By Ken Odhiambo
Health experts warned that Universal Health Coverage (UHC) is unachievable without the provision of quality health services. A new joint report by the Organisation for Economic Co-operation and Development (OECD), World Health Organisation (WHO) and the World Bank said poor quality health services are holding back progress on improving health in countries at all income levels.
Cu r re n t l y, i n a c c u r a t e diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices prevail in all countries. “The situation is worst in low and m i d d l e – i n c o m e countries where 10 per cent of hospitalised patients can expect to acquire an infection during their stay compared to 7 per cent in high income countries.
“This is despite hospital acquired infections being easily avoided through better hygiene, improved infection control practices and appropriate use of antimicrobials,” the report notes. At the same time, one in 10 patients is harmed during medical treatment in high income countries.
The joint report, dubbed ‘Delivering Quality Health Services – a Global Imperative for Universal Health Coverage’ also reveals that sickness associated with poor quality health care imposes additional expenditure on families and health systems. However, although there has been some progress in improving quality, for example, in survival rates for cancer and cardiovascular disease patients, the broader economic and social costs of poor quality care are estimated to amount to trillions of dollars each year.
The WHO Director-General, Dr Tedros Adhanom Ghebreyesus noted that WHO is committed to ensuring that people everywhere obtain health services when and where they need them. “We are equally committed to ensuring that those services are good quality. Quite honestly, there can be no UHC without quality care.” OECD SecretaryGeneral Angel Gurria observes, “Without quality health services, UHC will remain an empty promise.”
“The economic and social benefits are clear and we need to see a much stronger focus on investing in and improving quality to create trust in health services and give everyone access to high-quality, people-centred health services.” In addition, World Bank Group President Jim Yong Kim asserted that good health is the foundation of a country’s human capital, and no country can afford lowquality or unsafe health care.
“Low-quality care disproportionately impacts on the poor, which is not only morally reprehensible, it is economically unsustainable for families and entire countries,” He said that health care workers in seven low- and middle-income African countries were only able to make accurate diagnoses one third to three quarters of the time, and clinical guidelines for common conditions were followed less than 45 per cent of the time on average. In the report, the three organisations outline the steps governments, health services and their workers, together with citizens and patients, urgently need to take to improve health care quality.
“Governments should lead the way with strong national health care quality policies and strategies. Health systems should focus on competent care and user experience to ensure confidence in the system.” At the same time, the organisations want citizens empowered and informed to actively engage in health care decisions and in designing new models of care to meet the needs of their local communities.
“Health care workers should see patients as partners and commit themselves to providing and using data to demonstrate the effectiveness and safety of health care.” A study launched by the Director of Medical Services, Dr Jackson Kioko in February revealed that health care workers caused nine out of 10 maternal deaths by providing sub-standard care to mothers who delivered in public health facilities in 2014.
The first ever confidential report titled: “Saving Mothers Lives: Confidential Enquiry into Maternal Deaths in Kenya” says of the 484 maternal deaths assessed, 447 (92.4 per cent) did not receive the highest quality of care. Those who died had a median age of 27 years, with the youngest aged 14 and the oldest 47, succumbed to pregnancy and child birth conditions such as severe bleeding, intrapartum and postpartum. Others died from non-obstetric complications mainly HIV/Aids and anaemia.
And, in a bid to reverse the worrying trend, Dr Kioko urged the health workers to immediately change their attitude to stop the unnecessary maternal deaths as Kenya embraces UHC. President Uhuru Kenyatta has identified UHC as among his government’s four key pillars. Achieving UHC means access to essential health services for everyone—including safe, effective and affordable medicines and vaccines—without financial hardship.