Elizabeth Mitgang and colleagues argue that building capacity in applied systems thinking and human centred design mindsets and methods can help improve quality of care, particularly in low and middle income settings
Health systems are social systems where outcomes for people and communities hinge on their ability to access high quality care when and where they need it. Yet globally, health systems often do not adequately take into consideration the interactions between people, communities, healthcare providers, and the enabling environment.1 The complementary approaches of applied systems thinking and human centred design are gaining traction as methods that can help tackle deficiencies and improve the quality of health services and experiences.1234
Systems thinking offers a practical way to see inter-relations and patterns of change rather than static “snapshots,” and to visualise emergent connections across the people and processes that comprise health systems.56 Human centred
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 Commissio
Minara Chowdhury and colleagues reflect on workforce motivation for quality improvement projects in maternal and newborn healthcare in Bangladesh
Standards for delivering quality maternal, newborn, and child care, such as those from the World Health Organization, emphasise the importance of a competent, motivated workforce.1 Given that the emotional state of health workers and burnout affects their motivation for quality improvement, meeting these standards requires influencing the health system environment.2 We argue from evidence and our experience from healthcare improvement that working to gain greater understanding of what motivates a workforce will help health systems develop improved services. Aligned with this, the American business theorist W Edwards Deming asserted that, to transform quality culture, every employee should be able to achieve joy at work and that joy would lead to improved quality and a high performing organisation.3
Limited resources and space, excessive de
Ugo Okoli and colleagues argue that much can be learnt from Nigeria’s efforts to strengthen continuous measurement of quality using routine data sources to help improve quality of care for women and children
Continuous measurement is a core principle of improving quality of care.12 However, routine data on quality are often limited in resource constrained settings. In many such settings, the primary sources of information on quality of care are periodic assessments often household surveys and healthcare facility assessments. Such assessments, however, are usually too infrequent to be useful for improving care and are often driven by external agencies and donors rather than by local bodies. For example, in Kenya surveys of service provision from 2004 and 2010 showed that respiratory rate was evaluated in 24% and 25% of observed encounters with sick children, respectively.34 For healthcare workers trying to improve care for sick children, an assessment every 5-10 years has limited val
An approach to consistently deliver quality healthcare to everyone, everywhere
Quality healthcare is fundamental to the right to health and its delivery at all times.1 People are healthier and are living longer than ever before, but poor quality care is still causing preventable deaths and unacceptable inequities, especially in low and middle income countries. Despite widespread recognition of the importance of quality health services, improvement efforts continue to struggle against persistent gaps in financing, workforce, and healthcare infrastructure, alongside the overlapping global challenges from pandemics, conflicts, and climate change.23 As the covid-19 pandemic showed, quality matters even more for population health during a crisis.4
Health systems in low and middle income countries operate in different contexts and possess different capacities. Despite these differences, quality care can be sustained and scaled up if it is championed by consistent leadership and supported b