• quality of care
• quality methods
• developing countries

Quality methods used in health care have been developed in Western health systems. Here there is a growing awareness of the waste and risks caused by problems rooted in systems of care which are not well organised. Governments and others are making resources available to address these problems, and this is being seen as a necessary investment to save money and unnecessary patient suffering. In contrast, in lower income countries the development and quality of health services is severely limited by lack of resources and knowledge about quality methods.

Despite these differences, however, lower income countries increasingly recognise the value of quality methods and the need to raise the quality of their services. Many are making more use of quality methods, but the traffic is not one way—the West can also learn from their experiences of improving quality and safety. It is worth remembering that quality methods were first developed and put into widespread use in Japan after the Second World War—a country with few resources—and then re-imported into the West. This editorial considers some of the challenges in applying and adapting quality methods in these countries, as well as the potential for testing and developing more cost effective methods, some of which may be valuable for Western health care.

There are severe limitations to health care in most developing countries. One perhaps extreme example from a current programme in a low income Arabic country is presented here. The average spend on public health care per head of population is $6 a year, and it is falling every year. Although there are many health facilities, the services are unevenly distributed and there is a lack of many essential drugs (despite various programmes to solve this …