Webinar 22 August 2019
Dr Shams Syed & Dr Kamaliah Noh
Quality doesn’t occur spontaneously. That was the clear message put forward by Dr Shams Syed, head of Quality Systems and Resilience at WHO in Geneva. He was joined by Dr Kamaliah Noh, of the Cyberjaya University College of Medical Sciences, to talk about quality and primary health care in the third edition of the PHC Webinar Series.
There are, worldwide, 5 million deaths a year attributable to poor quality of care. Quality is not just for wealthy countries – it affects everyone. Ensuring that health systems provide high-quality care could, for example, prevent 2.5 million deaths from cardiovascular disease and half of all maternal deaths.
How does quality relate to universal health coverage and PHC? UHC is about ensuring that everyone has access to health care services, but access means nothing if the services received are of poor quality.
And PHC is central to this question, because a focused effort on quality at all levels of the health system holds the potential to really unlock prevention. PHC, in its turn, because it drives effectiveness and people-centredness, enables quality.
But what is “quality” in terms of health services? Quality health care services are those that are effective, safe, and people-centred. The other elements which define quality are that they be timely, equitable, integrated and efficient.
Dr Syed spoke on how countries can organize their thinking around quality interventions. It is very important that countries carefully select a practical set of interventions in a clearly articulated national direction on quality. The four key points to address are, first, to look at the system environment – how quality interventions are integrated within the PHC approach.
The other three things to consider when looking at quality are: reducing harm, improving clinical care, and community engagement and empowerment. Thus it becomes clear that quality and PHC are closely intertwined, as quality is key to all three elements that make up the PHC approach – multisectoral policy and action, integrated health services, and community engagement.
As Dr Noh pointed out, quality is about evaluating the effectiveness of the health system¸ not individual practitioners. It’s about “a culture of quality… We need to make sure that there are incentives for this, there’s technology which can enable this,” she said.
Dr Noh spoke to the experience of Malaysia in developing quality standards, emphasizing that it is important to look at the whole spectrum of care, from the community to the hospital. She stipulated that countries need to look to the training as well as the ongoing professional development of health care providers, but to also bear in mind that how facilities are managed will also impact on the quality of care.
Malaysia introduced its quality assurance programme in 1985. In 2010, the country began to systematically review the quality assurance programme – a process which took five years – which led to the conclusion that the measurement framework was unbalanced, and a revision of the indicators being used.
Quality frameworks are necessary, she said, because frameworks articulate knowledge and priorities. They define quality, they guide measurement, and they provide a common language for improvement. But frameworks are not enough. Without improvement, measurement is simply an exercise.
Nothing succeeds as a concept; it is action that is required in order to create, and maintain, quality. In short, quality is a journey, one in which the goalposts are always shifting.