Quality of care the missing link between coverage of care and health improvements
While coverage of health care has increased considerably since the international community defined its millennium development goals to improve health around the world, health gains remain stubbornly elusive, especially in developing countries, and poor quality of care may be the reason why.
These are the conclusions of leading maternal health scholar Dr. Wendy Graham and her colleagues as they reflect on the global progress in women’s and children’s health in preparation for the global maternal health conference in Arusha, Tanzania this week that brings together 700 delegates and political leaders from around the world.
While the proportion of women and children receiving health care in the poorest countries is increasing, the authors say, improved health outcomes such as falling maternal or newborn deaths “have not matched expectations from the gains in the coverage of care.” A recent Lancet analysis said only 13 countries in the world are expected to reach the millennium development goal (MDG) 5 to improve maternal health, and still an astonishing 300,000 women each year die trying to give birth. And while deaths among children under 5 years of age have declined in the past decade, still 7.2 million children died in 2011.
But focusing on coverage of care to redress these deplorable levels of preventable mortality is inadequate because it says only whether a person receives care, not whether that care was effective, safe, or a good experience for the patient. Quality of care involves examining these questions of effectiveness and appropriateness, and the necessary information to understanding the costs and consequences of delivering health care and improved health, but it has been a neglected area of international research and focus, and regrettably, quality of care “has not achieved the status of a political priority”, Dr Graham and colleagues say.
Last year a DFID report emphasized the importance of quality of care as a tool for achieving the MDGs. DFID estimated the economic and social costs of maternal and newborn mortality to be US$15 billion a year in lost productivity, whereas implementing quality care, including facility-based births and strengthening health systems, in 49 of the world’s poorest and aid dependent countries was said to be US$2.5 billion in 2009, rising to US$5.5 billion in 2015.
Quality of care must become the new priority in global health, Dr. Graham and colleagues say. It requires deliberate focus and investment in better data for measuring quality including adverse events, and the presence or absence of basic infrastructure such as safe water and sanitation in health clinics and hospitals. Understanding quality of care and its relationship to improved health also requires collecting information on women’s owns views about their care, which can differ markedly from how health planners and systems regard quality.