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Table 1 Quality of Care frameworks and components

From: Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives




Donabedian (1988)

- Using medical science and technology to improve health without compromising risk.

- QoC consists of technical care and interpersonal process.

- Structure

- Process

- Outcomes

National Academy of Medicine (formally the Institute of Medicine/IOM) (IOM 2001, Lohr 1990) [82]

“the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

- Safety

- Effectiveness

- Patient-centredness

- Timeliness

- Efficiency

- Equity

World Health Organization (2006) [83]

- Comprehensive whole-health system perspective that focus on outcomes for individuals and communities.

The working definition includes six dimensions.

- Effectiveness

- Efficiency

- Accessibility

- Acceptability

- Equity

- Safety

Hanefeld, Powell-Jackson, and Balabanova (2017)

- Quality is a complex concept.

- Includes both the demand and supply side of health care.

- Clinical quality

- Perceived quality

- Process

- Responsiveness

- Quality as a social construction

Bruce QoC Framework (1990)

- Consists of six elements outlined in a framework. It is both a subjective and outcomes-based concept.

It places an important emphasis on the experience of clients.

- Choice of methods

- Information given to users

- Technical competence

- Interpersonal relations

- Continuity mechanisms

- Appropriate constellation of services.

Bruce-Jain framework revised (2018).

- Revision of the Bruce/Jain QoC Framework with modification to five of the elements originally included. Maintains a human-rights base, client-centred focus.

- Focus on safety of contraceptive products, trained HCPs, and resources.

- Choice of methods

- Information given to users, to be replaced by information exchange that includes follow-up, and switching methods, service provider or outlet

- Technical competence, to include safety.

- Interpersonal relations, to emphasise dignity, respect, privacy, and confidentiality

- Continuity mechanisms – covered under the information element

- Appropriate constellation of services.

NDoH, South Africa

National Core Standards for Health Establishments in South Africa (2011).

- The common definition of QoC is to obtain the best possible results with available resources. To attain the goals of health improvement and responsiveness to the expectations of the population.

- Patient Rights

- Patient safety, clinical governance, & care

- Clinical support services

- Public health

- Leadership & corporate governance

- Operational management

- Facilities & Infrastructure

NDoH, South Africa

National Contraception and Fertility Planning Policy and Service Delivery Guidelines (2012) [13]

- Uses the common definition of QoC as set out in the National Core Standards for Health Establishments in South Africa.

- Management systems

- Accessible and acceptable services

- Rights

- Continuity of care

- Drug management and equipment

- Environment of care and infection control