A recent joint global report by the World Health Organisation (WHO), the Organisation for Economic Co-operation and Development (OECD), and the World Bank Group (WBG), found that quality of care, particularly in low- and middle-income countries, is suboptimal.
In several African countries, accurate diagnoses are made in some cases, as little as a third of the time, and clinical guidelines for common conditions are adhered to less than 45% of the time.
This is despite the global commitment to provide high-quality promotive, preventive, curative, rehabilitative, and palliative health services to all communities by 2030 as set out in the Sustainable Development Goals.
Jacqui Stewart, CEO of The Council for Health Service Accreditation of Southern Africa NPC (COHSASA) believes that issues of quality should take centre stage on health policy reform agendas and that aid funders could play an important role in assisting governments to drive cohesive quality programmes.
“Good resources, such as the WHO Toolkit on implementing a policy strategy, already exist but are not always implemented effectively,” she says.
For Dr Lydia Okutoyi, obstetric gynecologist at Kenyatta National Hospital in Nairobi, child and maternal health are a good indicator of the quality of care within a country’s health system. She says that, while there has been some progress on the continent, there is still an unnecessary high burden of maternal mortality from preventable conditions, such as obstructed labour, sepsis, and abortion-related conditions.
“Improving quality and outcomes must be a holistic effort that includes empowering women to know when to seek care,” says Okutoyi.
“Respectful care is another key factor in providing quality and safe care. This means not only care that is technically correct but must also enable the mother to feel safe through, for instance, applying good hygiene standards," she says.
Both experts believe that communities can and do play a significant role in improving the quality and safety of care.
In obstetric care, this could mean educating birth attendants or doulas on the danger signs during pregnancy, the importance of ante-natal care for the mother, or the establishment of ‘waiting homes’ close to a health facility for women who live in remote areas.
By including quality and standards education at undergraduate level for all healthcare professionals, Stewart believes these principles would be inculcated into the health system and in turn would assist in bringing about system-wide positive change.