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

Abstract

Universal Health Coverage is one of the Sustainable Development Goal targets. But coverage without quality health services limits benefits to populations. Performance-based financing programs (PBF) use strategic purchasing of services to expand coverage and promote quality by measuring quality and rewarding good performance. The widespread presence of PBF programs in lower and middle-income countries provide an opportunity to introduce and test new approaches for measuring and improving quality at scale. This article describes four approaches to improve quality of health services at scale in PBF programs. These approaches looked at structural and process measures of quality as well as outcome measures like patient satisfaction. Three types of tools were used in these approaches: clinical vignettes, competency tests and patient satisfaction surveys. Specific tools within each of the approaches are used in Kyrgyzstan, Cambodia, Democratic Republic of Congo and the Republic of Congo.

Figure 1

Rapid expansion of performance-based financing programs (PBF) in SSA 2006-2015.

Figure 2

Kyrgyzstan 3-year balanced score card (BSC) results in the three impact evaluation groups.

Figure 3

Republic of Congo: Quality Index in Health Centers increased from 43% to 62% over a one-year period.

Figure 4

: Cambodia results from the first two rounds of ex-ante verification Health Center, Hospital and Health Administration performance (quarter 2, 2017; first wave of scaling up).

Figure 5

Democratic Republic of Congo. Lowest, Average and Maximum Quality Index Scores at Baseline for health centers in the six health districts of Kwango Province, Q3, 2016.