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Use of standardised patients for healthcare quality research in low- and middle-income countries
  1. Ada Kwan1,
  2. Benjamin Daniels2,
  3. Sofi Bergkvist3,
  4. Veena Das4,
  5. Madhukar Pai5,
  6. Jishnu Das2,6
  1. 1School of Public Health, University of California Berkeley, Berkeley, California, USA
  2. 2McCourt School of Public Policy and School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
  3. 3ACCESS Health International, New York City, New York, USA
  4. 4Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Department of Epidemiology & Biostatistics, and McGill International TB Centre, McGill University, Montreal, Quebec, Canada
  6. 6Center for Policy Research, Delhi, India
  1. Correspondence to Dr Madhukar Pai; madhukar.pai{at}


The use of standardised patients (SPs)—people recruited from the local community to present the same case to multiple providers in a blinded fashion—is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges. A toolkit and manual for implementing SP studies is included as a companion piece in the online supplement.

  • standardized patients
  • quality of care
  • health care providers

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Seye Abimbola

  • Contributors Conceptualisation: JD. Funding acquisition: MP. Data analysis: AK and BD. Writing and original draft of manuscript: AK and JD. Writing, review and editing of manuscript: AK, SB, BD, JD, VD and MP. Writing of online supplement: AK, SB, BD, JD, VD and MP.

  • Funding This study was funded by Grand Challenges Canada, the Bill and Melinda Gates Foundation (OPP1091843), and the Knowledge for Change Program at the World Bank. MP is a recipient of a Tier 1 Canada Research Chair from Canadian Institutes of Health Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Individual deidentified interaction data, including data dictionaries, will be available. All variables needed to recreate the results reported in this article will be included, as will the code required to reproduce these results. Data will be available indefinitely on publication to anyone who wishes to access the data for any purpose. The data and code can be accessed at: