Adapted from: Unger J.-P., Marchal B., Green A. Quality standards for health care delivery and management in publicly-oriented health services. Int J Health Planning and Management 2003; 18: S79–S88.

Throughout this book, we have advocated the delivery of CHC. But the expected output of publicly oriented services also needs to be defined. This chapter therefore aims at specifying quality standards for health care delivery and management when the goal is not-for-profit. It argues that there is not one medicine, nor one science for the management of health but two, according to whether their purpose is social or commercial. The proposed criteria may be viewed as a complement to medical ethics (deontology).

Introduction

As early as 1997, an editorial in the British Medical Journal (BMJ) stated a case for a shared code of ethics that might bond all health care stakeholders into a consistent moral framework (Berwick et al., 1997). To elicit comments and discussion the multidisciplinary ‘Tavistock group’ issued five ethical principles that should govern all health care systems (Smith et al., 1999), in essence:

• Health care is a human right.

• The care of individuals is at the centre of health care delivery, within an overall preoccupation for generating the greatest possible health gains for groups and populations.

• The responsibilities of a health care delivery system include the prevention of illness and the alleviation of disability.

• Cooperation between providers and with those served is imperative.

• All individuals and groups providing access or services have a continuing responsibility to help improve its quality.

This paper elaborates these principles further in two directions.