Researchers: Health service quality must be a priority, not an afterthought

Countries need to ensure continuous attention to the quality of their health care services, including during emergencies, contends a new collection of articles launched in the British Medical Journal (BMJ). The authors call for greater investment and political attention to quality issues—not just access—as a cornerstone of universal health coverage.

Disruptions during the early stages of the COVID-19 pandemic show why health service quality must be explicitly addressed within emergency plans and response, authors state. Even when facilities were nominally open, many provided significantly reduced services that often failed to meet patients' needs, impacting both health outcomes and patient trust.

"People not only need access to health care, they need access to health care that is effective, delivered by health workers that are supported in their work and that treat them with respect," said Blerta Maliqi, Unit Head for Quality of Care at the World Health Organization (WHO), and a contributor to the series. "Health systems that deliver quality care continuously learn and adapt. This is fundamental to building resilience and responding to people's needs."

One article, "Prepared Health Systems Provide Quality Care at All Times," cites a 2020 survey of more than 1000 maternal and newborn health workers across 71 countries, which found several common concerns about quality of care during the COVID crisis, such as less family involvement and reduced emotional support for women. In some countries, critical interventions such as fetal monitoring were reduced; in others, women were separated from their newborn babies and/or denied a birth companion of choice.

The paper calls for health systems to ensure quality is included in emergency response plans so as to protect people's health and rights, with a greater commitment to ongoing learning and adaptation. A positive example is cited from Western Cape, South Africa, where regular information flows and virtual learning helped teams address common challenges and mitigate risks.

Improving the ability to consistently provide good quality care—care that is effective, safe, people-centered, timely, equitable, integrated, and efficient—is fundamental to universal health coverage. And yet, every year, an estimated eight million people in low- and middle-income countries die from conditions that would have been treatable with better health care provision. Lapses in quality can also jeopardize trust and deter people from accessing critical health services, with impacts that last for years.

Developed as a collaboration between the BMJ, WHO and the World Bank, the collection explores the emerging priorities and unfinished agenda for improving the quality of care in low and middle-income countries, providing examples from maternal, newborn and child health. Among other topics, the papers consider:

• Engagement of various actors—such as the health workforce, private sector and communities—in delivering quality care
• Measurement of quality of care
• Innovations and solutions that advance quality of care.

To cite an editorial from the series, quality health services are "not a 'nice to have' or a one-off project with a start and end date but must be consistently delivered to everyone, everywhere, starting from primary health services to the highest levels of care."