Are We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries?

Document Type : Letter to Editor


1 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia

2 Public Health Foundation of India, New Delhi, India

3 Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia


Are We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries?


Main Subjects

Dear Editor,

Quality of care (QoC) – what it is and how to achieve it – is a hot topic in Global Health. Contextualised by the widespread interest in universal health coverage (UHC) reforms in low- and middle-income countries (LMICs) a number of high-profile initiatives and networks now exist on the topic (eg, The Lancet Global health Commission on High Quality Health, the Network for Improving Quality of Care for Maternal, newborn and Child Health, The Primary Health Care Performance Initiative).1-3 ... (Read more...)

  1. Kruk ME, Kelley E, Syed SB, Tarp F, Addison T, Akachi Y. Measuring quality of health-care services: what is known and where are the gaps? Bull World Health Organ. 2017;95(6):389-389A. doi:10.2471/BLT.17.195099
  2. Spurring Improvements in Primary Health Care. PHCPI website. Published 2017.
  3. Quality of Care Network. A Network for Improving Quality of Care for Maternal, Newborn and Child Health. Published 2017. 
  4. Hanefeld J, Powell-Jackson T, Balabanova D. Understanding and measuring quality of care: dealing with complexity. Bull World Health Organ. 2017;95(5):368-374. doi:10.2471/BLT.16.179309
  5. Topp SM. The Lancet Global Health Commission on High Quality Health Systems-where's the complexity? Lancet Glob Health. 2017;5(6):e571. doi:10.1016/S2214-109X(17)30176-6
  6. Coarasa J, Das J, Gummerson E, Bitton A. A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries. Global Health. 2017;13(1):24. doi:10.1186/s12992-017-0246-4
  7. Das J. A Letter to Oxfam: Reframing the questions around private sector health care. PublishedJune 7, 2017.
  8. Sheikh K, Josyula LK, Zhang X, Bigdeli M, Ahmed SM. Governing the mixed health workforce: learning from Asian experiences. BMJ Glob Health. 2017;2(2):e000267. doi:10.1136/bmjgh-2016-000267
  9. Sheikh K, Saligram PS, Hort K. What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states. Health Policy Plan. 2015;30(1):39-55. doi:10.1093/heapol/czt095
  10. Morgan R, Ensor T, Waters H. Performance of private sector health care: implications for universal health coverage. Lancet. 2016;388(10044):606-612. doi:10.1016/S0140-6736(16)00343-3
  11. Topp SM. Health worker performance, practice and improvement. In: George A, Scott K, Govender V, eds. A Health Policy and Systems Reader on Human Resources for Health. Geneva: World Health Organisation; 2017:73-88.
  12. de Herdt T, Olivier de Sardin J-P. Real Governance and Practical Norms in Sub-Saharan Africa: The Game of the Rules. London and New York: Routledge; 2015.
  13. Freedman LP, Kruk ME. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Lancet. 2014;384(9948):e42-44. doi:10.1016/S0140-6736(14)60859-X
  14. Gilson L, Palmer N, Schneider H. Trust and health worker performance: exploring a conceptual framework using South African evidence. Soc Sci Med. 2005;61(7):1418-1429. doi:10.1016/j.socscimed.2004.11.062
  15. Topp SM, Chipukuma JM, Hanefeld J. Understanding the dynamic interactions driving Zambian health centre performance: a case-based health systems analysis. Health Policy Plan. 2015;30(4):485-499. doi:10.1093/heapol/czu029
  16. Spangler SA. Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities. Reprod Health Matters. 2012;20(39):133-141. doi:10.1016/S0968-8080(12)39603-4
  17. Storeng KT, Behague DP. "Guilty until proven innocent": the contested use of maternal mortality indicators in global health. Crit Public Health. 2017;27(2):163-176. doi:10.1080/09581596.2016.1259459
  18. Ebrahimipour H, Vafaei Najjar A, Khani Jahani A, et al. Health system responsiveness: a case study of general hospitals in iran. Int J Health Policy Manag. 2013;1(1):85-90. doi:10.15171/ijhpm.2013.13
  19. Peltzer K. Patient experiences and health system responsiveness in South Africa. BMC Health Serv Res. 2009;9:117. doi:10.1186/1472-6963-9-117