Quality health care in extreme adversity—an action framework

Abstract

Quality problem or issue: There are record-setting numbers of people living in settings of extreme adversity and they continue to increase each year. Initial assessment: There is a paucity of validated data on quality and safety across settings of extreme adversity. Choice of solution: This paper argues for an action framework to address the unique challenges of providing quality in extreme adversity. Implementation: We describe a preliminary Quality in Extreme Adversity framework which has been informed by—and will continue to be validated through—literature, data collection, WHO expert consultations and through working in settings of extreme adversity with national authorities and NGOs. Lessons learned: Poor quality care costs lives, livelihoods and trust in health services. The recommended framework, based on evidence and experiential lessons, intends to address the WHO goal for 2019–2023 of ‘one billion people better protected from health emergencies’ (9).