1. 1 Figure 1: Factors affecting the quality of care Impact (change in health status) Quality of Care Supply: health system Demand: expectations and needs

2. 2 High Quality Care Staff motivation Staff competency Adequate resources Appropriate content of care defined Good flow and organization of care Figure 2: Immediate Determinants of High Quality Care Patient responsiveness and compliance with standards

3. 3 High Quality Care Staff motivation Staff competency Adequate resources Appropriate content of care defined Good flow and organization of care Figure 3: QA interventions and their effects on determinants of high quality care Pre-service training Certification Licensing On-going capacity building Build culture of quality: (leadership, focus on client, teamwork, incentives) Accreditation Standards/Norms: (health tech. assessment, evidence-based guidelines) Quality improvement: quality design, process improvement Quality monitoring Define Scope of practice

4. 4 Quality of care Staff motivation Staff competency Adequate resources Adequate content of care defined Good flow and organization of care Figure 4: Health sector reform and its effect on quality of care Human resource mgmt Provider payment systems: incentives level Rationalization of health system: decentralization separation of functions Basic benefit package Improved managerial capacity Regulation Distribution of financial burden: public/private resource generation Resource allocation

5. 5 Staff motivation Figure 5: Interventions to improve staff motivation Human resource mgmt Provider payment systems: incentives level Build culture of quality: (leadership, focus on client, teamwork, incentives) Rationalization of health system: decentralization separation of functions Quality improvement: quality design, process improvement

6. 6 Staff competency Figure 6: Interventions to improve staff competency Human resource mgmt Regulation On-going capacity building Pre-service training Certification Licensing Accreditation

7. 7 Adequate resources Figure 7: Interventions to improve adequacy of resources Human resource mgmt Provider payment systems: incentives level Rationalization of health system: decentralization separation of functions Regulation Distribution of financial burden: public/private resource generation Resource allocation Accreditation

8. 8 Appropriate content of care defined Figure 8: Interventions to improve definition of content of care Basic benefit package Regulation Resource allocation Define Scope of practice Standards/Norms: (health tech. assessment, evidence-based guidelines)

9. 9 Good flow and organization of care Figure 9: Interventions to improve flow and organization of care Improved managerial capacity Quality improvement: quality design, process improvement Quality monitoring