24 September 2019
Quality does not occur spontaneously. Moves towards UHC are increasingly placing quality considerations at its heart. Countries need to set their national direction for quality health services and then take the necessary action at all levels – with a focus on primary health care – to make quality a reality for people. It is here that the power of partnerships can shine through.
In 2018, three publications significantly increased knowledge on quality of health services. The joint WHO, World Bank and OECD publication; the USA National Academies of Sciences report; and the Lancet Global Health Commission all covered aspects of quality in the context of UHC. All called for quality to be a core UHC consideration, with attention to national direction setting at the same time as front-line health services.
The Lancet Global Health Commission indicated that 8.6 million deaths per year (UI 8.5-88) in 137 low and middle-income countries are due to inadequate access to quality care. Of these, 3.6 million (UI 3.5-3.7) are people who did not access the health system. 5 million (UI 4.9-5.2) of these deaths are people who sought care but received poor quality care.
On publication of all three reports, the WHO Director-General could not have said it in simpler terms – “without quality, UHC remains an empty promise. Even with increased access to services, health improvements can remain elusive unless those services are of sufficient quality to be effective.” The case for quality could not be stronger.
But what is quality?
There is a commonly shared understanding that quality services are: effective, providing evidence-based healthcare services to those who need them; safe, avoiding harm to people for whom the care is intended; and people-centred, providing care that responds to individual preferences, needs and values.
In addition, to realise the benefits of quality health care, health services must be: timely, reducing waiting times and delays for both those who receive and those who give care; equitable, providing care that does not vary in quality on account of age, sex, gender, race, ethnicity, geographic location, religion, socioeconomic status, linguistic or political affiliation; integrated, providing care that is coordinated across levels and providers and makes available the full range of health services throughout the life course; and efficient, maximizing available resources and avoiding waste. The interlinkages between these multiple domains are of course complex. The common destination to consider is the point of care for the person.
Nothing however succeeds just as a concept; it is action that is required to create, and maintain, quality at the front line of health services and across the health system. Lives depend on it. Global solidarity between health workers around quality essential health services – harnessed through institutional health partnerships – has the potential to light the spark required for a quality revolution.