How quality improvement in health care can help to achieve the Millennium Development Goals.

A recent article in The Lancet analysed the barriers to reaching the Millennium Development Goals (MDGs) conc cerning maternal health, child health, tuberculosis, malaria and human immuc nodeficiency virus/acquired immunoc deficiency syndrome (HIV/AIDS).1 Inappropriate provider behaviour, insufficient case management, limited management capacity, and referral and communication failures were identified at the service delivery level; at the policy and strategic management level, insufc ficient coordination between actors, weak links between programmes, and inappropriate use of information were mentioned. Looking at this evidence from a quality improvement angle is particuc larly interesting. The majority of the barriers described by the authors relate to the classic quality dimensions that define a quality service (in both delivery and management): to be effective, efficient, accessible, timely, acceptable, evidencecbased, equitable, safe and clic ent centred. For example, inappropriate provider behaviour often results from a lack of patient orientation, unacceptable and ineffective communication, and the noncapplication of evidencecbased standards. If the majority of barriers to healthcrelated MDGs can be seen as qualitycrelated, quality improvement approaches may be able to tear down some of them. Quality improvement means any process or tool aimed at reducing the quality gap in systemic and organizational functions according to the dimensions of quality. The basic principles of quality improvement are common sense: customer focus, strong leadership, involvement of people, process approach, system approach to management, continual improvement, factual approach to decisioncmaking, and mutually beneficial supplier relac tionships.2 There is evidence that these basic principles can contribute to the improvement of health service delivery