1. World Health Organization
1 October 2019
Quality in Primary Health Care
Dr Shams Syed
Coordinator, Quality Systems & Resilience
WHO Headquarters
PHC Webinar Series
22 August 2019

2. 2018 - Affirming quality as central to UHC
Affirm quality central to universal health coverage - access to care means little if services are not effective;
Substandard care wastes significant resources, fails to turn investments into better health, harms the health of populations, and destroys human capital and productivity;
Quality of care is key to global health security, which starts with local health security, and in turn depends on high-quality PHC services;
Quality is not something that only rich countries can afford. Failure to build quality health systems from the start is what raises the cost.
Poor quality is the result of health system failures, not the fault of individual providers.
Among actions Called for---
National Quality Policy and strategy for every country
Specific focus on Quality in extreme adversity/FCV/emergencies
PHC focus
Measurement focus

3. Deaths due to poor quality
8.6 million deaths per year (UI ) in 137 LMICs are due to inadequate access to quality care.
High-quality health systems could prevent:
2·5 million deaths from cardiovascular disease,
1 million newborn deaths,
deaths from tuberculosis
half of all maternal deaths each year.
Of these, 3.6 million (UI ) are people who did not access the health system.
Whereas, 5.0 million (UI ) are people who sought care but received poor quality care.
Barriers to access hinder progress on UHC and need to be addressed: geographic and others
Even when access is ensured, gaps in quality further hinder progress towards UHC
Available here:

4. Quality health services? Health care that is…
Available here:

5. PHC, UHC & Quality
Quality requires the right HR, the right facilities and the right equipment/products and medicines.
HR either insufficient in numbers or not optimally trained
E/P/M often inadequate
- Combined deficits in HR/E/P/M pose a particular challenge in the context of concurrent chronic conditions which are not amenable to punctual, finite interventions.
See:

6. Available: https://www. who

7. Thinking through Quality Interventions
System environment
Reducing harm
Improvement in clinical care
Patient, family & community engagement & empowerment

8. Quality PHC – an illustrative patient journey
preventive measures to reduce risk of complications
secondary or tertiary care management of serious complications such as vascular or eye disease
Person with diabetes
self-management of blood sugar in the community
measures to adapt to secondary disability
long-term medication use
management of social impacts
Multiple & complex health needs and interactions with services
Heightened potential for worsened health outcomes due to poor quality
PHC uniquely placed to ensure quality throughout the patient journey, for example through:
Focus on individualized prevention, promotion, and treatment
Coordination and “gate-keeping” role to enhance the quality of care
Attention to complex medical and social backgrounds

9. Responding to Major Challenges
10/1/2019
Responding to Major Challenges
Misunderstanding on meaning of quality PHC.
National quality direction – connecting to local PHC.
PHC measurement disconnected from improvement.
Integration of efforts – PHC, districts & hospitals.
Quality initiatives as time-bound projects.
Quality interventions & contextual relevance.
1. …and how quality methods can be applied to PHC to improve health system performance and health outcomes.
2. …front line realities faced by PHC teams are often ignored when setting national directions.
3. …PHC teams provide the information but effective feedback loops are not in place.
4. …quality efforts at PHC level are not sufficiently integrated with overall health service delivery including district health teams as well as hospital level care.
5. …and not embedded within a sustainable and longer term approach for quality PHC.
6. …too often, the globally developed PHC solutions generate local challenges within PHC.
See:

10. Available: https://www. who