Whatever Happened to Quality of Care?

The quality of health services is a key dimension of universal health care

Oscar F. Picazo, second from the left, takes part in the international panel on high quality health systems held at the Radisson Blu Hotel in Sandton, South Africa on December 13, 2017 (Photo courtesy of HQSScomission)

Global discussions on the achievement of universal health care (UHC) has focused on three dimensions: broadening population coverage, expanding the breadth or health benefits and services, and increasing financial protection (or reducing out-of-pocket spending of households). While these three dimensions are important, and indeed have been enshrined in the UHC cube, one key dimension appears to have been relegated to the background: the quality of health services.

Cognizant of the importance of quality, The Lancet (the medical journal), in coordination with the Harvard School of Public Health, has organized a Global Health Commission on High Quality Health Systems (or HQSS, in short). The Global Commission has 30 representatives while six national commissions have been organized including one in the Philippines, of which I am the co-chair.

From December 12 to 14, 2017, the HQSS held a three-day meeting to highlight the importance of quality of health services and bring it back to the global policy agenda. Why is quality important? One, because unless quality services are provided, then achievements in population coverage, breadth of services, and financial protection will be for nothing. Quality cannot be assumed away; it needs to be measured. In health services, as in other social services, if it is not measured, it is not done. If it is not monitored, it is not achieved.

Two, quality cannot be an afterthought. It needs to be planned for and embedded in the actions of service providers and the decisions of program managers and fund-holders. Poor quality is extremely expensive. Think of hospital readmission and nosocomial infections. Bad quality is also dangerous. Think of Dengvaxia vaccines which were offered to Filipino children in three regions before all the necessary tests have been done.

Three, good quality buys people’s loyalty in the health system. Unless people can experience quality, they leave a health facility and may never come back. They may also resort to more expensive and less effective alternatives outside the formal health system. Quality also builds trust. It contributes significantly to social capital. Governments can be overthrown by poor quality of social services. Good quality is good politics.



About the Author
Mr. Oscar F. Picazo is a retired specialist in health systems, health economics, and social policy. He has worked in 24 countries for the World Bank, the United States Agency for International Development (USAID), and as an independent consultant. He returned to the Philippines in 2009 and became a senior research consultant for the Philippine Institute of Development Studies.
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