Intended for healthcare professionals


Improving the delivery of safe and effective healthcare in low and middle income countries

BMJ 2012; 344 doi: (Published 14 February 2012) Cite this as: BMJ 2012;344:e981
  1. M Rashad Massoud, director1,
  2. Nana Mensah-Abrampah, quality improvement fellow1,
  3. Pierre Barker, senior vice president, low and middle income countries2,
  4. Sheila Leatherman, research professor3,
  5. Edward Kelley, head, strategic programmes and coordinator4,
  6. Bruce Agins, medical director5,
  7. Sylvia Sax, lecturer 6,
  8. James Heiby, medical officer 7
  1. 1USAID Health Care Improvement Project, Bethesda, MD 20814, USA
  2. 2Institute for Healthcare Improvement, Cambridge, MA 02138, USA
  3. 3University of North Carolina, Gillings School of Public Health, NC, USA
  4. 4WHO Patient Safety, Geneva, Switzerland
  5. 5AIDS Institute, New York State Department of Health, New York, USA
  6. 6University of Heidelberg, Heidelberg, Germany
  7. 7United States Agency for International Development, Washington, DC, USA
  1. nmensah{at}

Research is needed into creating workable systems that can deliver and sustain interventions

Many resource constrained countries are unlikely to attain their millennium development goal targets by 2015,1 despite major global efforts and much progress (figure).2 3 For example, only 23 countries are currently estimated to be on track to achieve the target of a 75% reduction in maternal mortality.4 In addition, the rate of new HIV infections continues to outpace the number of HIV positive patients who start treatment—for every five people newly infected with HIV only two begin treatment each year, and about 5.5 million people needing treatment for HIV in low and middle income countries still do not receive it.5 6

Health millennium development goal scorecard for World Health Organization regions. Adapted, with permission, from …

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