Quality of care: measuring a neglected driver of improved health

Abstract

The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.

Quality of nursing care in a maternal intensive care unit

“…(5) Un modelo renombrado para evaluar la calidad de la asistencia en los servicios de salud toma en consideración los presupuestos de Donabedian, el cual comprende tres dimensiones de calidad de atención: estructura (infraestructura de instalaciones, gestión y personal), proceso (calidad clínica-técnica y experiencia del paciente) y resultados (satisfacción del paciente y resultados favorables de salud). (4) Para esta evaluación en enfermería, Haddad (6) propuso un instrumento que evalúa la estructura, el proceso y el resultado, dejando disponible con ese itinerario una evaluación de la realidad del servicio ofrecido al paciente en relación a la asistencia de enfermería, de forma integral. Tales resultados evidencian la realidad del servicio y proporcionan ayudas para planificaciones más orientadas con el objetivo de mejorar y perfeccionar la calidad de la asistencia.…”

“…Ante este paradigma, se cuestiona la calidad de la asistencia de salud que las gestantes y puérperas están recibiendo, especialmente cuando se piensa en la precariedad del cuidado como probable contribuyente para la no reducción de la mortalidad materna en el país. (3,4)…”

Positioning family planning quality within health financing for UHC: Connecting the discourse

“…While some lower-and middle-income countries (LMICs) have achieved UHC, they have not achieved effective coverage. 1 In Mexico, for example, where substantial progress toward UHC has been achieved over time, effective or quality-corrected coverage of health services remains relatively low and uneven across states (Lozano et al, 2006, in Akachia and Kruk, 2017).…”

“…While quality is integral to UHC, its measurement is 'inadequate to the task' (Akachia and Kruk, 2017). Ideally structure, process and outcomes measures, as defined by Donabedian's theory of quality (1988), would be tracked and linked.…”

Universal Health Coverage and Essential Packages of Care

“…Variations in observed clinical practice suggest that differential benefits from health care are likely within and between populations. Unfortunately, the quality of health services in LMICs is an understudied topic and is generally not considered in economic evaluations (Akachi and Kruk 2017;Kruk and others 2017). In the assessments presented in annex 3F, the authors have attempted to account for potential realworld reductions in value-for-money caused by low quality of care, particularly for complex and longitudinal services in low-income countries.…”