When it comes to universal health coverage (UHC), ensuring access and coverage to essential health services isn’t enough. When patients visit a doctor or receive emergency care, the quality of care matters for health outcomes.
To support learnings around quality, the USAID-funded Health Finance and Governance Project, in partnership with the JLN, the USAID ASSIST Project, and the WHO Global Learning Laboratory, organized the Governing for Quality learning exchange with 10 countries to examine governance strategies for improving the quality of health care. The exchange concluded last week with a consensus statement and new knowledge for implementers on the topic.
“The body of knowledge on this subject is moving forward quite rapidly and it helps us understand what countries are prioritizing,” said Shams Syed of the WHO Global Learning Laboratory.
Country representatives from Ghana and Mexico and technical experts discussed challenges and shared promising practices on improving governance for the quality of health care at an end-of-the-project event hosted by the HFG Project, “Smoothing Painful Bumps on the Path to Universal Health Coverage: Strengthening Governance to Improve Quality Care.”
Institutional Arrangements and Promising Practices in Ghana
Vivian Addo-Cobiah, acting director of quality assurance at Ghana’s National Health Insurance Authority, shared Ghana’s commitment and approach when it comes to monitoring and improving the quality of health services.
Over 70 percent of Ghanaians are covered by the national health insurance scheme. The country has over 4,000 accredited health care institutions and health officials conduct medical audits every two years. Ghana has also created a national health care quality strategy to improve quality across all levels of care.
“We are passionate about strengthening governance for the quality of care to ensure the quality of services that are provided,” Ms. Addo-Cobiah shared. “We want our citizens to have confidence in the National Health Insurance Scheme so that more will register for coverage and we can reach UHC in Ghana.”
The country’s insurance scheme is still facing challenges of sustainability and financing, disparities in the distribution of health facilities and a lack of incentives for facilities to improve quality. Ms. Addo-Cobiah noted that despite the challenges, there is significant momentum for progress in Ghana: “Ghana has strong political will to achieve UHC and the national quality strategy is being led by the Ministry of Health.”
Investments in Governance in Mexico
Speaking to smart investments for improving quality, Paulina Pacheco, director of inter-institutional entailment and follow-up to the international agenda of quality in healthcare at the Mexico Ministry of Health, discussed national initiatives that have been effective in incentivizing quality care.
Through the Patient Safety and Quality Management Framework, the Ministry of Health has implemented national quality indicators, developed an indicator tracking project, created national, state, and local quality committees, and opened a mechanism for civil society to participate in shaping quality health services.
“Mexico has a complex pluralistic health system and has made great progress toward UHC,” noted Ms. Pacheco. “We have more than 55 percent of citizens insured, with a package of more than 500 interventions, including for the treatment of cancers and HIV.”
Mexico is still addressing its remaining challenges, especially regarding the lack of resolution at the first level of care and a timely diagnosis. The country has prioritized increasing the quality of treatment for the most common health issues, including breast cancer, maternal care and diabetes.
Perspectives from Technical Experts
Technical experts from development partners also shared their insights on the topic.
Adam Koon, a governance specialist with the HFG Project, summarized findings from a three-country study in Southeast Asia on institutional arrangements for the governance of quality. From the experiences of Indonesia, the Philippines and Thailand, Mr. Koon found that non-financial incentives matter for improving quality, such as the example of Thailand’s quality award that honors excellence in service delivery. Likewise, accreditation is not the last step – clinical audits are still essential to monitoring quality. Lastly, quality is contingent on implementation – if standards aren’t enforced, the quality of health care services won’t improve.
Pierre Barker, chief global partnerships and programs officer at the Institute for Healthcare Improvement, emphasized the importance of defining quality and developing a national quality strategy when prioritizing quality improvements. “Why have a national quality strategy? The answer was that it was an important moment in the quality journey. It was a way of crystallizing the health vision of a country and providing a country with a sense of direction,” he elucidated.
Gina Lagomarsino, president & CEO of Results for Development, concluded the conversation with a focus on the private sector and the challenge of monitoring the quality of delivered services. She posed a pertinent question, “Many countries have very strong private sectors and providers where most people are getting care – how can we ensure quality and the governance of quality in the private sector itself?” Citing the experience of Nigeria, where 60 percent of services are delivered by a private provider, Ms. Lagomarsino recommended that governments invest in intermediary institutions that organize private providers so that these institutions become capable of responding to quality incentives.
The countries involved in the Governing for Quality learning exchange co-produced three knowledge products that provide guidance and outline where more research is needed to devise effective governance strategies for improving the quality of care. The three resources include:
- A Consensus Statement: This statement recognizes that quality of care should be prioritized in the pursuit of UHC and that governance has an impactful role in ensuring and improving health care quality. It also provides a common definition of governance for quality.
- Research Agenda: The agenda shares priority research questions for governing quality health service delivery.
- Guide for institutional relationships when linking finance to quality: The guide will be published soon.
The collaboration on governance for quality will continue through the WHO Global Learning Lab and JLN – stakeholders agreed that more work is needed to share learnings and improve governance for quality care. Click here to watch the recorded panel discussion.
- WHO National Quality Strategy Handbook: This handbook outlines an approach for the development of national policies and strategies to improve the quality of care. Such policy and strategy can help clarify the structures, roles and responsibilities within national quality efforts, support the institutionalization of a culture of quality, and secure buy-in from health system leaders and stakeholders.