title: Crossing the quality chasm in resource-limited settings.
abstract: Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.
authors.affiliation: Nyaya Health, Bayalpata Hospital, Ridikot VDC, Achham, Nepal. duncansr@post.harvard.edu
authors.forename: Duncan Smith-Rohrberg
authors.initials: DS
authors.lastname: Maru
authors.forename: Jason
authors.initials: J
authors.lastname: Andrews
authors.forename: Dan
authors.initials: D
authors.lastname: Schwarz
authors.forename: Ryan
authors.initials: R
authors.lastname: Schwarz
authors.forename: Bibhav
authors.initials: B
authors.lastname: Acharya
authors.forename: Astha
authors.initials: A
authors.lastname: Ramaiya
authors.forename: Gregory
authors.initials: G
authors.lastname: Karelas
authors.forename: Ruma
authors.initials: R
authors.lastname: Rajbhandari
authors.forename: Kedar
authors.initials: K
authors.lastname: Mate
authors.forename: Sona
authors.initials: S
authors.lastname: Shilpakar
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D055317:Evidence-Based Practice; D014943:Global Health; D006295:Health Resources; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D011785:Quality Assurance, Health Care; D012935:Social Justice