The Lancet Global Health Commission on High Quality Health Systems: countries are seizing the quality agenda

Abstract

The health needs and expectations of populations around the world are changing, and health systems need to change with them. As disease burdens shift from infectious to noncommunicable diseases, as citizens grow to expect more from their health systems, and as leaders set ambitious global goals for health, health systems are struggling to keep pace. 1-3 While improving access to and utilization of care were important for reducing infectious diseases and improving maternal and child health, it is increasingly clear that skilled, integrated, and longitudinal health care is needed in addition to improved access and utilization to address emergent chronic and complex conditions. 4-6 In others words, quality is more essential than ever. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Goals Era (HQSS Commission), composed of 30 academics, policymakers, and health system experts from 18 countries, was assembled to generate a vision for high quality health systems and propose new approaches to defining, measuring, and improving health system performance. 6 Its report, published one year ago, found that across low-and middle-income countries quality is poor. Poor quality does not discriminate by condition, but tends to be worst for the most marginalized populations. 7 Many patients do not receive the full range of recommended clinical actions in visits, frequently receive incorrect diagnosis and poor management of illness, and face major gaps in other important elements of quality such as safety, continuity, and coordination of care. 6,8-10 Commission research suggests that this poor quality results in more than 8 million deaths worldwide each year from conditions treatable by the health system; further, poor quality is now a greater contributor to mortality than poor access to care. 6 One thing is clear: incremental fixes are inadequate to the task. Meaningful and lasting improvement in the performance of health systems requires reform in the foundations of health systems. The report proposes 4 such universal actions to improve health system quality. First, leaders of the health system must govern for quality, which includes adopting a shared vision for quality, developing a quality strategy, regulating the system, and creating