Core components of quality

  • The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era revealed that quality of care globally is poor, and furthermore, that there is a paucity of data on quality. Thus, every country should make it a priority to better measure and improve the quality of care in their context. 34

    Countries that improve service quality in their health system may achieve the following outcomes and impact:

    • Improved patient experience and health status:  Adherence to evidence-based standards improves the accuracy and timeliness of care, ultimately supporting better clinical outcomes and patient experience of care. 578
    • More efficient, cost-effective care:  Adherence to established standards also promotes the efficient use of resources and time. In addition, timely access to high-quality services allows patients to use the PHC system as the first point of contact with the health system, helping to reduce the utilisation of emergency- or hospital-based services that may result in higher costs for the patient and health system. 568
    • Trust in PHC as the first point of contact:  Over time, delivering reliable, useful services for a population can help to build patient trust in the health system and enhance the perceived value of PHC. 56
    • Health equity:  Timely access to services is critical to achieving health equity for all populations; however, increased access to services will not translate to better health outcomes if these services are not high-quality. Marginalised populations, such as low-income and/or rural communities, are especially at risk of receiving poor-quality services. 59
    • Financial protection:  Facility hours and operations that align with patient needs and preferences help to mitigate additional costs for patients, such as those due to missed work hours or the need to find alternative childcare. 578
    • Resilience:  “Quality and resilience are closely linked concepts. 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. Quality health services are pivotal during emergencies and serve as the interface between communities and the health system.” 10

    Countries that deliver on the primary care functions in their health system may achieve the following outcomes and impact: 12111213

    • Increased patient and workforce satisfaction: Services that deliver on the core primary care functions can improve the experience of care for both patients and providers.
    • Service quality and health systems strengthening: They can also improve the quality of care, enhance patient health outcomes, and contribute to improved health system performance. For example, enhanced continuity and coordination of care can help to improve the flow of information and resources across care sites, which helps to reduce fragmentation and other inefficiencies in a health system.
    • Equity: Lastly, comprehensive, people-centred models of care help to ensure that equity is a priority in both public and private health systems and that patients’ holistic needs are met. Furthermore, first contact access, continuity, and coordination of care mechanisms help to ensure that no one is left behind. 

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content in this report represents the position of the partnership as a whole, it does not necessarily reflect the official policy or position of any individual partner organization.

References:

  1. Bitton A, Veillard JH, Basu L, Ratcliffe HL, Schwarz D, Hirschhorn LR. The 5S-5M-5C schematic: transforming primary care inputs to outcomes in low-income and middle-income countries. BMJ Glob Health. 2018 Oct 2;3(Suppl 3):e001020.
  2. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
  3. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Board on Global Health, Committee on Improving the Quality of Health Care Globally. Crossing the global quality chasm: improving health care worldwide. Washington (DC): National Academies Press (US); 2018.
  4. World Health Organization. Primary Health Care Transforming Vision into Action: Operational Framework. World Health Organization; 2018.
  5. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018 Nov;6(11):e1196–252.
  6. OECD, European Observatory. Improving healthcare quality in Europe: Characteristics, effectiveness, and implementation of different strategies. WHO; 2019.
  7. Sparkes S, Durán A, Kutzin J. A system-wide approach to analysing efficiency across health programmes. World Health Organization; 2017.
  8. WHO, World Bank, OECD. Delivering quality health services: a global imperative for universal health coverage. WHO, World Bank, and OECD; 2018.
  9. WHO. Transforming Vision into Action: Operational Framework for Primary Health Care. WHO; 2020 Dec.
  10. WHO. Fact sheet: Quality health services [Internet]. World Health Organization. 2020 [cited 2022 Mar 31]. Available from: https://www.who.int/news-room/fact-sheets/detail/quality-health-services
  11. WHO, UNICEF. Internal working draft: Primary health care performance: measurement for improvement- technical specifications. WHO; 2021 Oct.
  12. Armstrong, M. & Baron, A. (1998), Performance Management Handbook, IPM, London [Internet]. [cited 2019 Jan 30]. Available from: http://www.sciepub.com/reference/151290
  13. WHO. Continuity and coordination of care. WHO; 2018.