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It is estimated that the number of deaths due to poor quality health care is five times higher than annual deaths from HIV / AIDS worldwide – and three times more than deaths from diabetes.
This represents 5 million deaths per year in 137 low- and middle-income countries due to poor quality of care, and 3.6 million additional lives due to lack of access to care, according to the first study to quantify the burden of poor quality health systems worldwide.
The results come from a new analysis published in The lancetin the framework of the World Health Commission on High Quality Health Systems. The commission was a two-year project that brought together 30 academics, policy makers, and health system experts from 18 countries to examine how to measure and improve the quality of the health system worldwide. Its final report was published in The Lancet Global Health.
"As efforts to expand universal health coverage continue to drive the global health agenda, these numbers remind us that the quality of health systems must be a priority," said Joshua Salomon, professor of medicine. and member of the Stanford Health Policy Commission. , and lead author on The lancet study.
"Growing access to health care continues to be critically important, but we find that there is also a tremendous opportunity to better care for those who already have access to the health care system. health."
To quantify the burden of poor quality health care, the authors analyzed data on 61 different health problems and calculated the "excess mortality" observed in patients in low- and middle-income countries, namely the additional risk of death. in these countries. relative risks in high-income countries with strong health systems. Of the 5 million deaths due to poor quality care, 1.9 million, or nearly 40%, were recorded in the South Asia region, which includes India, Pakistan and Afghanistan. .
In a detailed report on its findings and general recommendations, the Committee noted systematic deficits in the quality of care in a number of countries, across a range of health problems and in primary and hospital care. These included:
- The more than 8 million excess deaths from poor health care systems resulted in losses of economic well-being of $ 6 trillion in 2015 alone.
- Poor quality is one of the leading health-related mortality factors in all conditions in low- and middle-income countries, including 84% of cardiovascular deaths, 81% of vaccine-preventable diseases, 61% neonatal diseases. road accidents, tuberculosis, HIV and other infectious diseases.
- About 1 million deaths from neonatal diseases and tuberculosis occurred in people who used the health care system, but received poor care.
"Quality care should not be the responsibility of the elite, nor an aspiration for the distant future; it should be the DNA of all health systems, "said Commission Chair Margaret E. Kruk of Harvard University. Chan School of Public Health.
"The human right to health does not make sense without quality care. High quality health systems give priority to people. They generate health, gain public trust and can adapt as health needs change, "said Kruk. "Countries will know that they are on the road to quality and responsible health systems when health workers and policymakers choose to receive health care in their own public institutions."
Commissioners used data from over 81,000 consultations in 18 countries and found that on average, mothers and children receive less than half of the recommended clinical actions during a visit, including postpartum examinations, tuberculosis and failures to monitor blood pressure during labor.
And perhaps not surprisingly, poor quality care is more common among the most vulnerable.
The richest women attending antenatal care are four times more likely to report blood pressure measurements and urine and blood tests than the poorest women. teenage mothers are less likely to receive evidence-based care; and children from wealthier families are more likely to receive antibiotics. People with stigmatized health problems, such as HIV / AIDS, mental disorders and addictions, as well as other vulnerable groups such as refugees, prisoners and migrants are less likely to receive quality care.
"Given our findings, it is not surprising that only a quarter of people in low- and middle-income countries believe that their health system is working well," Kruk said.
The right to quality care
In an editorial accompanying The Lancet, editors recognize that expanding universal health coverage remains essential, but that without high-quality health systems, universal care will "be a abstract myth and meaningless.
The commission proposes several ways to address the quality of the health system, starting with public accountability and transparency of health system performance.
He found that many approaches to improvement have had limited effects. In addition, commonly used health system indicators, such as the availability of drugs, equipment or the proportion of births with skilled birth attendants, do not reflect the quality of care and may lead to false complacency about progress.
The commission calls for fewer but better measures of the quality of health systems and proposes a scoreboard of measures to be implemented in counties by 2021 to enable transparent measurement and reporting of health care. quality.
"The vast epidemic of poor quality care suggests that there is no quick fix and policy makers need to commit to reforming the foundations of health systems," said Muhammad Pate, Co-Chair of the Commission and former Minister of State for Health in Nigeria.
"This includes the adoption of a clear quality strategy, the organization of services to maximize results, not access alone, the modernization of health worker training and mobilization of the public for better quality care, "said Pate.
"For too long, the global health discourse has focused on improving access to care, with little emphasis on quality of care," he said. "Providing health services without guaranteeing a minimum level of quality is inefficient, useless and unethical."
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