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The National Academies - Crossing the Global Quality Chasm: Improving Health Care Worldwide

PIPSQC is pleased to share the new report by the National Academies of Sciences, Engineering, and Medicine, "Crossing the Global Quality Chasm: Improving Health Care Worldwide."

PIPSQC is also pleased to highlight the first-ever global report on quality co-authored by the WHO, OECD, and World Bank Group, "Delivering Quality Health Services: A Global Imperative for Universal Health Coverage," as well as the recently published "WHO Handbook for National Quality Policy and Strategy."


Crossing the Global Quality Chasm: Improving Health Care Worldwide

Poor-quality health care around the globe causes ongoing damage to human health. In low- and middle-income countries (LMICs), between 5.7 and 8.4 million deaths occur each year from poor quality of care, which means that quality defects cause 10 to 15 percent of the total deaths in these countries. The resulting costs of lost productivity alone amount to between $1.4 and $1.6 trillion each year.
A move toward universal health coverage (UHC) is the central theme of global health policy today, but the evidence is clear: Even if such a movement succeeds, billions of people will have access to care of such low quality that it will not help them—and indeed often will harm them. Without deliberate, comprehensive efforts to improve the quality of health care globally, UHC will be largely an empty vessel.

With support from 7 sponsors, the National Academies of Sciences, Engineering, and Medicine undertook a study to examine the global impacts of poor-quality health care and to recommend ways to improve quality while expanding UHC, particularly in low-resource areas. The resulting report, "Crossing the Global Quality Chasm: Improving Health Care Worldwide," builds on the work of the landmark 2001 Institute of Medicine (IOM) report "Crossing the Quality Chasm" by calling attention to the gaps in health care quality that still remain globally and suggesting approaches to bridge them.

Delivering Quality Health Services: A Global Imperative for Universal Health Coverage

Universal health coverage (UHC) aims to provide health security and universal access to essential care services without financial hardship to individuals, families and communities. UHC enables a transition to more productive and equitable societies and economies and is enshrined in the 2030 Sustainable Development Goals (SDGs). But UHC should not be implemented without considering the quality of the care provided. Quality means care that is effective, safe, people-centered, timely, equitable, integrated and efficient. High-quality care improves health outcomes and reduces waste. It is integral to a high-value, sustainable health system. Universal access to high-quality health care is not a luxury only rich countries can afford. It can be achieved in all settings with strong leadership, planning and implementation. The returns are worth the investment. While significant progress to improve care quality has been made, more effort is needed in both developing and developed countries. This report describes the current situation with regard to UHC and global quality of care, and outlines the steps governments, health services and their workers, together with citizens and patients need to urgently take.

Key findings in the report include:
- Health care workers in seven low- and middle-income African countries were only able to make accurate diagnoses one-third to three-quarters of the time, and clinical guidelines for common conditions were followed less than 45 percent of the time on average.
- Research in eight high-mortality countries in the Caribbean and Africa found that effective, quality maternal and child health services are far less prevalent than suggested by just looking at access to services. For example, just 28 percent of antenatal care, 26 percent of family planning services and 21 percent of sick-child care across these countries qualified as 'effective.'
- Around 15 percent of hospital expenditure in high-income countries is due to mistakes in care or patients being infected while in hospitals.

WHO Handbook for National Quality Policy and Strategy

The "WHO Handbook for National Quality Policy and Strategy" outlines an approach for the development of national policies and strategies to improve the quality of care. Such policy and strategy can help clarify the structures, roles and responsibilities within national quality efforts, support the institutionalization of a culture of quality, and secure buy-in from health system leaders and stakeholders.

The handbook is not a prescriptive process guide, but is designed to support teams developing policies and strategies in this area, and very much recognizes the varied expertise, experience and resources available to countries. It outlines eight essential elements to be considered by teams developing national quality policy and strategy: national health goals and priorities; local definition of quality; stakeholder mapping and engagement; situational analysis; governance and organizational structure; improvement methods and interventions; health management information systems and data systems; quality indicators and core measures.

The NQPS handbook was co-developed with countries each finding themselves at different stages of the development and execution of national quality policies and strategies, and was informed by the review of a sample of more than 20 existing quality strategies across low-, middle- and high-income countries globally.