Journal Article

Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study

Jeffrey Braithwaite, Charles D. Shaw, Max Moldovan, David Greenfield, Reece Hinchcliff, Virginia Mumford, Marie Brunn Kristensen, Johanna Westbrook, Wendy Nicklin, Triona Fortune and Stuart Whittaker

in International Journal for Quality in Health Care

Published on behalf of International Society for Quality in Health Care

Volume 24, issue 6, pages 568-577
Published in print December 2012 | ISSN: 1353-4505
Published online October 2012 | e-ISSN: 1464-3677 | DOI:
Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study

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The study aim was twofold: to investigate and describe the organizational attributes of accreditation programmes in low- and middle-income countries (LMICs) to determine how or to what extent these differ from those in higher-income countries (HICs) and to identify contextual factors that sustain or are barriers to their survival.


Web-based questionnaire survey.


National healthcare accreditation providers and those offering international services. In total, 44 accreditation agencies completed the survey.

Main outcome measure(s)

Income distinctions, accreditation programme features, organizational attributes and cross-national divergence.


Accreditation programmes of LMICs exhibit similar characteristics to those of HICs. The consistent model of accreditation worldwide, centres on promoting improvements, applying standards and providing feedback. Where they do differ, the divergence is over specialized features rather than the general logic. LMICs were less likely than HICs to include an evaluation component to programmes, more likely to have certification processes for trainee surveyors and more likely to make decisions on the accreditation status based on a formulaic, mathematically oriented approach. Accreditation programme sustainability, irrespective of country characteristics, is influenced by ongoing policy support from government, a sufficient large healthcare market size, stable programme funding, diverse incentives to encourage participation in accreditation by Health Care Organizations as well as the continual refinement and improvement in accreditation agency operations and programme delivery.


Understanding the similarities, differences and factors that sustain accreditation programmes in LMICs, and HICs, can be applied to benefit programmes around the world. A flourishing accreditation programme is one element of the institutional basis for high-quality health care.

Keywords: low- and middle-income countries; higher income countries; accreditation; healthcare standards; political circumstances

Journal Article.  4298 words.  Illustrated.

Subjects: Public Health and Epidemiology

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