Country report. The road to institutionalizing quality assurance in Ecuador in an environment of health sector reform

Autor: Jorge Hermida
Rok vydání: 1999
Předmět:
Zdroj: International Journal for Quality in Health Care. 11:447-450
ISSN: 1464-3677
1353-4505
DOI: 10.1093/intqhc/11.5.447
Popis: Bethesda, USA, to initiate activities aimed at improving Ecuador’s healthcare system clinical case management of cholera and acute diarrhea in two small rural areas of the Pacific coast. Until 1995, QAP Ecuador has around 12 500 000 inhabitants, an infant morworked with physicians and nurses of rural health centers tality rate of 20.4 per thousand live births and a maternal and one hospital in those areas applying focused quality mortality rate of 159 per 100 000 live births. The proportion assurance tools. Using direct observation, checklists, clinical of the population without access to potable water is 42.9%; records review, and provider and patient interviews, QA without an indoor drainage system, 60.4%; and without teams identified gaps between ideal clinical performance electricity, 21.2%. The principal causes of infant mortality are according to the MOH’s national standards and the actual perinatal respiratory conditions, prematurity, pneumonia and clinical practice in health centers and the hospital. Numerous acute diarrhea [1,2]. problems were identified, for example, the overuse of intraThe delivery of health care in Ecuador is fragmented into venous solutions and insufficient use of oral rehydration salts. five different institutions: the Ministry of Health (MOH), the QA teams applied fishbone diagrams for cause analysis and Social Security Institute (SSI), non-profit non-governmental designed and implemented intervention plans to address main organizations, private health care clinics and hospitals, and causes. Although it was not feasible to implement a structured military facilities. Each of them provides care to a different monitoring system, preand post-intervention measurements portion of the population. According to recent national were taken, permitting documentation of significant imestimates, the MOH, with 122 hospitals, 6694 beds and 1535 provements in compliance with clinical norms and cost ambulatory facilities, reaches 30% of the population, mainly reductions attributable to a more rational use of drugs [5,6]. the poorest. The SSI follows, covering 20%, and the private sector, 15%. More than 25% of the population lack access to any form of health care services; only 26% have some form of insurance [3]. The MOH upgrades QA to a national The percentage of the government budget allocated to program health care for 1995 was 4.4% of the overall budget. Total public expenditures on health care were equal to 0.75% of These initial results drew the attention of national MOH the gross domestic product (GDP) [4]. authorities who had been struggling for years with the issue of how to improve performance with very limited possibilities of budget increases. After a period of planning and discussion, The evolution of quality assurance in early 1996 the Minister of Health issued an official decree creating the National Program for Quality Improvement of activities in the MOH in Ecuador Health Services (NPQI). Led by a coordination committee composed of the directors of the main MOH divisions, the Quality Assurance (QA) activities began with a focus on a specific priority program. In 1994, the MOH of Ecuador NPQI trained a cadre of 15 facilitators, who embarked on promoting and providing technical assistance to QA teams requested technical assistance from the Quality Assurance Project (QAP) of University Research Corporation in in hospitals and health districts selected by the MOH. Between
Databáze: OpenAIRE
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