Quality of Care
Care that is ‘clinically effective, safe and a good experience for the patient’ is needed.
One of the greatest concerns of an effective health system is the quality of care that it delivers.
The presence of fully equipped public health centres and skilled health care workers does not always ensure desirable health outcomes. Several quality issues in service provision and clinical practice are a result of gaps in technical knowledge or its wrong application, breaches of standard and recommended procedures and practices, lack of commodities, poor referral processes, etc. Care is also hampered by a poor understanding of patient needs, low motivational levels of health care workers, etc. which result in inappropriate communication with women or at time disrespectful treatment.
On several occasions, women are confronted by such inadequate and poor quality services. A recent report – Failure to Deliver, highlights the various quality failures in the care provided to women in Kenyan health care centres, which tantamount to human rights violations.
Women’s and their families’ experience with the health care system influence their decisions around future use of these services. These can be life-determining. In pregnancy and childbirth every woman faces a potential risk of complication, some which can very rapidly slide into becoming life-threatening. Any delays to appropriate care as a result of women’s own decisions or quality failures of the health system therefore deserve attention.
Quality improvements to a health system can be done at different levels. Some of the quality issues which are result of poor management, organisational issues and lack of finances can be addressed for example, through accreditation, laws, regulatory bodies, or clinical guidelines. The use of organisational change models such as ‘Total Quality Management’ or ‘Quality Assurance’ are also used to improve health workers practice Enhancing the provision of quality care by health workers can be achieved through initiatives in continuous education, performance based payments, good supervision and support, clinical audits, maternal death reviews, etc. In Angola, clinic-based audits of referrals in obstetric emergencies helped to improve quality of care and decrease maternal mortality from 17.8% to nil, as reported by a recent article - Audit of Referral of Obstetric Emergencies in Angola: A Tool for Assessing Quality of Care (PDF). The success of any quality improvement tool or programme is ultimately depends on the action it can bring about in the health system. And changes are possible, as shown by a UNICEF programme in Uzbekistan.