PLoS Medicine
(Accessed 17 April 2011)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

The Quality of Medical Care in Low-Income Countries: From Providers to Markets

Jishnu Das Perspective, published 12 Apr 2011
doi:10.1371/journal.pmed.1000432

[Initial paragraphs]
It is widely believed that people in low- and middle-income countries (LMICs) are in poor health because they cannot reach medical services on time. Predicated on this belief, much of global health policy focuses on the physical provision of goods (clinics, equipment, and medicine) and getting doctors to “underserved” rural areas. Yet, recent evidence shows high utilization rates, even among the poor [1],[2].

While problems of access are certainly salient for particular disadvantaged populations, quality is likely the constraining factor for the majority.

The excellent systematic review in this week’s PLoS Medicine by Paul Garner and colleagues [3] focuses discussion on this critical issue. Their finding of poor quality in both the public and private sectors along different dimensions (competence is similar in both, but the private sector is more patient centered) brings much needed evidence to an ongoing debate. The review reflects a logical initial focus in the literature on individual providers rather than the interactions between providers; going forward, broadening the discussion on quality to health care markets can generate valuable insights for policy.