Quality problem or issue
There are record-setting numbers of people living in settings of extreme adversity and they continue to increase each year.
Initial assessment
There is a paucity of validated data on quality and safety across settings of extreme adversity.
Choice of solution
This paper argues for an action framework to address the unique challenges of providing quality in extreme adversity.
Implementation
We describe a preliminary Quality in Extreme Adversity framework which has been informed by—and will continue to be validated through—literature, data collection, WHO expert consultations and through working in settings of extreme adversity with national authorities and NGOs.
Lessons learned
Poor quality care costs lives, livelihoods and trust in health services. The recommended framework, based on evidence and experiential lessons, intends to address the WHO goal for 2019–2023 of ‘one billion people better protected from health emergencies’ (9).
Quality issue: Improving quality of care has become a global health priority to improve health outcomes and strengthen health systems, particularly in the context of achieving universal health coverage. Initial assessment: The delivery of quality essential health services in settings of extreme adversity, such as fragile, conflict-affected, vulnerable or disaster contexts, has been identified as a high priority globally to address the massive level of need. Choice of solution: This paper provides an action framework to systematically address the quality of health services for state and non-state actors working in such settings. The framework is designed to be practical, comprehensible and simple in adoption and implementation. It describes challenges, a set of medical needs and population priorities, a menu of quality-related interventions, and a hierarchy of health system levels defining the roles and responsibilities of key actors. Conclusion: Optimizing the use of limited resources in delivering the best quality possible in ‘the hardest of the hard settings’ is imperative.
Quality problem or issue
Armed conflicts pose significant challenges to ensuring timely access to quality health care services for millions around the world.
Initial assessment
Ensuring access and basic infrastructure for conflict-affected populations are overlooked in the global movement to provide quality of care.
Choice of solution
This paper identifies strategies and interventions to improve access to good quality care in settings and communities afflicted by conflict.
Lessons learned
t is crucial to focus more attention on, and develop an evidence base for, ensuring access and basic infrastructure to improve quality of care in conflict-affected regions.
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