This learning session, held on the 13th July, aimed to increase FCDO’s (formerly DFID) internal capacity to build considerations on improving quality of care into health programming and policy strengthening efforts in partnership with the global community. It was delivered as part of the Health Systems Strengthening Learning Journey, which aims to support FCDO’s understanding, capacity and influence in strengthening health systems to improve the health and well-being amongst the poorest and marginalised in low- and middle-income countries. This session involved a combination of content delivery with trainee participation and interaction.
Why is the topic important?
Efforts in achieving universal health coverage must include a global focus on improving the quality of health care as increasing access alone will not achieve the transformative change that is needed to ensure healthy lives and promote well-being for all at all ages. Of the 8.6 million deaths per year in 137 LMICs due to inadequate access to quality care, 5.0 million (58%) are people who sought care but received poor quality care (Kruk et al. 2018). Poor quality care also results in morbidity, pain, loss of function, antimicrobial resistance, loss of trust in health systems and government, waste and economic losses and ultimately risk to health emergencies. For example, poor infection prevention and control compliance will undermine a successful response to COVID-19 (Roder- DeWan, S 2020; Powell-Jackson T et al. 2020). The COVID-19 pandemic also highlights the need for a focus on quality care in managing cases, maintaining routine essential health services, and health systems recovery.
We must prioritise raising the bar on healthcare quality following in the footsteps of the global leadership that DFID has shown in raising the bar on teaching quality. Health systems – across public and non-state sectors – must weave quality into their fabric in order to have the desired impact on population health. Action to improve quality of care requires an appreciation of core foundational concepts that will be covered within this learning journey. This spans systems level issues all the way to enhancing quality at the point of care. This requires an embracing of multiple strategies to transform care, support effective coordination, identify and engage with sustainable funding sources, build capacity and capability and start with scale in mind.
- Outline the case for improving quality of care
This includes the critical linkages with universal health coverage; the contextual adaptation required for fragile, conflict-affected and vulnerable settings; and the relevance to COVID-19.
- Understand the evidence base on quality interventions and how to organize thinking
This includes an organisation of quality interventions that can be used to set national strategic direction on quality, as well as an exploration on what we know works, as well as what we do not yet know.
- Recognise entry points for DFID to promote national action to improve quality of care
This includes an exploration of how DFID Advisers can strengthen national efforts to improve quality of care through its health systems strengthening work.
We have collated a number of resources to support this session – please see below for essential and optional reading lists. You can also find the presentations below:
- The case for quality of care | Shams Syed | WHO
- Planning action for quality at national, district and facility levels | Matthew Neilson | WHO
- The effectiveness of specific strategies to improve quality of care | Alex Rowe | CDC
Some essential reading on this session:
- How could health care be anything other than high quality?
Ghebreyesus TA. | Lancet Glob Health | 2018 | Comment
- Improving quality of care in fragile, conflict-affected and vulnerable settings
Syed SB, Leatherman S, Neilson M, et al. | Bull World Health Organ. | 2020 | Editorial
If you would like to read further, please find below a list of additional resources. Note that these resources have abstracts or executive summaries should time not permit to read through the full documents.
- Delivering quality health services: a global imperative for universal health coverage
World Health Organization, Organisation for Economic Co-operation and Development, the World Bank | 2018
- Crossing the Global Quality Chasm: Improving Health Care Worldwide
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. Washington (DC): National Academies Press (US) | 2018
- High-quality health systems in the Sustainable Development Goals era: time for a revolution
Kruk ME, et al. | Lancet Global Health | 2018
- Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review
Rowe AK, Rowe SY, Peters DH, Holloway KA, Chalker J, Ross-Degnan D. | Lancet Global Health | 2018
- “My quality” – real stories from the ground
World Health Organization
- Health system quality in the time of COVID-19
Roder-DeWan S | Lancet Global Health | 2020
- Infection prevention and control compliance in Tanzanian outpatient facilities: a cross-sectional study with implication for the control of COVID-19
Powell-Jackson T et al. | Lancet Global Health | 2020
- Handbook for national quality policy and strategy: A practical approach for developing policy and strategy to improve quality of care
World Health Organization | 2018
- HIV quality of care technical brief available here:
Maintaining and improving quality of care within HIV clinical services
World Health Organization | 2019
- Quality PHC paper that touches on the link with essential public health functions:
Quality in primary health care
World Health Organization | 2018
- NQPS tools and resources compendium which accompanies the handbook:
National Quality Policy and Strategy Tools and Resources Compendium
World Health Organization | 2019
- The potential of integrated continuous surveys and quality management to support monitoring, evaluation, and the scale-up of health interventions in developing countriesRowe AK | American Journal of Tropical Medicine and Hygiene | 2009
The WHO handbook for national quality policy and strategy, co-developed with countries, outlines an approach for the development of national policies and strategies to improve the quality of care. As well as providing useful framing and background on quality of care and the action required by countries, the handbook presents an overview of key considerations teams setting national quality direction under eight essential elements: 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.
In partnership with K4D, Session 2 was provided by LSHTM, WHO and CDC. The facilitator was Professor Joanna Schellenberg (LSHTM), and the trainers were Dr Shams Syed (Quality Team Lead, Department of Integrated Health Services, WHO HQ), Dr Matthew Neilson (Quality Team, Department of Integrated Health Services, WHO HQ) and Dr Alexander K. Rowe (Guest Researcher, Malaria Branch, Division of Parasitic Disease and Malaria, Center for Global Health, Centers for Disease Control and Prevention).
Dr Shams Syed is the Quality Team Lead within the Department of Integrated Health Services in the UHC & Life Course Division at WHO Headquarters. He currently directly oversees the WHO national quality policy and strategy initiative as well as WHO technical work on quality in fragile, conflict affected and vulnerable settings. Dr Syed also oversees WHO work on twinning partnerships for improvement and has led WHO work in this arena since 2009. His WHO career has provided an opportunity to work directly with over 30 countries across the world. He has a focused academic interest in reverse innovation in global health systems. He maintains teaching roles in his spare time, including at Johns Hopkins. Dr Syed received his medical degree from St. George’s, University of London, and practiced as a General Practitioner in the UK. He received postgraduate public health training at the University of Cambridge. Subsequently, he trained in Preventive Medicine at Johns Hopkins University, is US Board Certified in Public Health & Preventive Medicine and a Fellow of the American College of Preventive Medicine. His previous experiences include: involvement in a multi-country health systems research consortium; working at the Pan American Health Organization with seven Caribbean countries on strengthening health systems and specifically surveillance systems; and working as the Advisor on Family and Community Health at WHO Trinidad and Tobago.
Dr Alexander Rowe is a medical epidemiologist with the Malaria Branch at the Centers for Disease Control and Prevention (CDC) in Atlanta. He received an MD from Cornell University and an MPH from Emory University. He has worked at CDC since 1994 in several areas: the chronic diseases center, an international child survival unit, and malaria. Key interests include improving health worker performance in developing countries (for all health conditions), strengthening health systems, monitoring and evaluation methods, and systematic reviews. He is the author or co-author of more than 70 scientific publications.
More information on the K4D Health Systems Strengthening Learning Journey can be found here.