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Quality of Health Services & Products in Low Income Countries Workshop
September 5-6, 2014World Bank Headquarters, Washington, D.C., USA
Leading researchers in the field of quality of care were invited to discuss alternative ways to measure quality of care and health products, emerging patterns of variation in the data measurement, and evidence on what works.

Agenda: PDF

The one and half-day event was jointly organized by the World Bank’s Development Research Group and the Strategic Impact Evaluation Fund. Leading researchers in the field of quality of care were invited to discuss alternative ways to measure quality of care and health products, emerging patterns of variation in the data measurement, and evidence on what works.

As access to health care has improved for populations around the world, global discussions are increasingly centered on quality of care received by patients from low income countries. Administrative data, typically used in high-income countries to measure quality of care, is scarce in low-income countries. Hence, researchers have experimented with novel field-measurement of quality of health products and services in low-income countries. These include studies that systematically count the number health care providers (e.g. Cambodia and India); test drug samples for active pharmaceutical ingredients to determine their quality; and send trained surveyors to act as patients and test the knowledge of the health care provider that serves them. 

Some of these measurements are now being scaled-up to the national level and new initiatives (e.g. Service Delivery Indicators, World Bank) have started implementing them in multiple countries.

 

During the first day of the event, speakers presented their research, followed in the course of the second day by brief discussions around future directions for research in this area. A brief synopsis of each session is provided in the text below:

A Systematic Review of Strategies to Improve Health Care Provider Performance in Low and Middle Income Countries

Providers play an essential role in the delivery of care, but their performance is often inadequate. This session summarized a systematic review of 829 studies published before 2007 about the effectiveness of strategies designed to improve provider performance with the goal of providing evidence-based guidance on how health system investments can improve performance.

Quality of Care Measurement in Health Pay-for-Performance Pilot Programs

In recent years, there has been a marked increase in health system pilot programs that include a pay-for-performance dimension implemented at a primary clinic level. This session reviewed how quality of care is measured and incentivized through a Balanced Scorecard approach and provided examples of quality of care measurement instruments (e.g. video vignettes, simulations of pregnancy complications) by using two evaluations conducted in Burkina Faso and Kyrgyzstan.

Quality of Drugs in Low-Income Countries

The proliferation of sub-standard pharmaceutical products and the overuse of antibiotics are significant global health challenges today. Two research papers were presented. The first looked at the quality of drugs manufactured in India but marketed globally, while the second looked at the rise of antimicrobial resistance and its association with out-of-pocket payments. Both papers suggest an increasing role for country and global regulation and diligence around the trade of pharmaceutical products and their use in patient populations.

Quality of Primary Care

Since the Alma-Ata declaration of 1978, countries have widely expanded access to primary care. Yet, even as access has expanded, the quality of primary care remains a significant challenge. Part of the problem is that measuring quality in primary care is difficult. Traditionally, measures of quality have been restricted to measures of infrastructure and the availability of drugs, but it is increasingly recognized that such measures are very weak proxies for the quality of the interaction between the health care provider and the patient. The papers in this session used novel quality of care measurements in India, China, Nigeria, Tanzania and Cambodia, presented new evidence on patterns of practice-quality variation and conducted experiments to improve the quality of care. 

The event was jointly organized by the World Bank’s Development Research Group and the Strategic Impact Evaluation Fund in collaboration with London School of Hygiene and Tropical Medicine (LSHTM), Center of Disease Control (CDC), University of Maryland, Stanford University, John Hopkins University, Duke University and University of California, San Diego (UCSD).

The material presented during each session can be found below:

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Day 1

Day 2

Additional Materials

Event Details
  • Date: 5-6 September, 2014
  • Venue: World Bank Group Headquarters, Washington, D.C., USA
  • CONTACT: Diana Pirjol, dpirjol@worldbank.org
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