Over the past 30 years substantial investments have been made to enhance access to basic health services in developing countries. However, there has been relatively little emphasis on the quality of the care. Only few studies have been done to investigate the quality of the services delivered. WHO's targets urge every member state to build effective mechanisms for ensuring quality of patient care. The World Health Assembly has adopted a revised strategy for the 21st century that continues to emphasize availability, accessibility and quality of care.

It has been proved from the experience from the quality assurance projects generated e.g. by USAID in many countries (Niger, Ecuador, Russia, Chile, Jordan, Guatemala) about decade ago that mostly quality can be improved by making changes to healthcare systems without necessarily increasing resources. There are many dimensions to improve the quality. Good guide is found in "Quality Assurance of Health Care in Deveoping Countries"

In 1990's in Tanzania there have been effective efforts to provide standard guidelines of good medical treatment and nursing care. Ministry of Health continues to develop quality service standards and also a client service charterwhere health service principals and core values are pronounced. It is also advised from MOH to regularly and conveniently conduct inspection and supervision visits to all health facilities. The Health Sector Reform in Tanzania focuses especially on the improvement of the quality of the care offered to the clients and the community. In Managed Health Care Programme (MHCP) the Evangelical Lutheran Church of Tanzania (ELCT) has launched the goals for the church health facilities to practice good and holistic clinical and nursing care.

The continuing education built on the basic training and experience of the health worker facilitates to improve the health worker's competence and enables the worker to adapt to changing health needs in the community and changing practices in health care. Improving teamwork and co-ordination will in turn, improve the efficiency and performance of the health system. Quality of support systems including inspection, supervision, provision of essential drugs and medical supplies helps to maintain standards. Infection control committees' responsibility in each health facility is to tackle against infections so that safe care is guaranteed for the patients. Tools in determining surgical and other infection rates can be found in "Monitoring the Quality of Hospital Care". Communication systems are under improvement process as well. In hospital care some areas such as care of critically ill patients is still very much behind. Better transport management is one of WHO's main objective to improve the care of pregnant women and emergency cases.

The quality care research that has been done also shows that health counseling and communication with the patients is constantly quite poor. Evidence of positive health outcomes associated with effective communication is strong. Patient satisfaction, remembrance of received information, following the rules, compliance with therapeutic regimens and appointment keeping as well as improvements in health status e.g. in physiological markers such as blood pressure and blood glucose levels and functional status have all been linked to good service, communication and counseling.