Using Quality Improvement to Address Healthcare Challenges in Developing Countries

In recent years, the need for improved quality in healthcare has become increasingly clear. This paper demonstrates the specific need for improvement in developing countries and the applicability of quality improvement (QI) to this unique context. Developing countries are still searching for sustainable solutions to a variety of health crises. Inefficiencies in systems still diminish health outcomes and result in needless loss of life. In order to close the gap in performance and bring improved care to patients in the developing world, organizations must increasingly look to QI. QI has been applied in the United States to healthcare and public health settings as a means of identifying areas for improvement and establishing the infrastructure to implement changes. The same methodologies can be applied in developing countries as a sensible means of addressing their healthcare challenges, which are often attributed to system failures rather than lack of available treatments. This paper clarifies how the Model for Improvement, developed by the Associates in Process Improvement, can be simply understood and utilized by QI teams in any context. The Model helps organizations identify what they wish to accomplish, how to identify when a change has resulted in improvement, and what changes can be made. A Plan, Do, Study, Act (PDSA) cycle allows organizations to decide how changes will be implemented and measured; implement the change; analyze the change and its effects; and determine how to move forward based on the results. Project 20,000+ in KwaZulu-Natal (KZN), South Africa, offers a clear example of the applicability of QI and the Model for Improvement to healthcare systems in developing countries and can serve as a model for other organizations. This partnership between the KZN Department of Health, the University of KZN, and the Institute for Healthcare Improvement seeks to improve the program for prevention of mother-to-child transmission (PMTCT) of HIV in the province. With prevalence estimated around 40% and MTCT rates of over 20%, the need for effective change is clear. The project relies on QI teams, guided by trained quality mentors and comprised of local administrators and providers, to identify and implement changes. Thus far, these teams have already seen improvements in delivery of care as well as collection and reporting of data. Though the impact of this partnership on rates of MTCT has yet to be measured, the improvement of intermediate measures warrants the modeling of other QI efforts after this project. Developing countries present unique challenges, but this paper shows that the principles of QI are applicable in this setting. Project 20,000+ has shown that QI can empower providers and administrators and revitalize their commitment to creating positive change. In addition to the work in South Africa, examples from Ghana, Malawi, and Latin America demonstrate the value of QI for addressing a variety of healthcare challenges. Learning from these few examples, other organizations can better understand how QI methods provide the opportunity to generate sustainable improvement and reduce the burden of high morbidity and mortality in the developing world.