By Nana A. Mensah Abrampah, Service Delivery and Safety Department, World Health Organization, Geneva; Bejoy Nambiar, Malawi University of Science and Technology; and Lisa Hirschhorn , Northwestern University – as part of the Thematic Working Group (TWG) on Quality for UHC and WHO Global Learning Laboratory (GLL) for quality UHC .
In developing countries, one in 10 hospitalized patients is expected to acquire a hospital-associated infection . In high-income countries, the same statistic applies to adverse related events during treatment. Taking this further, though institutionalized birth deliveries have increased, a high number of complications are reported once a woman is at the point of care. In each of these cases, a closer look confirms the lack of focused attention on the quality of services delivered, a challenge which includes outpatient and community-delivered care as well. Quality of health services is critical to achieving Universal Health Coverage (UHC). The sustainable development goals (SDG) target 3.8 emphasizes the importance of quality essential health care services as central to achieving UHC. While multiple quality domains have been described over decades, there is growing acknowledgment and consensus that quality health services across the world should be effective – providing evidence-based care, safe – avoiding harm to people care is intended for, and people-centred, providing care that responds to the needs and preferences of the individual. Additionally, in order to realize the benefits of quality health care, health services should be timely, equitable, integrated and efficient. Further, in order to provide quality health services, a few system-wide conditions should be in place. Without a skilled health workforce, health financing strategies that aim to improve access, appropriate medical supplies and commodities, committed leaders and health information systems that monitor and action changes, quality of care cannot be improved.
2018, has seen heightened focus on the work of quality in health service delivery. WHO, World Bank and OECD recently released a report on “Delivering quality health services : a global imperative for UHC.” In addition, two major reports on quality are expected late this year, one in September 2018. Each of these reports will describe the pivotal role of quality in service delivery. Each will call on countries to move forward on developing national quality policies and strategies as a means to institutionalize quality of care. Each will highlight the role of disease and technical programmes in moving forward the work on quality. And, each will describe the importance of monitoring, research and learning for improvement.
This blog post aims to generate responses to three questions. Responses from this blog post will feed into a session organized at the Health Systems Research Symposium on “fostering learning for quality Universal Health Coverage”. For those unable to be in Liverpool, this virtual meeting provides an opportunity to share perspectives, reflections and frontline experience. Please use the chat feature below to share your thoughts.
A national quality policy and strategy is an organized effort by a country to promote and plan for improved quality of care. Many countries are moving forward with developing a national quality policy and strategy (NQPS) with a view to improve the overall performance of their health system and improve health outcomes. With this in mind, a key action emerging from the major quality reports is a call to all governments to develop a NQPS. The development of a NQPS can create a culture shift and support providers to deliver and users to demand quality care; bring together multiple quality initiatives in a systematic and organized effort to improve quality of care across the health system; secure high-level commitment and, clarify structures for governance and accountability. Traditionally, policy, strategy and implementation are thought of as a linear process. However, the WHO NQPS Handbook suggests moving to a triangular process where implementation experience drives policy and strategy development (see Figure below). On ground implementation should inform eight key elements captured in the NQPS development process. This includes identifying the national health priorities, developing a local definition of quality, stakeholder mapping and engagement and situational analysis, quality indicators and core measures, health management information systems, improvement methods and interventions, governance and organizational structure.
Questions 1: How can the work on national quality policies and strategies serve to action recommendations from emerging global consensus on quality?
The work on quality recognizes that, it is not the sole responsibility of one entity but rather a culmination of actions by various stakeholders working collaboratively to improve health care quality. This will require the integration of improvement and measurement efforts of disease-specific and population-based programmes. Specifically, this recognizes that countries have made significant strides in improving care in multiple technical areas, for example maternal and child health; infection prevention and control; water, sanitation and hygiene and others. The work on overall quality can serve to gain from these past experiences and contribute to informing these areas further.
Question 2: What is the role of specific technical programmes in advancing integration on quality at the primary care level?
Improving the delivery of quality health services requires careful attention to monitoring and learning. Without measurement and learning, improvement efforts can be wasteful. The Lancet Commission on High Quality Health Systems focuses on how we better define quality, identifying robust measures of health system-wide quality that are feasible, finding entry points for improving improvement across the health systems continuum at all levels and having a citizen perspective of on quality of health care.
Question 3: What are priority technical areas for research and evidence generation needing further exploration and how can these emerging quality reports help accelerate change and learning?
To provide your responses to the three questions posed above, please use the chat function below. Responses to this blog post will feed into a synthesis report developed by the Health Systems Global (HSG) Thematic Working Group (TWG) on Quality for UHC and WHO GLL for quality UHC.