Assessing the quality of care in low- and middle-income countries: a rapid review of the landscape of assessment tools.

Abstract

Background: Despite its broad conceptual scope, the Donabedian model (input-process-outcome) remains one of the most widely used frameworks for evaluating quality of care globally. Numerous tools have been developed to operationalise this model, yet no synthesis has focused specifically on those applied in low-resource settings or examined their validity and applicability in real-world settings.

Objective: This study sought to review the landscape of tools used to assess each component of quality of care-according to Donabedian's model-in low- and middle-income countries (LMICs), and to evaluate their reported validity and applicability in routine health system settings.

Method: A rapid review was conducted from June to November 2023. The following databases were searched using English and/or French keywords with no time limitation: Google Scholar and PubMed.

Results: A total of 1451 articles were retrieved from PubMed (n=1164) and Google Scholar (n=287), with an additional 74 articles identified through Google. After title, abstract and full-text screening, 85 studies met the inclusion criteria. The review identified a wide range of tools used to assess quality of care in LMICs, characterised by considerable variation in the aspects of quality of care covered, the types of tools and the assessment techniques applied. These tools were categorised as institutional-such as Services Availability and Readiness Assessment, Demographic and Health Surveys (DHS) and Patient Satisfaction with Nursing Care Quality Questionnaire-or investigator-developed, often tailored to particular contexts. While most tools focused on input and process components, outcome measures-especially objective health outcomes-were under-represented. Gaps were also noted in the reporting of tool validation and cost-effectiveness, with few tools integrated into routine health system practices.

Conclusions: This review highlights the need for context-appropriate, validated and cost-effective tools for assessing quality of care in LMICs. Tools should be user-friendly and embedded within routine monitoring systems to better support continuous quality improvement.