This qualitative research study used a collective case study design to explore quality assurance practices and perceptions within Belize's higher education institutions. Despite the passage of the National Accreditation Council of Belize Act (NACB Act) in 2004, the Council was never established and there remains, to date, no formal external quality assurance system in Belize. This study provides useful information for those policymakers and institutional leaders contemplating a way forward. In-depth interviews were conducted with 17 academic leaders, including 2 presidents, 1 provost, 13 deans, and 1 quality assurance officer, drawn from 10 of the 12 existing local higher education institutions in the country. On-site visits were made to each institution and relevant documents were collected and analyzed. Data collection and analysis focused on concepts of quality, internal quality assurance strategies, perceptions on external quality assurance, and implications for the NACB Act. The findings revealed that institutions and academic leaders conceptualize quality in both traditional (excellence) and contemporary terms (fitness-for-purpose and transformation). Structures and systems for internal quality assurance were found to be lacking; however, some promising practices were also noted. Participants agreed that there is a need for an external quality assurance system, particularly to set minimum standards and control entry into the sector. They described their preference for a locally-based system that is funded primarily by the government, but fully autonomous in its operations. This vision, however, is not in perfect alignment with either the system called for in the NACB Act or the sector's political, social, and economic contexts. The study concludes by recommending a full review of the NACB Act, development of a conceptual framework and comprehensive strategy for quality assurance, and improvements to the internal quality assurance structures and processes within institutions. Recommendations for future research include qualitative and quantitative studies with other groups of stakeholders and with other categories of institutions. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]