ABSTRACT
In industrialised countries, quality of care is widely debated in the context of health care reform, and increasingly this is also becoming the case in middle- and low-income countries. The Alma Ata Declaration had a direct influence in developing countries in focusing efforts to improve access to health services at primary health care (PHC) level. Budget implications of policy statements need to be assessed at an early stage so that implementation activities can be programmed into annual work plans of regions and districts. Successful policy implementation requires continuity of resourcing and will not be sustainable on the basis of special funding or one-off budget allocations. Adopting an off-the-shelf package might be evidence of a government’s response to public demand for better services. Quality assurance provides an approach with a great deal of potential for middle- and low-income countries and evidence from Central America and Ghana has demonstrated that it is possible to improve quality within existing resource constraints.
