This function includes:

• Promoting the implementation and quality improvement of evaluation systems.
• Promoting the development of standards on the basic characteristics of quality assurance and improvement systems, as well as monitoring providers for compliance with these standards.
• The definition, explanation, and guarantee of the user rights.
• An evaluation system for health technologies that can assist in the health system decision making process and that contributes to improving the quality of the health system as a whole.
• The utilization of scientific methods to evaluate health interventions of various degrees of complexity.
• The implementation of systems to evaluate user satisfaction, and the use of these assessments to improve the quality of health services.

Indicators:

1. Definition of the standards and evaluation for the quality improvement of individual and collective health services.
2. Improvement of user satisfaction with health services.
3. System of technological management and assessment of health technologies to support decision-making in public health.
4. Advisory services and technical support for the sub-national health entities in order to ensure quality of services.

Results EPHF 9: Quality assurance in personal and population-based health services

This function revealed the lowest performance among countries in the Region, with a median of 0.26. The countries presented homogenous results of low to intermediate performance, with the exception of one country that clearly deviated from others in the Region.



Although all indicators performed poorly, indicators 3 (evaluation of health technologies to support decision making in public health) and 2 (improving user satisfaction with health services) obtained the best results. The low performance exhibited by indicator 4 (support to sub-national entities) is probably a consequence of the low overall performance of the function.



The indicators with the greatest variability were the definition of standards for evaluating quality improvement of health services (indicator 1) and support to sub-national entities (indicator 4). Although these indicators represent weaknesses for the entire Region, some countries have made important progress in these areas. While the indicator for improving user satisfaction with health services presented less dispersion, it still remains a critical area for all countries. With respect to indicator 3, one-third of the countries in the Region have not made any developments in this area.

The primary factors determining this function’s performance are:

• Forty-nine percent of the countries have policies for continuous quality improvement of services, 43% adopt quality performance standards, and 27% have measured their progress in these areas. In general, few countries evaluate the quality of health services, and even fewer disseminate the results among the population. Only 22% of the countries have autonomous agencies to accredit and evaluate the quality of health services providers.

• In general, actions were more directed towards evaluating the quality of individual health services rather than collective health services (especially evaluating the processes, and less frequently, the results).

• There is limited development of systematic and periodic strategies at the national level to evaluate user satisfaction with health services (both individual and collective), although countries reported isolated experiences at the intermediate and local levels. Forty-one percent of the countries use their results to enhance the strategies for quality improvement of health services. However, countries acknowledged that results are not used to guide decision making on the matter, and that they are not disseminated to users. In general, most countries do not have mechanisms to guarantee the confidentiality of the information volunteered by users.

• Thirty percent of the countries have agencies responsible for managing technology and supporting decision making on this matter. However, these countries are not successful at supporting decision-making processes with respect to health policies. They are also unsuccessful at making recommendations on the use of technologies to those responsible for health services. The countries acknowledged some progress, although insufficient, in evaluating the safety and efficacy of technologies.

• Corresponding with this function’s low level of implementation, it was observed that the NHA partially supports sub-national entities, especially in evaluating the quality of individual health services.