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August 30, 2018

‘Poor healthcare kills up to 8m people in low, middle-income countries’


August 30, 2018

Islamabad: In low- and middle-income countries, between 5.7 million and 8.4 million deaths occur each year from poor quality of care, which means that quality defects cause 10 per cent to 15 per cent of the total deaths in these countries, states a new report released Tuesday by the National Academies of Sciences, Engineering, and Medicine.

“Recent gains against the burden of illness, injury, and disability, and commitment to Universal Health Coverage (UHC) are insufficient to close the enormous gaps that remain between what is achievable in human health and where global health stands today,” the report states, calling for urgent efforts led by ministries of health worldwide to transform the design of health care through systems thinking and principles of human factors, acknowledge and engage the informal care sector, focus on settings of extreme adversity, embrace digital technologies and emerging innovations, and address corruption.

“For billions of people, UHC will be an empty vessel unless quality improvement becomes as central an agenda as universal health coverage itself,” said Sania Nishtar, co-chair of the committee that conducted the study and wrote the report. Dr. Sania is the founder president of Heartfile and co-chair of the World Health Organization’s Independent High-Level Commission on Non-Communicable Diseases. “Increasing quality is not an endpoint, but an ongoing, all-hands-on-deck effort that will require investment, responsibility, and accountability on the part of health system leaders. Health systems need to embrace a vision of the patient journey that is anticipatory and preventive, and wholly centered on continually improving the experience of patients, families, and communities,” she states in a press release issued on the report’s release in Washington.

The United Nations’ Sustainable Development Goals adopted in 2015 include a commitment to achieving UHC by 2030 so that all people and communities receive the quality services they need and are protected from health threats, without suffering financial hardship.

The report recommends underlines the need for health systems to embrace emerging digital technologies, and for this to take effect, calls upon the United Nations System to convene an international task force to provide guidance on governance mechanisms, standards, and regulatory oversight appropriate for new technologies.

“People in many parts of the world, more than 75 percent of the population in some countries, choose to seek care from informal providers either because they lack access to formal providers or because they do not trust the formal system. However, little is known about the quality of this care. Governments should assess and integrate informal providers into national health strategies and quality monitoring and improvement plans, and undertake efforts to improve their care through education, training, and realigning incentives,” the report states.

Even when care is available, quality problems are widespread, and high levels of excessive and inappropriate care are also pervasive, the report says. In the US, for example, 30 percent of estimated prescriptions for antibiotics are found to be unnecessary, posing risk to patients and contributing to antimicrobial resistance.

The report sees settings of extreme adversity such as conflict zones and refugee camps as posing severe quality challenges. “About 2 billion people live in fragile conflict settings worldwide. Research on these areas should be an urgent priority to identify common quality problems, and to tailor and implement strategies to reduce both preventable deaths and the waste of scarce resources,” thereport flags. Terming corruption as another contributor to poor quality of care worldwide, the report calls upon ministries of health to include safeguards in their health care quality strategies against corruption and collusion. The effects of corruption are evident in longer wait times, poorer treatment by health care workers, absenteeism of providers, unnecessary charges for services, and general misuse and pilfering of funds. The report also includes recommendations for increased investments in future research on interventions to improve the quality of care at the system level.

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