Quality agencies at the global level: characteristics and functions—a narrative review

To provide a comparative description of the structure, function and activities of quality agencies around the world and describe the published evidence of their impact on the health system. A narrative review was conducted using the information found on websites, articles, books and gray literature in English and Spanish. The search process included three complementary approaches: (i) websites of agencies, ministries of health and quality-related official institutions; (ii) evaluations, reports, audits or documents regarding quality agencies; and (iii) scientific articles and gray literature found (key word: quality agency) using Ebsco databases. Information was completed using the 'snowball' technique, tracking internet materials and citing literature of reviewed documents. The analytical framework to summarize the information included the agencies' mission, structures, target institutions, activities (following a six-domain model), funding, information management and impact evaluations. Information was found regarding quality agencies in 62 countries. Those focusing mainly on accreditation were discarded for further analysis. Agencies with a broader focus, according to the six-domain model for quality improvement (QI) strategies, were found in nine countries. Information resulted very heterogeneous in form and substance. However, they share the function of strengthening and advising on 'public goods', through information, knowledge management and development of standards. No impact evaluations of any type were found. The characteristics of existing quality agencies are very heterogeneous, being accreditation the main common focus. There is a lack of both a comprehensive approach to QI strategies and a formal assessment of their impact or contribution for improving quality.