What is quality health services?
Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with evidence-based professional knowledge. This definition of quality of care spans promotion, prevention, treatment, rehabilitation and palliation, and implies that quality of care can be measured and continuously improved through the provision of evidence-based care that takes into consideration the needs and preferences of service users – patients, families and communities.
Multiple quality elements have been described over the past decades. There is now clear consensus that quality health services should be:
- effective by providing evidence-based health care services to those who need them;
- safe by avoiding harm to the people for whom the care is intended;
- people-centred by providing care that responds to individual preferences, needs and values, within health services that are organized around the needs of people;
- timely by reducing waiting times and sometimes harmful delays for both those who receive and those who give care;
- equitable by providing the same quality of care regardless of age, sex, gender, race, ethnicity, geographic location, religion, socio-economic status, linguistic or political affiliation;
- integrated by providing care that is coordinated across levels and providers and makes available the full range of health services throughout the life course; and
- efficient by maximizing the benefit of available resources and avoiding waste.
Many of the above domains of quality are intimately related to ethical principles.
Universal health coverage and quality: a global commitment
The overarching aim of UHC is for all people who need health service to receive high- quality care without financial hardship. Quality health services (promotive, preventive, curative, rehabilitative and palliative) is thus embedded within the definition of UHC. Even with increased access to services, health improvements can remain elusive unless those services are of sufficient quality to be effective.
The UN Political Declaration on UHC adopted by world leaders in September 2019 reaffirmed the commitment to progressively cover one billion additional people by 2023 with quality essential health services, with a view to cover all the world’s people by 2030.
Taking action for quality
Quality health services are a product of both the wider health systems environment and the actions of providers and individuals working within the system. WHO, OECD and the World Bank have proposed a series of actions from key constituencies – governments, health systems, citizens and patients, and health workers – that need to work together to achieve the goal of quality health service delivery at the front line.
National strategic direction on quality: National policies and strategies aimed at improving quality of care provide a strong foundation for improving quality across the health system and need to be closely aligned with broader national health policy and planning. At the heart of national quality policy and strategy is a pragmatic package of interventions reflecting the action needed across the health system to shape the system environment, reduce harm, improve clinical care, and engage patients, families and communities. An illustrative list of quality interventions for each of these areas is available for countries to consider.
Quality across the health system: In addition to an enabling policy environment, the provision of quality services requires good governance; a skilled and competent health workforce that is supported and motivated; financing mechanisms that enable and encourage quality care; information systems that continuously monitor and learn to drive better care; medicines, devices and technologies that are available, safe and appropriately regulated; and accessible and well-equipped health care facilities.
High quality primary health care: Primary health care is central to delivering high-quality universal health coverage. The three interrelated pillars of primary health care – empowered people and engaged communities; multisectoral action for health; and health services that prioritize the delivery of high-quality primary care and essential public health functions – all require careful consideration of quality.
Monitoring and evaluation: Quality needs to be continually measured and monitored to drive improvement. This relies on accurate, timely and actionable data. The integration of global and national measurement efforts is critical to ensuring that countries collect data that matters and use that data to transform and improve their service delivery systems. The role, for instance, of adverse event reporting and learning systems is critical in this context.
Sharing and learning: Beyond the measurement of key indicators for improvement, there is a clear need to collect and share lessons and experiences on quality within and across countries for a cross-fertilization and activated learning process. Such knowledge, emerging from countries across all health system levels, must be shared globally and within the local health system.
Quality resilient health systems: Quality and resilience are closely linked concepts. For health systems to be resilient, they require quality health services that are delivered prior to, maintained during, and improved upon following a public health emergency. Quality health services are pivotal during emergencies and serve as the interface between communities and the health system.
Finally, across the world, a fundamental shift in service delivery is needed such that quality services are delivered with compassion, focused on the needs of people and communities, as providing services with compassion has been shown to improve outcomes in several settings.
- The Sustainable Development Goals stress that quality is a key element of universal health coverage (UHC). SDG target 3.8 calls on countries to achieve UHC, including financial risk protection alongside access to quality essential health care services.
- Between 5.7 and 8.4 million deaths are attributed to poor quality care each year in low- and middle-income countries (LMICs), which represents up to 15% of overall deaths in these countries.
- Sixty per cent of deaths in LMICs from conditions requiring health care occur due to poor quality care, whereas the remaining deaths result from non-utilization of the health system.
- Inadequate quality of care imposes costs of US$ 1.4–1.6 trillion each year in lost productivity in LMICs.
- In high-income countries, 1 in 10 patients is harmed while receiving hospital care, and 7 in every 100 hospitalized patients can expect to acquire a health care-associated infection.
- It has been estimated that high quality health systems could prevent 2.5 million deaths from cardiovascular disease, 900 000 deaths from tuberculosis, 1 million newborn deaths and half of all maternal deaths each year.
- Globally, the essential structures for achieving quality care are inadequate: one in 8 health care facilities has no water service, one in 5 has no sanitation service, and one in 6 has no hand hygiene facilities at the points of care.
- An estimated 1.8 billion people, or 24% of the world’s population, live in fragile contexts that are challenged in delivering quality essential health services. A large proportion of preventable maternal, childhood and neonatal deaths occur in these settings.
WHO is working with Member States and partners to ensure that quality of health services is a key component of making UHC a reality.
Specifically, WHO is:
- supporting countries in the development, refinement and implementation of national quality policies and strategies for an integrated approach to quality health services;
- working with partners and a network of countries to learn how to improve the quality of care for maternal, newborn and child health at scale and in a sustainable way;
- developing the technical foundations for improving quality of care in fragile, conflict-affected and vulnerable settings;
- strengthening infection prevention and control (IPC) capacity alongside efforts on water, sanitation and hygiene (WASH), since both are pivotal to quality health services;
- promoting patient safety initiatives to reduce harm to patients in the delivery of quality essential health services;
- spearheading the development of quality of care measurement frameworks, indicators and reporting on progress;
- supporting the sharing of lessons and experiences within and between countries through the WHO Global Learning Laboratory for Quality UHC and by fostering twinning partnerships to improve quality of care; and
- providing support to countries in their work on community engagement for quality, people-centred and resilient health services.