In recent years attention in developing countries has concentrated upon strategies to improve the equitable provision of essential health care-the primary health care approach. Very little work has been reported in connection with the quality of medical care, and yetfor the successful outcome of care it is necessary that adequate health care processes be carried out. Conceptual, methodological, data, and organizational issues related to quality assessment and assurance are presented. Thefew examples of reported work concerned with these important aspects of medical care in developing countries are reviewed. Suggestions are made as to how measures to ensure reasonable quality might be further developed and refined.
Get full access to this article
View all access options for this article.
References
1.
ABBATT, F. R.
(1980) Teaching for Better Learning: A Guide for Teachers of Primary Health Care Staff. Geneva: WHO.
2.
BARZEGAR, M. A.
and A. DJAZAYERY (1981) "Evaluation of rural primary health care services in Iran: report on vital statistics in West Azabaijan."Amer. J. of Public Health71 (July): 739-742.
3.
BERGGREN, W. C.
, D. C. EWBANK, and G. G. BERGGREN (1981) "Reduction of mortality in rural Haiti through a primary health-care program."New England J. of Medicine304 (May): 1324-1330.
4.
BROOK, R. H.
and F. A. APPEL (1973) "Quality of care assessment: choosing a method for peer review."New England J. of Medicine288 (June 21): 1323-1329.
5.
BROOK, R. H.
, A. DAVIES-AVERY, S. GREENFIELD, J. C. HARRIS, T. LELAM, N. E. SOLOMON, and J. E. WALLE (1977) "Assessing the quality of medical care using outcome measures: an overview of the method."Medical Care15 (September): Supplement.
6.
Chinese Paramedical Manual
(1977) A Barefoot-Doctor's Manual. Philadelphia: Running Press.
7.
COLE-KING, S.
(1979) Approaches to the Evaluation of Maternal and Child Health Care in the Context of Primary Health Care. HSM/79.2. Geneva: WHO.
8.
CUMPER, G.
(1981) "Resource requirements for achieving Health for All by the Year 2000." (Mimeo) London: Evaluation and Planning Centre for Health Care, London School of Hygiene and Tropical Medicine.
9.
DE KADT, E.
and M. SEGALL [eds.] (1981)"Health needs and services in rural Ghana."Social Sci. and Medicine15A (July): 395-518.
10.
DONABEDIAN, A.
(1966) "Evaluating the quality of medical care."Milbank Memorial Fund Q.44 (July): 166-206.
11.
ESSEX, B. J.
(1976) Diagnostic Pathways in Clinical Medicine: An Epidemiological Approach to Clinical Problems. Edinburgh: Churchill Livingstone.
12.
ESSEX, B. J.
(1975) "Approach to rapid problem solving in clinical medicine."British Medical J.3(July 5): 34-36.
13.
FARUQEE, R.
(1981) "Analyzing the impact of health services: Narangwal and other experiences."Population and Human Resources Division, Discussion Paper No 81-6. Washington: World Bank.
14.
FOWKES, F. R. G.
(1982) "Medical audit cycle: a review of methods and research in clinical practice."Medical Education16 (July): 227-238.
15.
GWATKIN, D. R.
, J. R. WILCOX, and J. O. WRAY (1980) "Can health and nutrition interventions make a difference?"Washington, DC: Overseas Development Council.
16.
HABICHT, J. P.
(1979) "Assurance of quality of provision of primary medical care by non-professionals."Social Sci. and Medicine13B (January): 67-75
17.
HOHNEN, J.
(1982) Assessment of the Use of Standard Management in Health Centres. Mendi, Papua New Guinea: Division of Health, Southern Highlands Province.
18.
HULKA, B. S.
and J. C. CASSEL (1973) "The AAFP-UNC study of the organization, utilization, and assessment of primary medical care."Amer. J. of Public Health63 (June): 494-501.
19.
HULKA, B. S.
, F. J. ROMM, G. R. PARKERSON, I. T. RUSSELL, N. E. CLAPP, and F. S. JOHNSON (1979) "Peer review in ambulatory care: use of explicit criteria and implicit judgments."Medical Care17(March): Supplement.
20.
KESSNER, D. M.
, C. E. KALK, and J. SINGER (1973) "Assessing health quality-the case for tracers."New England J. of Medicine288 (June 25): 184-189.
21.
KIELMAN, A.
and C. McCORD (1977) "Home treatment of childhood diarrhea in Punjab villages."Environmental Child Health23 (August): 197-210.
22.
KING, M.
, F. KING, and S. MONTODIPUERO (1978) Primary Child Care: A Manual for Health Workers. Volumes I and II. Oxford: Oxford Univ. Press.
23.
LENNOX, C. E.
(1979) "Standard treatment: a must but a myth."Papua New Guinea Medical J.22 (June): 140-144.
24.
LITSIOS, S.
(1976) "Developing a cost and outcome evaluation system."Int. J. of Health Services6, 2: 345-360.
25.
MALONE, M. I.
(1980) "The performance of enrolled community nurses in the management of child morbidity at an integrated maternal and child health clinic."East African Medical J.57 (January): 72-23.
26.
NELSON, A. R.
(1976) "Orphan data and the unclosed loop: a dilemma in PSRO and medical audit."New England J. of Medicine295 (September): 617-619.
27.
NEWELL, K.
[ed.] (1975) Health by the People. Geneva: WHO.
28.
Papua New Guinea Paediatric Society
(1981) Standard Treatment for Common Illnesses of Children in Papua New Guinea. A Manual for Nurses, Health Extension Officers and Doctors. 3rd ed.Goroka: Marquell Press Pty. Ltd.
29.
PETIT, P. L.
(1979) Management Schedules for Dispensaries: A Manual for Rural Health Workers. Nairobi, Kenya: African Medical Research Foundation.
30.
REES, P. H.
, L. R. RAGG, D. P. HANSEN, and J. J. THUAU (1978) "Medical care in a tropical national reference and teaching hospital: outline study of cost-effectiveness."British Medical J.ii (July): 102-104.
31.
RUTSTEIN, D. D.
, W. BERENBERG, T. C. CHALMERS, C. G. CHILD, A. P. FISHMAN, and E. B. PERRIN (1976) "Measuring the quality of medical care: a clinical method."New England J. of Medicine294 (March): 582-588.
32.
SCHULL, C. R.
(1980a) Diagnosis and Treatment of Common Health Problems of Adults in Papua New Guinea. Madang: Papua New Guinea Kristen Press Inc.
33.
SCHULL, C. R.
(1980b) Standard Management of Common Medical Problems of Adults in Papua New Guinea. 2nd ed.Madang, Papua New Guinea Kristen Press Inc.
34.
SIMMONDS, S. P.
and G. J. A. WALKER (1982) "Essential drugs for primary-healthstandard care: package."LancetI (February): 435-436.
35.
SOLARSH, G.
, L. M. IRWIG, S. G. REINACH, and E. J. MULLER (1982) "Primary health care nurse training in Kwazulu: an evaluation of diagnostic flow charts versus a conventional training method."South African Medical J.62 (July 17): 100-104.
36.
United Republic of Tanzania
(1978) Primary Health Care: Tanzania Experience. Dar es Salaam, Tanzania: Ministry of Health.
37.
VUORI, H. V.
(1982) Quality of Assurance of Health Services: Concepts and Methodology. Public Health in Europe 16. Copenhagen: WHO.
38.
WALKER, G. J. A.
(1982) "Primary health care activities: what are they?"Tropical Doctor12, 2 (October): 194-196.
39.
WALKER, G. J. A.
(1981) The Health Components: IASER External Evaluation of the World BankSouthern Highlands Rural Development Project. Port Moresby: Paua New Guinea Institute of Applied Social and Economic Research.
40.
WALKER, G. J. A.
and M. K. CHAM (1981) "The need for an integrated approach to the provision of essential health care: a study from the Gambia."J. of Tropical Medicine and Hygiene84, 5 (October): 203-208.
41.
WALKER, G. J. A.
and O. GISH (1977a) "Inequality in the distribution and differential utilisation of health services: a Botswana case study."J. of Tropical Medicine and Hygiene80 (November):238-243.
42.
WALKER, G. J. A.
and O. GISH (1977b) "Mobile health services: a study in cost-effectiveness."Medical Care15, 4 (April): 267-276.
43.
WALT, G.
and J. P. VAUGHAN (1981) "An introduction to the primary health care approach in developing countries." Ross Institute Publication No 13. London: London School of Hygiene and Tropical Medicine.
44.
WATKINS, C. J.
(1981) "The measurement of the quality of general practitioner care." Occasional paper 15. London: The Royal College of General Practitioners.
45.
WERNER, D.
(1979) Where There is No Doctor. A Village Health Care Handbook. London and Basingstoke: Macmillan Press Ltd.
46.
WILLIAMSON, J. W.
, H. R. BAASWELL, and S. D. HORN (1979) "Validity of medical staff judgement in establishing quality assurance priorities."Medical Care17 (April): 331-339.
47.
WOOD, E.
(1982) Community Health Worker's Manual. Nairobi, Kenya: African Medical Research Foundation.
48.
WOOD, E.
(1981) Health Programme Evaluation. Guiding Principles. Geneva: WHO.
49.
World Health Organization
(1980a) The Primary Health Worker. Geneva: WHO.
50.
WOOD, E.
(1980b) "Expanded program on immunization. Module 4: Evaluate achievement of objectives."Atlanta, Georgia: U.S. Department of Health, Education and Welfare.
