There are many definitions of quality in health care but the following provides a useful starting point.

• Doing the right thing in the right way at the right time
• Doing the best with the resources available

The delivery of quality health services is central to improving the health status of the population and results in decreased case fatality rates and complication rates. Efforts to improve quality are particularly relevant in resource-constrained settings. Furthermore, satisfied patients and clients are more likely to follow advice and prescribed treatments. This becomes increasingly important in situations where the prescribed therapy is complex – as in the case of HIV treatment – and in settings where clients have to pay for services.

Initial attempts to improve quality often took place on an ad hoc basis or were linked to vertical programmes. Early experience showed that it is relatively easy to improve structural and organisational aspects of quality of care, tackling technical quality including supervision and staff-patient interaction is more difficult – particularly in chronically underfunded health systems.

In recent years countries have begun to introduce comprehensive, continuous quality monitoring mechanisms. Quality Assurance Models or Total Quality Management Tools are increasingly used to assist organisations, such as hospitals to look at all aspects of performance and quality of services. These models explore the inputs, processes and outcomes of the health care system, and seek to involve all departments/sub-systems and every health care worker in ongoing processes of quality improvement.

The World Health Organisation has an important role in safeguarding quality in technical aspects, setting standards and ensuring patient safety. WHO develops guidelines and best practice recommendations based upon regional working contexts which Ministries of Health around the world can refer to for guidance. Furthermore, it has a mandate to “develop, establish and promote international standards with respect to food, biological, pharmaceutical and similar products” (Article 2, WHO Constitution). Their advisory role covers also environmental health, for example, with regards to water and air quality and contamination levels.

Introduction: STI, Quality of care in resource-constrained settings