authors.forename: Max
authors.initials: M
authors.lastname: Moldovan
authors.forename: David
authors.initials: D
authors.lastname: Greenfield
authors.forename: Reece
authors.initials: R
authors.lastname: Hinchcliff
authors.forename: Virginia
authors.initials: V
authors.lastname: Mumford
authors.forename: Marie Brunn
authors.initials: MB
authors.lastname: Kristensen
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook
authors.forename: Wendy
authors.initials: W
authors.lastname: Nicklin
authors.forename: Triona
authors.initials: T
authors.lastname: Fortune
authors.forename: Stuart
authors.initials: S
authors.lastname: Whittaker
mesh_terms: D000068:Accreditation / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D006298:Health Services Administration / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D011057:Politics