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Comparison of health service accreditation in low- and middle-income countries with those in higher income countries: a cross sectional study


Braithwaite, J and Shaw, C and Moldovan, M and Greenfield, D and Hinchcliff, R and Mumford, V and Kristensen, M and Westbrook, J and Nicklin, W and Fortune, T and Whittaker, S, Comparison of health service accreditation in low- and middle-income countries with those in higher income countries: a cross sectional study, International Journal for Quality in Health Care, 24, (6) pp. 568-577. ISSN 1353-4505 (2012) [Refereed Article]

Copyright Statement

Copyright The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

DOI: doi:10.1093/intqhc/mzs064


OBJECTIVE: The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival. DESIGN: Web-based questionnaire survey. PARTICIPANTS: National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey. MAIN OUTCOME MEASURE(S): Income distinctions, accreditation programme features, organizational attributes and cross-national divergence. RESULTS: Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the divergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, diverse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery. CONCLUSIONS: Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.

Item Details

Item Type:Refereed Article
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Greenfield, D (Professor David Greenfield)
ID Code:110963
Year Published:2012
Web of Science® Times Cited:38
Deposited By:TSBE
Deposited On:2016-08-24
Last Modified:2017-11-06

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