To improve the quality of healthcare delivery, governments and health systems must engage citizens as active partners. Citizens – many of whom are patients or family members of patients – represent one of four dimensions included in a call to action sounded in a recently released report about healthcare quality across the globe. Governments, health systems, and healthcare workers are the other three dimensions.
Developed by the Organization for Economic Co-operation and Development (OECD), the World Bank and World Health Organization (WHO), the report uses data and published evidence to evaluate the effect of poor quality on healthcare providers, as well as individuals, families, local communities and national economies. It calls for quality improvement (QI) in the context of the WHO’s campaign for universal health coverage.
Engagement identified as a high-priority action
Having examined 23 specific interventions designed to improve quality, the report recommends giving seven actions highest priority. In addition to “engaging and empowering patients, families and communities,” the actions include improving frontline clinical practice; setting standards; providing education and training for healthcare professionals and policymakers; using proven QI processes; basing incentives on performance; and pursuing legislative and regulatory actions.
The problem of poor quality in healthcare cuts across political, cultural and economic differences, and so, too, can improvement. The report states that although high quality care may seem ambitious in some circumstances, “it can be achieved in all settings with good leadership, robust planning, and intelligent investment.”
Programs for national or community implementation must vary according to the needs of citizens and the resources available in health systems and provider communities. Successful programs offer lessons learned in diverse communities across the globe. The report includes inspiring examples of quality improvement in Canada, Ethiopia, Mexico, and Sudan.
Engaging citizens to drive improvement in Uganda
In Uganda, for example, a project model called Citizen Voice and Action(CVA) has been used to strengthen primary care by educating and empowering citizens. In the CVA model, people learn about the staffing, equipment, materials and so on necessary for a given project, such as compliance with a standard for vaccination. They are also trained to work within the system to collect data, convene community meetings, hold government and health officials accountable and participate in improvement initiatives. In Uganda, meaningful improvement, including a 33% decrease in mortality of patients under 5 years old, was seen in one year and sustained four years after the project began, according to the report.
Every sector must do its part
The report issues a broad call to action, with high-level recommendations for each sector: government authorities, health systems, healthcare workers, and citizens and patients.
The recommendations for citizens and patients enlist the power of the public sector and private organizations, as well as providers, to help develop engagement and participation. With their help, citizens and patients should:
- Be empowered to actively engage in care to optimize their health status.
- Play a leading role in the design of new models of care to meet the needs of the local community.
- Be informed that it is their right to have access to care that meets achievable modern standards of quality.
- Receive support, information and skills to manage their own long-term conditions.
By making citizens and patients equal and active partners, the OECD, World Bank and WHO acknowledge that high quality care cannot be achieved with their help.
Photo credit: NASA Earth Observatory,“Black Marble – City Lights 2012”