This chapter deals with quality control in the virology laboratory, including quality control and quality assurance. It stresses the need to conduct regular audits of the service to maintain quality standards and the need for accredition schemes (e.g. UKAS). Sources of errors in the laboratory and factors associated with technical quality are also discussed.

Despite the rapid advance of technology which has been felt throughout society, the impact on healthcare delivery has taken much longer to be felt. The role of psychiatrists and clinical staff more widely in the design, delivery and development of clinical systems has similarly taken a long time to develop although there has been a significant shift in recent times. The development can be traced through a series of important events including several at national level. There are significant challenges to the current approach to training at all levels, and there remains an urgent need for a well-developed career pathway to make the most of the talent and experience which currently exists whilst providing opportunity for development and support of new staff interested in this work.

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (L&MICs). Improving the quality of health care is complex, yet the health care sector has benefitted from many experiences in other industries and developed its own approaches to quality improvement (QI). It is challenging to identify what works in each situation, make the intended improvements, and ensure it is well measured and sustained. Yet there are several examples from L&MICs that offer a lot of learning and illustrate those factors that underpin successful experiences in QI. This Chapter looks at the evolution of QI in health care over time; the types of health care QI approaches, and their relationship with patient safety and UHC; the opportunities to address the commonly occurring health care quality and safety challenges, as well as what works or does not work in L&MICs.

Private hospitals, clinics, and pharmacies, and the doctors, nurses, and other medical personnel who staff them provide a large portion of healthcare services in low- and middle-income countries (L&MICs). In some, the private sector delivers much more care than the government. Understanding the scale, capacity, quality, constraints and motivations of private providers and private facilities – whether for-profit, non-profit, formal or informal – is critical to assuring that health services and medicines support and expand the goals of access to quality health care for all. This chapter sets out what is known regarding private care provision, from world-class hospitals to unlicensed and untrained village drug-sellers and summarizes the experience and frameworks being applied around the world to measure, regulate, and assure the efficient and effective provision of private health care as part of mixed-health-systems in L&MICs. In many settings the challenges of private sector governance are complicated by limited data, minimal financial transfers, and weak regulatory systems. Despite this, advances have been made in L&MICs to defining and applying good governance strategies.

Issues of education, training, accreditation and standards are increasingly important, and this is reflected in the considerable efforts that have been taken to develop quality, standards and accountability in mediation to enhance process safeguards for commercial parties and professionalise the service. While mediator standards leave some issues unresolved, experience from practice and mediator training should help to clarify statements in codes of conduct on issues of neutrality, impartiality, confidentiality and the use of mediator power. Greater precision should also come from some standards being judicially defined. There are a number of factors for mediators to consider in avoiding liability claims. A carefully drafted mediator liability exclusion clause in an agreement to mediate is important. As many lawyers mediate, it is important that there is a clear distinction between the role of a lawyer and the role of a mediator. Where a judge mediates, private caucus mediation sessions should be avoided and the mediation should be referred to a judge other than the trial judge or to a non-judicial court official to address procedural fairness and bias issues.

This chapter examines the origins and the future role of digitally induced shared learning and, in this context, of micro-credentials as a currency towards earning a degree qualification, possibly in combination with the flexibility where to seek the qualification. We argue that the general trend towards the deinstitutionalization of tertiary education, to be understood as the unbundling and re-bundling of educational services, will help to make digitally based micro-credentials fungible by taking advantage of the so far reluctantly utilized degrees of freedom for accreditation and assessment more liberally. The COVID pandemic is encouraging a merger of the world of theoretically face-to-face programmes, now delivered virtually, and the world of MOOCs and micro-credentials. It will ultimately change the underlying economics of shared learning and will thereby help to make it a core feature of a much more accessible higher education.

Following an overview of Quality Management concepts and the creation of a Quality Management System (QMS) there is a discussion of the principles of Accreditation and Accreditation schemes. The importance of training is emphasized, and the goal-orientated reiterative assessments apporach described, including defining criteria for competence as the endpoint of training. There are also discussion on quality control, measurement uncertainty, test method selection and comparison,laboratory equipment monitoring, and External Quality Assurance (EQA). A section on regulatory aspects includes a comparison between Standards (including the new ISO 23162) and guidelines. A final section describes a framework for validating new test methods.

The chapter describes the training needs of international EMTs and how these might best be met and the training delivered. This is a three-step approach of first completing in country speciality training, then training to adapt that to the austere environment, and finally a full simulated operational deployment to exercise as a team. Immediately prior to a specific deployment additional “just-in-time” training may be required.

In this chapter we investigate how certification and accreditation organizations put much effort in constructing an image of independence for the outside world to see and endorse. It is difficult for an organization to proclaim its own independence; rather, a fundamental way of convincing others of its independence is through entering dependency relationships with other formal organizations that grant the organization independence, like the dubbing of knights. We analyse the character of organizational dependencies with respect to rules, sanctions, hierarchy, monitoring, and membership and conclude that the search for independence result in the addition of elements to elements, driving more and more organization. We discuss how the adding of elements form a complex system of interdependent organizations, which resembles a rational, authoritative Weberian bureaucracy. Although this bureaucratic system may be understood as organization – a decided and systematized order – it is not a discernible entity. It is partial and as such it lacks a central authority to govern and to which an overall responsibility could be ascribed. Paradoxically, the efforts aiming at ensuring independence resulted in the organizations becoming dependent not only on each other, but also on the decided order surrounding them.

Markets and organizations are often contrasted with each other and are sometimes even treated as opposites. But they share at least one characteristic: They are both organized. Many markets have been created by organization, and virtually all markets are organized to a greater or lesser extent; for markets to function according to the normative ideals of economists, a high degree of organization is necessary. In this chapter, the organization of markets is contrasted to other ways by which markets are formed – mutual adaptation among sellers and buyers and institutions. Organization adds substantially to the uncertainty that has been seen as a typical trait of markets. The chapter describes how different combinations of organizational elements are used in different markets. In addition to sellers and buyers, there are two types of market organizers: ‘profiteers’, who organize in order to benefit their own business; and ‘others’, who claim that they organize for the benefit of other people or of everyone. Market organization is the basis for a form of democracy on the global level – a form other than that tied to a formal organization, such as a state.

IUI is often the first intervention offered for unexplained or mild to moderate male infertility and appears to be a safe method to prevent HIV transmission. Pregnancy and delivery rates per cycle remained stable for years. Factors influencing IUI results and studies evaluating if first line IVF rather than IUI could be a better option for couples with unexplained or mild male infertility will be discussed.Increased risks compared to spontaneous conceptions have been described. However, data on comparison with IVF is limited and points to similar or lower perinatal risks. Multiple pregnancies are responsible for most of perinatal morbidities and are dependent on the use and aggressiveness of ovarian stimulation. Cost efficiency appears to be influenced by the indication, associated medications and perinatal complications mainly related to multiple pregnancies. While currently IUI with ovarian stimulation seems cost-effective, further studies are needed to confirm it in settings with advanced ART techniques.