“…According to [6]there is a strong relationship between total quality management (TQM) and health services quality improvement (HSQI).However, for these authorsThere is no relationship between demographic factors gender, profession, years of experience, except age with top manager's commitment (TMC), training (T), health services quality improvement (HSQI), qualification with the top manager's commitment (TMC), continuous improvement (CI), training (T), health services quality improvement (HSQI) and job with all study variables. But for [7], fragile states experience, corrupt financial regimes and are influenced by skewed global market systems and reduced equitable market access that decrease food and health security.They outline how the manipulation of free market systems and decreased state capacity not only decrease food and health security but also contribute to state fragility and failure.…”