Country experience in organizing for quality: Ecuador.

This article presents an overview of Ecuadors efforts to maintain quality assurance (QA) in the care and delivery of health services. The Ministry of Health (MOH) established the National QA Program (QAP) in March 1996. Most of the efforts have been directed toward 7 of the 21 provinces. QAPs permanent resident advisor has coached teams in implementing QA microprojects. QAP has worked with district level officials in development of action plans and to define basic quality standards. MOH is moving to incorporate QA within a larger health sector reform process. New draft policies include ways to improve quality of care. A coordinator provides supervision and support to pilot projects and will strengthen the integration of QA within health sector reforms. QA pilot projects in Azuay and Bolivar have led to formation of QA teams at provincial hospital and health district levels. The first year of GAP was spent developing capacity by training QA facilitators at the national level. Azuay and Bolivar provinces have held provincial level training in problem solving process improvement strategic planning for quality and standards development. Technical assistance was provided by JHPIEGO to revise national norms and clinical standards for reproductive health (RH). The MOH is piloting a training program in the new RH standards in Cotopaxi province. QAP conducted QA design efforts and development of local quality indicators under a new World Bank funded project. A newsletter was started in 1997 to disseminate QA information and progress reports. QA has been institutionalized within MOH.