Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e984-e992 (doi:10.1542/peds.2007-1395)

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SPECIAL ARTICLE

Global Initiatives for Improving Hospital Care for Children: State of the Art and Future Prospects

Harry Campbell, MD, FRCP, FRSE^a, Trevor Duke, MD^b, Martin Weber^c, Mike English, MBBChir, MD^d, Susanne Carai, MD^c, Giorgio Tamburlini, MD, PhD^e Pediatric Hospital Improvement Group

^a Public Health Sciences, Institute of Genomics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
^b Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
^c Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
^d Kenya Medical Research Institute, Wellcome Trust Research Programme, Nairobi, Kenya
^e Institute for Child Health IRCCS Burlo Garofolo, Trieste, Italy

Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurses, and other child health workers in many developing countries. This collective experience was brought together in a global World Health Organization meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of pediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale and to support research into their use, impact, and sustainability in different environments.

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Key Words: children • quality of health care

Abbreviations: WHO—World Health Organization • UNICEF—United Nations Children's Fund • IMCI—Integrated Management of Childhood Illness • QI—quality improvement • ICHRC—International Child Health Review Collaboration • ETAT—Emergency Triage Assessment and Treatment • MOH—Ministry of Health • CCP—critical care pathway • PHI—Pediatric Hospital Improvement Initiative

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Accepted Sep 17, 2007.

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