What is the number one cause of death for sick people seeking treatment in developing countries? If you think it is lack of access to healthcare, think again. A recent report by The Lancet Global Health Commission on High Quality Health Systems found that 5.7 million people die in low and middle-income countries every year from poor quality healthcare compared with the 2.9 million who die from lack of access to care. In other words, in many countries, a person has a greater chance of dying from receiving poor quality care than from going without care entirely.
At the UN General Assembly in September, heads of states and governments adopted a high-level declaration committing to achieving Universal Health Coverage (UHC) by 2030. This was an important political moment for global health and most welcome development. As we head down the path of UHC, we at the World Bank Group believe that now, more than ever, we must translate this commitment to concrete actions and place the issue of quality at the front and centre of our efforts.
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At a recent conference in Bogota co-organized with the Colombian government, the World Bank Group announced its recommendations to improve the quality of care in the health sector. The recommendations were directed to all stakeholders that play a role in improving the quality of frontline care in the sector, including healthcare providers, insurance companies, local authorities, governments and patients. We chose to pilot a novel, system-wide quality-of-care diagnostic tool developed by the World Bank and the International Finance Corporation (IFC) (an arm of the World Bank Group that works to strengthen the private sectors in emerging economies).
Why did we announce this initiative in Colombia? Because, since 2006 when it first identified quality improvement as a priority action area, the country’s government has shown exemplary leadership and we are keen to partner with them to make further tangible progress.
Based on a comprehensive methodology and lessons from leading quality health systems worldwide, our team carried out a comprehensive assessment of the strengths and weaknesses of Colombia’s healthcare system and developed recommendations for raising standards of quality for all Colombians. The assessment was released at the Bogota conference and will be followed by a financial commitment from the World Bank Group to support quality improvements and commitments from the government and many stakeholders in the sector. The focus will be on bolstering the policy and regulatory framework including financial incentives through payments systems reforms, as well as, from the IFC side, supporting private healthcare providers through investments and advisory services.
Healthcare coverage in Colombia, at 94-96%, is well above average compared with other middle-income countries and Colombia can claim that it has mostly reached UHC coverage — but there is still a lot of progress to be made with quality of care. Like many of its peers, maternal mortality rates remain too high, and alarming disparities in care quality and access exist between social groups. If you live in a rural part of Colombia you will, on average, wait more than a month to get a consultation with a paediatric specialist, compared to a week if you live in an urban area. While one in three women aged 50 to 69 years is screened for breast cancer nationally; in the poorest regions, as few as one in a hundred women in this age group receives a mammography. We need to address such disparities.
As part of this assessment, the World Bank Group combined its system-wide healthcare quality diagnostic tool with the IFC’s Quality tool, which judges the quality of care at the facility level, to create a holistic assessment of the quality gaps in the sector.
With an active portfolio of $20 billion, including $2 billion in healthcare, the IFC has invested in and advised more than 200 hospitals, clinics, insurers and pharmaceutical producers and distributors globally, guided by the overarching mission to increase access to affordable, quality care. Equipped with the expertise on quality care garnered from managing these investments, the IFC is expanding its advisory arm, as many clients acknowledge that this is a high impact issue and want to make progress but sometimes do not know how to address it.
IQ-Healthcare is a grassroots-level, quality-of-care diagnostic tool which tackles a broad range of issues at a facility level, including ensuring that patients’ informed consent is obtained for each treatment, that medications are safely managed and that onsite infections are eliminated. The tool comprises an initial assessment, including an onsite visit, of how well the facility follows 34 international standards in eight vital areas; an advisory phase where the IFC works through the issues flagged by the assessment, and a follow-up inspection 6-12 months later to measure how fully any recommendations have been implemented.
What we are learning, most encouragingly, is that there is an enormous appetite to address this issue in healthcare facilities all over the world. In less than two years, we have been able to deploy the IFC tool in more than 30 countries, including Colombia, Egypt, Ethiopia, Mexico, Nepal, Pakistan and Uganda.
The road to achieving better quality in health systems is long. We are confident that this two-pronged approach — encompassing top-down and bottom-up, combining the IFC and the World Bank expertise — is a winning formula as governments and facilities gain an ever greater appreciation of how important it is to embed quality in health care systems at every level. We look forward to rolling out the World Bank Group’s system-wide quality tool across the region and globally. Embedding quality in health systems will save lives and improve the health we purchase with money spent in healthcare.