Kevin Croke and colleagues consider how demand for quality health systems can be made a political and public priority to drive change in low and middle income countries
The root causes of gaps in quality of care in the health systems of low and middle income country generate considerable debate, and opinions differ about how to tackle these gaps. The debate is illustrated by three important reports published in 2018.123 The consensus view of major global health institutions is well captured by the 2018 report from the World Health Organization, World Bank, and Organisation for Economic Cooperation and Development, which emphasised technical strategies to improve system quality such as changes to payment systems, adoption of new technologies, and scale-up of facility level quality improvement interventions. This approach is consistent with most published evidence in the quality improvement field, which explicitly or implicitly takes the same approach. The Lancet Global Health Commission for High Quality Health Systems, by contrast, argued that quality interventions focused on frontline services were effectively sticking plasters, unlikely to drive systemic change. Real progress would require fundamental, system level changes in medical education, service delivery models, measurement, and health system governance. This perspective drove the argument that “moving to a high quality health system … is primarily a political, not a technical, decision.”1
Both the Lancet commission and the 2018 report on health system quality from the National Academies of Medicine, Science and Engineering highlighted the importance of “igniting” or “activating” demand for quality.23 But neither offered a detailed explanation of where that demand might come from and how it could be cultivated. Drawing on theory and evidence from political science and public policy studies, as well as recent experiences from Nepal, we argue that existing thinking about demand for health …
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Ethiopia , Estonia , Kenya , Tanzania , Ghana , Thailand , Brazil , Nepal , Addis Ababa , T10 , Amit Aryal , Kevin Croke , Regina Kamoga , Emma Veitch , Juan Franco , Margarete Kruk , Sudip Pokhrel , Jennifer Rasanathan , Gagank Thapa , Quality Evidence For Health System Transformation Network , Melinda Gates Foundation , Ethiopia Public Health Institute , World Health Organization , Organisation For Economic Cooperation , Ministry Of Health , Quality Evidence For Health System Transformation , Addis Ababa University , National Academies Of Medicine , World Bank , Economic Cooperation , Lancet Global Health Commission , High Quality Health Systems , National Academies , Quality Evidence , Health System Transformation , Health System Transformation Network , Global Health Commission , Melinda Gates , Open Access , Creative Commons Attribution ,
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