It's much easier to tell if a child gets a vaccination than it is to tell if a pregnant woman gets proper prenatal care. The first you can easily observe, and therefore count or measure; the second is trickier. But determining the appropriateness of a health service involves first defining what is considered to be high-quality is and then being able to measure it. There are lots of good ideas about how to do both, but it is not nearly as standardized as measuring number of assisted deliveries or utilization rates at clinics. So it is unsurprising that we are at a moment in global health history when quality questions have surfaced at the top of the agenda and questions about access are perhaps temporarily taking a backseat.

As explained in the DCP2 chapter on quality of care in developing countries, quality is generally broken down into two categories: quality that is perceived by patients and observed quality (also referred to as technical or practice quality). A new series in Health Affairs presents a collection of seven papers that take a deeper look at the latter. An overview article frames the problem of our lack of knowledge about practice quality and defines how to measure it, and six case studies investigate the variation in quality of care in five poor countries. Overwhelmingly, the cases show that there is not only variation in quality between countries, but also within countries. Based on evidence that high technical quality care of care has important positive impacts on health outcomes, this suggests that there is work to be done to improve quality of care in poor countries.

But how? The series asserts that answers lie in improving access to quality, empowering patients through better information, and addressing discrimination. A CGD working group on performance-based incentives is finding that quality - both observed and perceived - can also be improved through financial or other material incentives. If quality is better and more often measured, then individual health workers or facilities can be rewarded for achieving a set of quality targets. Global health movements have proven to be most successful when there is consensus among technical experts. It seems a broad-based consensus on how best to measure healthcare quality in poor countries could go a long way.