Quality Assurance

Last update: June' 2014

 Standard Operating Procedure

 Patient Satisfaction Survey Checklist

 Patient Monitoring Checklist

 Use of Patient Monitoring Checklist

 Quality Assurance Team

   *  Action Plan                       *  Present Status 



Quality of health care has been defined by Roemer and Aguilar (WHO, 1998) as follows:

Proper performance [according to standards] of interventions that are known to be safe, that are affordable to the society in question and that have the ability to produce an impact on mortality, morbidity, disability and malnutrition”.

The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks.  The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits.                                          - Avedis Donabedian, M.D., 1980

The most comprehensive and perhaps the simplest definition of quality is that used by advocates of total quality management:  Doing the right thing right, right away.



At first glance, high-quality health services may appear to be a luxury beyond the budgetary limits of most LDC health systems.  However, improving quality often does not cost, it pays.

Attention to quality is essential to the success of primary health care programs, a fact that

health managers with restricted budgets cannot afford to ignore.

Besides evaluating population coverage and the technological merit of health interventions, health providers must assess the quality of services compared with prescribed standards.

Suppose, for example, that a measles immunization campaign meets its target coverage rates,but close examination reveals that many vaccines were ineffective due to poor cold chain maintenance.  In such a case, the intervention is impact is compromised and resources are wasted.  Similarly for tuberculosis treatment, the initial drug dosages will be ineffective and the advantage of early treatment lost if the quality of counseling is poor and patients default.

When symptoms recur the patient must be treated again, resulting in duplication of care and an increased risk of drug resistance.  In both examples, attention to quality would have helped to reduce waste.

Health care providers and the community are expected to cooperatively assess health needs and to select a cost-effective health care approach.  QA promotes confidence, improves com-munication, and fosters a clearer understanding of community needs and expectations.  If providers do not offer quality services, they will fail to earn the population’s trust, and clients will turn to the health system only when in dire need of curative care.  This scenario is particularly unfortunate in developing countries, where the success of lifesaving preventive care,such as immunization, growth monitoring, family planning, and antenatal care, depends on the willing participation of communities.  Moreover, as primary health care programs adopt cost-recovery strategies, the quality of service must be sufficient to attract the population to the clinic on a fee-for-service basis.

QA efforts also offer health workers an opportunity to excel, thereby increasing their job satisfaction and status in the community.  Severe resource constraints limit the capacity of most developing country health care systems to offer salary increases and professional advancement as rewards for high performance; but these are not always necessary to improve quality.

Very often, quality is a reward by itself.  QA is a systematic approach for conveying the importance of excellence to individuals and teams.  It provides the health team with tools that gauge current performance levels and facilitate continuous improvement.  With the interest and active involvement of the organization’s leadership, health workers can better meet and surpass performance standards, solve problems, and serve their clients’ needs.  Increased health worker satisfaction and motivation start a continuous cycle of improved health care and heightened effectiveness.

QA has the potential to improve primary health care programs without requiring additional supplies, logistical support, or financial and human resources.  In fact, a legitimate QA ob-jective is to maximize effectiveness and efficiency from current systems.  Thus, QA affords donors, governments, health care providers, and communities the chance to realize more benefits from existing investments in health care.


What’s wrong in today’s Health Care?

lAvoidable errors

lUnderutilization of services

lOveruse of services

lVariation in services

lCommunication problems

lLack of Evidence

lDissatisfied clients


What can we do about it?

·        Do nothing

·        Better education and training

·        Policing, Inspection, Punishment

·        Change, Improve, Reward

·        Comprehensive Approach: Quality Assurance


Key Activities in the Development of a Quality Assurance Program

  •  Foster commitment to quality

  •  Conduct a preliminary review of QA-related activities

  • Develop the purpose and vision for the QA effort

  • Determine level and scope of initial QA activities

  • Assign responsibility for QA

  • Allocate resources for QA

  • Develop a written QA plan

  • Strengthen QA skills and critical management systems

  • Disseminate QA activities

  • Manage change




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Present Status:

  Introduction of Quality Assurance Programme

  1. Kustia DH
  2. Manikgong DH
  3. Pabna DH
  4. Coxsbazar DH
  5. Joypurhat DH
  6. Tangail DH
  7. Khulna DH

  Main Challenge of implementation: Ownership of the Service provider , Monitoring , Supervision






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Action Plan: Quality Assurance








Introduction of SOP, Monitoring tool for QA countrywide





















Monitoring & Supervision





















Capacity development of the service provider





















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