Report: Global health care must improve quality to save lives
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* Julia Haskins

Poor-quality health care contributes to up to 8 million deaths in low- and middle-income countries each year, but interventions can be carried out at multiple levels to close the gap in quality of care, a new report states.

Released in August, “Crossing the Global Quality Chasm: Improving Health Care Worldwide” is based on a study led by the National Academies of Sciences, Engineering, and Medicine looking at the effects of poor-quality health care, focusing on low-resource settings.

It found that between 5.7 million and 8.4 million deaths that occur in low- and middle-income countries each year result from poor-quality health care. Defects in quality of care therefore account for 10 percent to 15 percent of total deaths in such countries. In addition, low- and middle-income countries experience 134 adverse events in hospitals annually, leading to 2.5 million deaths.

“Crossing the Global Quality Chasm” focused on six dimensions of quality health care: safety, effectiveness, person-centeredness, accessibility, timeliness and affordability, efficiency and equity. It also included integrity, defined as “the reduction and elimination of corruption and collusion,” as a critical goal in improving quality of care.

The report called attention to the plight of nearly 2 billion people living in settings of extreme adversity, including failed states and refugee camps. Access to quality health care is particularly challenging in such environments, where corruption and collusion are rampant and can lead to failures in supply chains and equipment, said Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement.

The report provided recommendations for closing gaps in quality of care to ensure that universal health coverage does not become an “empty vessel.” Universal health coverage can also be leveraged to work toward better quality care, it said.

“Unless we commit to improvement of quality, we don’t think universal health coverage will deliver the goods that it should,” APHA member Don Berwick, MD, MPP, FRCP, co-chair of the committee that led the study and report, told *The Nation’s Health*.

Ministries of health were encouraged to lead health care transformation efforts by creating national health care strategies and adopting goals for quality care with respect to their own nations. In addition to high-level health care leaders, non-traditional providers can also play an influential role in improving the health outcomes of communities, according to the report. Providers without formal training or certification as health care professionals are often trusted community members and should be incorporated into the greater health care system to help improve quality of care, the report said.

“We need to work on quality in the informal system rather than ignoring it or insisting that it go away,” Berwick said.

It is not only health care that will determine the outcomes of populations, Berwick said. Social determinants of health such as housing, food security and air and water quality are also important to consider.

“If you look at what creates health and well-being in populations, it has to do with a lot more than health care,” he said.

For more information, visit [www.nationalacademies.org/globalhealthquality](http://www.nationalacademies.org/globalhealthquality).

*   Copyright The Nation’s Health, American Public Health Association