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Quality Revolution in Health Care; Fundamental for Achieving SDGs

27 September 2018
The report of the Lancet Global Health Commission on High Quality Health Systems in the SDG era (HQSS) shows quite clearly that the universal health coverage strategy is not sufficient to improve health in low-income and middle-income countries (LMICs). Provision of good-quality health care is essential for the attainment of sustained improvement in health outcomes and the full realisation of the human right to health.

The report which is titled “Time for a Quality Revolution”, was released in September. It highlights the importance of strong health systems and the need for governments to invest in designing and building people-centred health systems which deliver safe, effective and quality care.

This perspective buttresses some of the views jointly expressed by the World Health Organization (WHO), World Bank (WB) and Organisation for Economic Cooperation and Development (OECD) earlier in July. In the document “Delivering quality health services A global imperative for universal health coverage”, the three international organisations observed that “better access to care without attention to its quality will not lead to desired population health outcomes.”

They further agreed “that high-quality, safe, people-centred health care is a public good that should be secured for all citizens”, emphasising the fact that quality of care is the foundation of people-centred health care.

These are positions that Public Services International and its affiliates across the world have upheld over the years, in the face of reforms driven by international financial institutions which undermined the capacities of already fragile health systems. We have always advocated universal access to quality health services. PSI has also continually stressed the obvious: this is possible, only as universal public health care.

Thoroughgoing reform must be implemented by governments to carry out a quality revolution in health care. On this, there is a consensus by all stakeholders in the health and social sector, including PSI. But when it is argued, as in the Bellagio Declaration on high-quality health systems that, “these reforms will not succeed without including the private health sector and other sectors”, a seeming truth acquires ominous undertones.

The question is not so much about involving the private sector. It is about how this is to be done. PSI has affiliates in the private sector which it represents. It might not be realistic to wish away some level of private sector involvement in health care delivery. But, such involvement must take due cognisance of health as a fundamental right of all persons in truth and in deed. Consequently, it must be appreciated that health care is not a commodity, even when delivered through private providers. The marketization of health services must be curtailed, to make quality health universally accessible.

Starting from the 1980s as Private Finance Initiatives (PFI), and later through other forms of Public-Private Partnerships (PPPs), private sector involvement in public health, including through contracting out of services and staff, contributed to the crisis of quality we face today.

Pharmaceutical corporations and health insurance companies, giants of the private sector have also skimmed off billions of dollars which could have been invested into providing quality public health services, as rents – well beyond what could legitimately be considered as profits. Quite a few, multinational health companies have equally been involved in tax evasion.

Besides, quality health care delivery by private providers is priced beyond the reach of the vast majority of the population, particularly in low-income and middle-income countries. The only way these people could have access to quality health care is with governments being firmly in the saddle of driving the process.

As Rosa Pavanelli, the PSI General Secretary stated:

"Health is a fundamental human right. The responsibility to ensure that every woman, man and child has quality health rests squarely on the shoulders of governments. It is worrisome as the Lancet Global Health Commission observed, that we lose not less than 8 million people every year due to poor quality of care. We thus need to go beyond the dominant perspective of universal health coverage.

The challenge before governments all over the world, is to put people over profit. Ordinarily this should not be a challenge, because governments are supposed to serve the people and not big business. But, the questionable influence of multinational corporations over governments and multilateral international organisations decision-making processes has become so pervasive in re-defining otherwise lofty goals. “Universal health coverage” for example, has not meant universal access to quality health.

Governments must invest adequately in the public health system, and promote concerted tripartite social dialogue in the sector, as agreed upon in the Working for Health: Five-Year Action Plan. They must also make sure that the private health care providers uphold quality standards in terms of service delivery and the working conditions of health workers."

Public Services International and its affiliates will continue advocacy for universal quality public health care. We will work with governments, international organisations and civil society organisations to make sure the future of health is genuinely people-centred. Thus, we will lay the foundations for a healthier, better world, as envisioned in the sustainable development goals.

Article in Russian

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