Investing in Education One of the most important ways to improve health in developing countries is by educating citizens. Educating people enables them to obtain safer jobs, increased health literacy, take preventive healthcare measuresavoid riskier health behaviors and demand better-quality health services. In developing areas, the poor are subjected to higher risk of contracting diseases and lower access to quality healthcare. This is solely due to the cost of medicine, treatments and vaccinations.
Elements of Quality Quality comprises three elements: Structure refers to stable, material characteristics infrastructure, tools, technology and the resources of the organizations that provide care and the financing of care levels of funding, staffing, payment schemes, incentives.
Process is the interaction between caregivers and patients during which structural inputs from the health care system are transformed into health outcomes.
Outcomes can be measured in terms of health status, deaths, or disability-adjusted life years—a measure that encompasses the morbidity and mortality of patients or groups of patients.
Outcomes also include patient satisfaction or patient responsiveness to the health care system WHO Structural measures are the easiest to obtain and most commonly used in studies of quality in Developing healthcare in third world countries countries.
Many evaluations have revealed shortages in medical staff, medications and other important supplies, and facilities, but material measures of structure, perhaps surprisingly, are not causally related to better health outcomes Donabedian Although higher technology or a more pleasant environment may be conducive to better-quality care, the evidence indicates only a weak link between such structural elements and better health outcomes Donabedian The notable exceptions are cases in which physical improvements either increase access to primary care in very poor settings or increase the volume of a clinical procedure, such as cataract surgery, that is specifically linked to better health outcomes Javitt, Venkataswamy, and Sommer At best, however, structure is a blunt approximation of process or outcomes; structural improvements by themselves rarely improve the health of a population.
Process, by contrast, can be measured with every visit to a provider. Measuring process is difficult, however, particularly in developing countries.
The private nature of the doctor-patient consultation, a lack of measurement criteria, and the absence of reliable measurement tools have limited the ability to assess process Peabody, Tozija, and others However, new methods are being developed that can provide valid measurements of clinical practice Thaver and others In addition, evidence-based clinical studies have steadily revealed which process measures lead to better health outcomes.
This combination of ubiquity, measurability, and linkage to health outcomes makes the measurement of process the preferred way to assess quality. Although good outcomes are the objective of all health actions, outcomes alone are not an efficient way to measure quality for two reasons.
The first is the quality conundrum. A patient may receive poor-quality care but may recover fully, or a patient may receive high-quality care for an illness such as cerebral malaria and still not recover.
Second, adverse health outcomes are relatively rare and obviously do not occur with every encounter. The classic framework of structure-process-outcome is well established. However, in recent years the concept of quality has been expanded to include specific aims for improvement.
For example, the Institute of Medicine's landmark report, Crossing the Quality Chasm, broadens the concept to include other, more contextual elements to illuminate how process changes can improve care. It focuses on six aims: Are the risks of injury minimal for patients in the health system?
Is the care provided scientifically sound and neither underused nor overused?
Quality Assessment Perspectives We can look at the Institute of Medicine's aims from two perspectives: Patients' perceptions of quality depend on their individual characteristics and affect their compliance, follow-up decisions, and long-term lifestyle changes Zaslavsky and others Interpersonal relationships, cultural appropriateness, and gender sensitivity—long thought to be luxuries of wealthier countries—are also major determinants of patient access and utilization in developing countries.
These findings have led to the inclusion of patient satisfaction and patient responsiveness as outcome measures. Technical assessment concerns whether providers meet normative standards for appropriateness of care or adherence to explicit evidence-based criteria. Although patient perception or satisfaction is important, researchers increasingly rely on objective, evidence-based quality criteria that can be more readily linked to better health outcomes at both the individual and the population levels.
Population-Level Considerations Quality is typically assessed through the interaction between individual doctors and patients. However, emerging evidence shows that the average quality of care given by groups of doctors and other providers is an important determinant of overall community health status.
For example, in a cross-sectional analysis in the former Yugoslav Republic of Macedonia, researchers found not only that patients' heath status was significantly higher in areas where quality was higher but also that the overall self-reported health status of those members of the general population who had not recently received care was higher Peabody, Tozija, and others Despite the modern advancements of this era, developing countries still have poor access to quality, cost-effective healthcare.
Attempting to close the socioeconomic gap created by poverty, there are three initiatives that governments and national organizations can take to . In developing countries – where two-thirds of these deaths occur – such poisonings are associated strongly with excessive exposure to, and inappropriate use of, toxic chemicals and pesticides present in occupational and/or domestic environments (8, 9).
Health provision varies around the world. Almost all wealthy nations provide universal health care (the US is an exception). Health provision is challenging due to the costs required as well as various social, cultural, political and economic conditions. An alarming number of countries are failing to provide the most basic health services that would save lives, with 30 percent of children in developing countries not getting basic health.
ABSTRACT. Effective health care interventions are underutilized in the developing world, and income-related disparities in use are large.
The evidence concerning this access problem is summarized and its demand side causes are identified. Quality of Care in Developing Countries The process of providing care in developing countries is often poor and varies widely.
A large body of evidence from industrial countries consistently shows variations in process, and these findings have transformed how quality of .