Methods to improve quality performance at scale in lower- and middle-income countries

Area of Science:

• Global Health
• Health Services Research
• Health Policy

Background:

• Universal Health Coverage (UHC) is a key Sustainable Development Goal, but coverage alone does not guarantee effective healthcare.
• Quality of health services is crucial for realizing the benefits of UHC, yet remains a challenge in many settings.
• Performance-based financing (PBF) programs offer a mechanism to incentivize and improve healthcare quality.

Purpose of the Study:

• To describe four distinct approaches for improving health service quality at scale within PBF programs.
• To evaluate the application of structural, process, and outcome measures for quality assessment.
• To identify tools and strategies for quality improvement in resource-limited settings.

Main Methods:

• The study examined four PBF program approaches focused on enhancing healthcare quality.
• Quality was assessed using structural, process, and outcome measures, including patient satisfaction.
• Tools employed included clinical vignettes, competency tests, and patient satisfaction surveys.

Main Results:

• Four distinct approaches were detailed for implementing quality improvement within PBF frameworks.
• The methods incorporated a mix of quality measurement tools suitable for large-scale application.
• Implementation sites included Kyrgyzstan, Cambodia, Democratic Republic of Congo, and the Republic of Congo.

Conclusions:

• Performance-based financing programs provide a viable platform for introducing and testing quality improvement initiatives at scale.
• A combination of measurement tools and strategic purchasing can effectively drive quality enhancements in health services.
• These approaches hold potential for strengthening healthcare systems in lower and middle-income countries aiming for UHC.