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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

Authors Definition Components
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