Quality in Primary Health Care

The World Health Organization (2018) reports that:

Inherent in universal health care is the need to think beyond improving access to services to also ensuring that those services are of good enough quality to be effective. While many elements of quality have been described over decades, there is growing acknowledgment that high-quality health services across the world should be effective, safe, and people-centered. In addition, in order to realize the benefits of high-quality health care, health services should be timely, equitable, integrated, and efficient.

Primary health care is central to delivering on the promise of high-quality universal health care. The three interrelated pillars of primary health care are; empowered people and engaged communities; multisectoral action for health; and health services that prioritize delivery of high-quality primary care and essential public health functions. While the ways that a primary health care approach promotes quality of care are well recognized, it is widely accepted that quality does not occur spontaneously. Indeed, embedding a culture of quality in primary health care lies at the heart of sustainable improvement in care.

The challenges to improving the quality of primary health care across the world are substantial. Six stand out.

  1. There is often a misunderstanding of what quality means and how methods to improve quality can be applied to primary health care to improve health system performance and health outcomes.
  2. National strategic approaches to quality are often disconnected from local primary health care efforts – front-line realities faced by primary health care teams are often ignored when setting national directions.
  3. Efforts to measure indictors at the primary health care level are disconnected from improvement efforts; primary health care teams provide the information but effective feedback mechanisms are not in place
  4. Efforts to improve quality at the primary health care level are not sufficiently integrated with overall health service delivery including district health teams and hospital-level care.
  5. Initiatives are often seen as projects that are time-bound and not embedded within a sustainable and longer-term approach to develop the quality of primary health care.
  6. Evidence-based interventions that are adopted are not contextually relevant; too often, solutions to improve primary health care that are developed globally create challenges for primary health care at the local level.
World Health Organization. (2018. 02 August). Quality in primary healthcare. https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.54

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