Akachi Yoko, Kruk Margaret E
United Nations University World Institute for Development, Katajanokanlaituri 6B, FI-00160, Helsinki, Finland.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, United States of America.
Bull World Health Organ. 2017 Jun 1;95(6):465-472. doi: 10.2471/BLT.16.180190. Epub 2016 Feb 21.
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
卫生系统提供的医疗服务质量有助于实现关于健康和福祉的可持续发展目标3。越来越多的证据表明，在低收入国家，医疗服务质量低下削弱了卫生干预措施的效果。医疗服务质量对于全民健康覆盖倡议的成功也至关重要；对所涵盖服务的质量和范围不满意的公民不太可能支持医疗保健的公共融资。此外，存在一种道德动力，以确保所有人，包括最贫困者，都能获得对改善健康有效的最低质量标准的医疗服务。然而，如今在低收入和中等收入国家，质量测量不足以完成这项任务。卫生信息系统提供的数据不完整且往往不可靠，机构调查收集了太多效用不确定的指标，只关注有限数量的服务且很快过时。现有措施难以捕捉医疗服务过程和患者体验。对医疗实践敏感的患者结局，这是高收入国家质量评估的主要支柱，却很少被收集。我们提出六项政策建议，以改善医疗服务质量测量并扩大其政策影响：（i）加倍努力改善民事登记和人口动态统计系统并使其制度化；（ii）改革机构调查并加强常规信息系统；（iii）为资源匮乏环境创新新的质量衡量标准；（iv）从患者角度看待质量；（v）投资国家质量数据；（vi）将质量证据转化为政策影响。
