Developing countries need more quality assurance: How health facility surveys can contribute

Quality assurance is a discipline which has developed rapidly over the last decade. This development has, however, been almost entirely concentrated in the United States and Europe. Very few works on quality assurance of health care in developing countries have been published. This article briefly reviews the current literature on this subject, and related work in some international organizations. The Programme for Control of Diarrhoeal Diseases in the World Health Organization (CDD/WHO) has recently produced a manual for a health facility survey, in which the structure and process of caring for children with diarrhoea is assessed. This paper introduces the methodology and summarizes findings from some applications. The health facility survey is directly linked to the needs of national CDD programmes, and provides a useful example of how an instrument for quality assurance in developing countries can be used for identification of problems and their possible solutions. The article concludes that there is a need to develop similar tools for quality assurance of primary health care in developing countries.