Worldwide: Low Quality Healthcare Is Increasing The Burden Of Illness And Health Costs Globally: WHO Report

The World Health Organization (WHO), Organization for Economic Co-operation and Development (OECD) and the World Bank have jointly prepared a report titled "Delivering Quality Health Services – a Global Imperative for Universal Health Coverage1" which was released on July 05, 2018. It shows that poor quality health services are holding back progress on improving health in countries at all income levels. The report highlights that sickness associated with poor quality health care imposes additional expenditure on families and health systems.

The report also shows that quality of care in most countries, particularly low- and middle-income countries, is suboptimal, as is revealed by the following examples.

  1. Adherence to clinical practice guidelines in eight low- and middle-income countries was below 50% in several instances, resulting in low-quality antenatal and child care and deficient family planning. For example, just 28 % of antenatal care, 26% of family planning services and 21% of sick-child care across these countries qualified as 'effective.'
  • The Service Delivery Indicators initiative in seven low- and middle-income countries showed significant variation in provider absenteeism (14.3–44.3%), daily productivity (5.2–17.4 patients), diagnostic accuracy (34–72.2%), and, adherence to clinical guidelines (22–43.8%).
  • A systematic review of 80 studies showed that suboptimal clinical practice is common in both private and public primary health care facilities in several low and middle-income countries.
  • OECD's data from high- and middle-income countries show that 19–53% of women aged 50–69 years did not receive mammography screening, and that 27–73% of older adults (age 65 years and above) did not receive influenza vaccination.

The situation is worst in low and middle-income countries where 10% of hospitalized patients can expect to acquire an infection during their stay, as compared to seven percent in high income countries. This is despite hospital acquired infections being easily avoided through better hygiene, improved infection control practices and appropriate use of antimicrobials. At the same time, one in ten patients is harmed during medical treatment in high income countries.

There has been some progress in improving quality, for example in survival rates for cancer and cardiovascular disease. Even so, the broader economic and social costs of poor quality care, including long-term disability, impairment and lost productivity, are estimated to amount to trillions of dollars each year2.

The report describes the essential role of quality in the delivery of health care services. As nations commit to achieving universal health coverage by 2030, there is a growing acknowledgement that optimal health care cannot be delivered by simply ensuring coexistence of infrastructure, medical supplies and health care providers. Improvement in health care delivery requires a deliberate focus on quality of health services, which involves providing effective, safe, people-centered care that is timely, equitable, integrated and efficient.

Building Quality Mechanisms into the Foundations of Health Care Systems

The report outlines the five foundational elements critical to delivering quality health care services are health care workers; health care facilities; medicines, devices and other technologies; information systems; and financing. To ensure that quality is built into the foundations of systems, governments, policy-makers, health system leaders, patients and clinicians should work together to:

  • ensure a high-quality health workforce;
  • ensure excellence across all health care facilities;
  • ensure safe and effective use of medicines, devices and other technologies;
  • ensure effective use of health information systems;
  • develop financing mechanisms that support continuous quality improvement.

Call for action

The report based on the perspective of OECD, the World Bank and the WHO proposes a way forward for health policy-makers seeking to achieve the goal of access to high-quality, people-centred health services for all. High-level actions are called-for from each of the key constituencies that need to work together with a sense of urgency to enable the promise of the Sustainable Development Goals for better and safer health care to be realized.

  1. All governments should:

    • have a national quality policy and strategy;
    • demonstrate accountability for delivering a safe high-quality service;
    • ensure that reforms driven by the goal of universal health coverage build quality into the foundation of their care systems;
    • ensure that health systems have an infrastructure of information and information technology capable of measuring and reporting the quality of care;
    • close the gap between actual and achievable performance in quality;
    • strengthen the partnerships between health providers and health users that drive quality in care;
    • establish and sustain a professional healthcare workforce with the capacity and capability to meet the demands and needs of the population for high-quality care;
    • purchase, fund and commission based on the principle of value;
    • finance quality improvement research.
  2. All health systems should:

    • implement evidence-based interventions that demonstrate improvement;
    • benchmark against similar systems that are delivering best performance;
    • ensure that all people with a chronic disease are enabled to minimize its impact on the quality of their lives;
    • promote the culture systems and practices that will reduce harm to patients;
    • build resilience to enable prevention, detection and response to health security threats through focused attention on quality;
    • put in place the infrastructure for learning;
    • provide technical assistance and knowledge management for improvement.
  3. All citizens and patients should:

    • be empowered to actively engage in care to optimize their health status;
    • play a leading role in the design of new models of care to meet the needs of the local community;
    • be informed that it is their right to have access to care that meets achievable modern standards of quality;
    • receive support, information and skills to manage their own long-term conditions.
  4. All health care workers should:

    • participate in quality measurement and improvement with their patients;
    • embrace and practice philosophy of teamwork;
    • see patients as partners in the delivery of care;
    • commit themselves to providing and using data to demonstrate the effectiveness and safety of the care.

Note- While no single actor will be able to effect all these changes, an integrated approach wherein different actors work together to achieve their part will have a demonstrable effect on the quality of health care services around the world.




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