As a part of Sustainable Development Goals (SDGs), the quality of healthcare available to people reflects the global goal.  Changing health needs and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value. Health systems are judged primarily on their impacts, including better health and its equitable distribution, on people’s confidence in the health system, and on their economic benefit and care processes. Quality in healthcare is not a purview of the elite or an aspiration for some distant future; it holds the DNA of all health systems. A high-quality health system optimizes health care in a given context by consistently delivering care that improves or maintains health outcomes.

The lowest-income countries and the poorest people within countries generally had the worst outcomes, despite considerable efforts to increase health care use.  In low-income nations, primary care has traditionally been the main platform for healthcare delivery. Shifting disease burden, urbanization, and rising demand for cutting-edge treatments and a positive user experience are posing challenges to this model of care.

Measuring Healthcare

An emergent attribute, quality of care is honed via iterative attempts to improve and learn from successes and failures. To achieve this, all actors in the health system must have common goals.

The current system measures performance through indexes but monitoring healthcare has vast blind spots in areas such as user experience, system competence, confidence in the system, and the well-being of people, including patient-reported outcomes.

Health systems should measure and report what matters most to people, such as competent care. In short, it is becoming clear that access to health care is not enough, and that good quality of care is needed to improve outcomes.

As per the Institute of Medicine (IOM) America, 21st-century health systems should seek to improve performance on six dimensions of quality of care: safety, effectiveness, patient-centredness, timeliness, efficiency, and equity. A focus on equity means that high-quality health care needs to be available and affordable for all people, regardless of underlying social disadvantages.

Framework for Health System

A framework for high-quality health systems and quality improvement consists of three key domains: foundations, processes of care, and quality impacts as per The Lancet global health commission report.

Image: A framework for high-quality health systems


  • Population- Individuals, families, and communities as citizens, producers of better health outcomes, and system users.
  • Governance- Leadership: political commitment, regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioral architecture, and public health functions.
  • Platforms- Number and distribution of facilities, public and private mix, service mix, and geographic access to facilities.
  • Workforce- Health workers, laboratory workers, planners: number and distribution, skills, training in ethics and people-centered care
  • Tools- Hardware: equipment, supplies, medicines, and information systems.


Process of care

  • Competent care and Systems -Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management.
  • Positive user experience- non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use.


Quality Impacts

  • Better health level and distribution of patient-reported outcomes- function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering
  • Confidence in system Satisfaction- recommendation, trust, and care uptake and retention
  • Economic benefit- Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection


People are not just beneficiaries of health services but have a right to health care. Health systems must work together with communities not only to enhance health outcomes but also to create non-health-related value for everyone, especially the most vulnerable and underprivileged members of society.

Secondly, the idea that providing high-quality care should be the main focus of the health system rather than being just a side project for ministries of health.

The article is based on the report: High-quality health systems in the Sustainable Development
Goals era: time for a revolution

Image Courtesy: Global Health & Sustainable Development Goals – Dalla Lana School of Public Health (



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