By John Tingle
The WHO (World Health Organization), the World Bank Group and OECD (Organization for Economic Co-operation and Development) have jointly produced a report which states that poor quality health services are holding back progress on improving health in countries at all income levels.
The report describes the essential role of quality in the delivery of health care services and highlights failings such as inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices, or providers who lack adequate training and expertise.
These failings prevail in all countries. Low quality health care is increasing the burden of illness and health costs globally. The report works from the base premise of the UN (United Nations) Sustainable Development Goals (SDG’s).
The point is made in the report that health quality is fundamentally important to the achievement of UHC:
“But universal health coverage should not be discussed and planned, let alone implemented, without a focus on quality. It is essential to ensure that care is effective, safe, and in keeping with the preference and needs of the people and communities being served. (p.16)”
Poor quality care undermines the very idea of UHC. What is the point of giving people access to a health care system that harms them? Without a quality base UHC can be viewed as just another piece of political rhetoric, almost a waste of time and effort. The report states that quality is not only the prerogative of high income countries. If a country can afford to provide any health care, then that should also be of good quality. Poor quality care provision is a bad investment of scarce resources which could well have been used to fund schools, social services or major building projects such as road creation. The trust of the population in the benefits of modern medicine can also be adversely affected.
The report supports this contention with several facts and figures:
- In high-income countries, one in 10 patients is adversely affected during treatment.
- In high-income countries, seven in 100 hospitalized patients can expect to acquire a health care-associated infection (in developing countries this figure is one in 10).
- Unwarranted variations in health care provision and delivery persist and a considerable proportion of patients do not receive appropriate, evidence-based care.
- Influenza vaccination rates vary across high-income countries from 1% to over 78%.
- Antimicrobial resistance has become a major global public health issue.
- -Globally, the cost associated with medication errors has been estimated at US$ 42 billion annually, not counting lost wages, foregone productivity or health care costs.
- The World Health Organization (WHO) estimates that 303 000 mothers and 2.7 million new born infants die annually around the time of childbirth, and that many more are affected by preventable illness. Further, some 2.6 million babies are stillborn each year.
- Nearly 40% of health care facilities in low- and middle-income countries lack improved water and nearly 20% lack sanitation.
Are health services safe?
The report provides some very useful perspectives on world patient safety and states that patient harm is the fourteenth leading contributor to the global disease burden.
The report gives some figures on adverse health events in low and middle-income countries. The evidence suggests that more than one in three adverse events in these countries occurs in none-complex situations and up to 83% may be preventable.
The report is to be warmly welcomed. It provides what can be viewed as a ground breaking contemporary appraisal of global health systems quality from several very valuable perspectives. The report is authoritative, evidenced based and very well written. It puts the key issues relating to the global quality of health care into a sharp focus and suggests common sense ways of moving forward and setting improvement agendas.