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Guest Post: Embedding quality care into the culture of emerging market health

IFC Guest Post HBI

It is tempting to think of universal health coverage as a quantitative endeavour since, after all, the goal is to bring sustainable and accessible health care to more and more of the planet’s people. But while numbers and quantity matter, the mission is about quality at its heart.

It may seem obvious but health care is meaningless unless it is quality health care. Whether the errors are human, procedural or infrastructural, hospitals and health care providers slip up worldwide, putting their patients, their community’s confidence and their professional reputations at risk.

The struggle is especially acute in lower-to-middle-income countries already grappling with resource constraints and facility limitations. 

This is why we highlight “quality” as the fourth foundational cornerstone — along with affordability, accessibility and ethical governance — essential to the building of emerging-market health systems.

Why is it critical to embed quality in the culture of health systems? A 2018 study of 137 low and middle-income countries found that at least 5 million deaths were due to poor quality services, far more than the 3.6 million deaths attributed to the lack of access to health care*. 

In fact, nearly one in six deaths in these countries can be traced to low-quality health care, and deaths from low-quality care are five times higher than all deaths from HIV/AIDS and three times higher than all deaths from diabetes. Not surprisingly, the vulnerable often suffer the most: The rate of surgical infection is 6.1 percent in low- and middle-income countries, compared to 0.9 percent in the U.S.

Shoddy care may seem like the stuff of daytime soap operas and primetime medical melodramas, but they happen often enough that the World Health Organization has highlighted patient safety as a serious global public health issue. The scope is broad and ranges from errors of omission (like not strapping in or securing a patient before transportation) to mistakes of commission (mislabelling lab samples or administering the wrong drugs).

In the U.S. alone, wrong-site surgery, like operating on the left kidney instead of the right, is said to occur about 40 times a week, with figures harder to find in developing countries but estimated to be higher.

Poor quality health care carries a grave financial burden. The U.S. National Academy of Medicine estimates that low-quality care costs developing nations between $1.4 trillion to $1.6 trillion a year in lost productivity. **

Fortunately, the world is beginning to understand the importance of improving health care quality, and there are resources to help hospitals and clinics in emerging economies take the right steps on the path to quality.

For instance, the Joint Commission International works with global customers to find practical solutions for improving patient safety. The International Finance Corporation, the private sector arm of World Bank Group, has developed a quality tool to help health organisations improve safety and ingrain quality considerations into both their core values and their day-to-day operations. 

The business case for it is strong: Providers with a rigorous focus on quality tend to have better-functioning facilities and often are better positioned to sustain growth, attract investments and engage financial and strategic partners.

Because quality is not merely a checklist but a culture, the IFC tool, for example, is designed to apply 150 internationally recognised standards to emerging market health organisations in eight core areas, namely:

  • international patient safety goals
  • ethics, patient and family rights
  • management and use of medications
  • quality improvement and patient safety
  • infection control
  • governance, leadership and direction
  • facilities management and safety
  • human resources

The standards are broken down into measurable elements that can be self-assessed. This is often followed by an on-site visit with IFC staff, and ensuing reports that let organisations know where they stand and what corrective actions they can take. 

The evidence-based approach is easy to use and time-efficient, allowing collaborative skills transfers between visiting and local staff, and practical action-oriented output to plug the quality gaps commonly found in areas ranging, say, from clinical governance to patient process flow, from infection control to financial management.

After all, improvements in health care isn’t just a matter of improving the delivery of health care. And quality improvements don’t always require expensive equipment upgrades or big staff spending. The important thing is to build quality considerations into every step of the health care system, until the attention to quality becomes integral and inseparable from the care itself.

* “Mortality due to low quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries”, Margaret E Kruk, Anna D Gage, Naima T Joseph, Goodarz Danaei, Sebastián García-Saisó, Joshua A Salomon, Lancet 2018; 392: 2203–12— https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(18)31668-4/fulltext

** National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Global Health; Committee on Improving the Quality of Health Care Globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington (DC): National Academies Press (US); (2018) — http://www.nationalacademies.org/hmd/Reports/2018/crossing-global-quality-chasm-improving-health-care-worldwide.aspx 

Charles Dalton and Raju Narayan are global sector specialists for Health at the International Finance Corporation (IFC), the private sector arm of World Bank Group. 

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