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Crossing the quality chasm in resource-limited settings

Duncan Smith-Rohrberg Maru1238*, Jason Andrews17, Dan Schwarz123, Ryan Schwarz123, Bibhav Acharya14, Astha Ramaiya1, Gregory Karelas1, Ruma Rajbhandari12, Kedar Mate256 and Sona Shilpakar1

Author Affiliations

1 Nyaya Health, Bayalpata Hospital, Ridikot VDC, Achham, Nepal

2 Brigham and Women’s Hospital, Department of Medicine, Boston, MA, USA

3 Children’s Hospital of Boston, Department of Medicine, Boston, MA, USA

4 Department of Psychiatry, University of California San Francisco, School of Medicine, San Francisco, CA, USA

5 Institute for Healthcare Improvement, Cambridge, MA, USA

6 Department of Medicine at Weill Cornell Medical College, New York, NY, USA

7 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

8 Global Health Equity Program Brigham and Women's Hospital and Children's Hospital of Boston, Boston, USA

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Globalization and Health 2012, 8:41  doi:10.1186/1744-8603-8-41

Published: 30 November 2012


Over the last decade, extensive scientific and policy innovations have begun to reduce the “quality chasm” - the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

Resource-limited; Health system; Global health; Quality improvement