The World Health Organization defines quality of care as ‘The extent to which health care services provided to individuals and patient populations improve desired health outcomes’.
To implement its vision for quality of care in which ‘Every woman, child and adolescent receives quality care throughout the continuum of care’[1], WHO published a quality of care framework, and a series of eight standards to improve quality of maternal and newborn care in health facilities, followed by standards for improving quality of care for children and young adolescents in health facilities. They define what is required to achieve high quality care for maternal, newborn and children health, and are applicable to all health-care facilities that offer maternity and paediatric services. The standards place mothers, newborns and children at the centre of care by improving both the provision of, and patients’ experience of, health care.
Quality care is:
• Safe: delivering health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors.
• Effective: providing services based on scientific knowledge and evidence-based guidelines.
• Timely: reducing delays in providing/receiving health care.
• Efficient: delivering health care in a manner that maximizes resource use and avoids wastage.
• Equitable: delivering health care that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status.
• People-centred: providing care that takes into account the preferences and aspirations of individual service users and the cultures of their communities.
[1] As per WHO vision articulated in 2015
There is evidence that despite the progress made in increasing access and coverage, the gap in quality of care is contributing to unnecessary complications and deaths among women, newborns and children.
It is estimated that 303,000 mothers and 2.7 million newborn infants die annually [1] around the time of childbirth, and, according to The Lancet Global Health Commission on High Quality Health Systems in the SDG Era ‘The burden of mortality attributable to poor care is larger than that due to lack of access to care’. By end 2017, at least half the world’s population could not obtain essential health services, because they were inaccessible, unavailable, unaffordable or of poor quality[2].
[1] Health in 2015: from MDGs to SDGs, WHO
[2] Tracking Universal Health Coverage: 2017 Global Monitoring Report, WHO and the World Bank, 2017.
Mothers, newborns and children continue to die from preventable causes, even when they are in the care of health services. Poor quality care also increases the risk of illness and life-long disability. For countries who have committed to achieving the Sustainable Development Goals, improving the quality of care will be critical to end preventable maternal, newborn, and child deaths by 2030.
The Sustainable Development Goals place a clear emphasis on achieving Universal Health Coverage (UHC) by ‘ensuring that all people and communities can access and use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality, while also ensuring that the use of these services doesn’t expose the user to financial hardship’. Achieving UHC will require more than just increased coverage. The success of UHC depends on its ability to provide quality services to all people, with dignity, everywhere.
The member countries of the Quality of Care Network – Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania and Uganda – are pathfinder countries that are already taking the lead in improving quality of care for maternal, newborn and child health. Nine of them joined the Quality of Care Network at the onset, in 2017, while Sierra Leone joined in 2018.
In addition, 11 other countries are engaging with the Quality of Care Network to learn from the pathfinder countries and work to institutionalise quality of care. These are: Botswana, Cameroon, Chad, DRC, Liberia, Mozambique, Namibia, Niger, Senegal, South Sudan, Sudan, Bhutan, Indonesia, Maldives, Myanmar, Sri Lanka and Timor-Leste.
If the Quality of Care Network is successful, millions of women and their newborns who endure unnecessary and preventable risks in childbirth will benefit from better care; health workers who face enormous challenges in resource-poor settings will have access to quality of care improvement solutions that are adapted to their context; nations which see investment in healthy women and children as the bedrock of economic and social development will implement their maternal, newborn and children health strategies more efficiently; and global development partners will see rapid progress towards the Sustainable Development Goals and the targets of EWEC’s Global Strategy.