Quality of care

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes.  It is based on evidence-based professional knowledge and is critical for achieving universal health coverage. As countries commit to achieving Health for All, it is imperative to carefully consider the quality of care and health services.  Quality health care can be defined in many ways but there is growing acknowledgement that quality health services should be:

• Effective – providing evidence-based healthcare services to those who need them;
• Safe – avoiding harm to people for whom the care is intended; and
• People-centred – providing care that responds to individual preferences, needs and values.

To realize the benefits of quality health care, health services must be:

• Timely – reducing waiting times and sometimes harmful delays;
• Equitable – providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socio-economic status;
• Integrated – providing care that makes available the full range of health services throughout the life course;
• Efficient – maximizing the benefit of available resources and avoiding waste.

The Sustainable Development Goals urge countries to achieve Universal Health Coverage (UHC), including financial risk protection and access to quality essential health care services. However, the reality in many settings is that providing quality care remains a significant challenge, and inadequate quality results in avoidable mortality, human suffering and significant economic losses.

While challenges to improving the quality of care are substantial, the need for action is clear, and many countries are making progress to build quality into their health systems. The WHO-World Bank-OECD report –  Delivering quality health services – highlights the need for action across multiple stakeholders at all health system levels. The provision of quality services requires good governance; a skilled and competent health workforce that is supported and motivated; financing mechanisms that enable and encourage quality care; information systems that continuously monitor and learn to drive better care; medicines, devices and technologies that are available, safe and appropriately regulated; and accessible and well-equipped healthcare facilities.

WHO, World Bank and the OECD have proposed a series of actions from key constituencies – governments, health systems, citizens and patients, and health workers – that need to work together to achieve the goal of quality health service delivery at the front line. 

• UHC cannot be achieved without attention to quality of care in all settings including those experiencing fragility, conflict and vulnerability. 
• Quality health services should be: effective; safe; people-centred; timely; equitable; integrated; and efficient.
• Improving the quality of health services requires strong national direction from governments, focused sub-national support, and action at the health facility level. Across all levels there is a need for engagement and empowerment of the communities served by the health system.
• National policies and strategies aimed at improving quality of care provide a strong foundation for improving quality across the health system and need to be closely aligned with broader national health policy and planning.
• Quality needs to be continually measured and monitored to drive improvement, which relies on accurate, timely and actionable data.
• Improving the quality of health services requires attention to knowledge generation and learning. Lessons on delivery of quality care should be systematically captured, documented and shared within and between countries.
• Major public health crises – such as outbreaks of highly infectious diseases – are a priority for countries. For health systems to be resilient, they require quality health services that are delivered prior to, maintained during, and improved upon following a public health emergency.