Design and implementation of a program quality assessment tool : three case studies of primary health services in developing countries

The total service quality paradigm has been slow in diffusing to the health service domain, and TQM techniques are even less widely used to govern primary health services in the developing world. This interdisciplinary work analyzes the design of a TQM-based quality assessment tool (PQAT) used to evaluate quality of care in family planning programmes in Africa, Asia, and the South Pacific. It shows how family planning service quality models have failed to keep pace with advances in management theory, introduces the process theory model to overcome the limitations of the variance model, and grounds the tool in the context of quality theory. The paper goes on to report results from field use of the PQAT in three widely varying sites in the Asia Pacific region, and to draw useful conclusions for primary health researchers and practitioners.