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Prioritize patient safety to achieve universal health coverage
Health leaders have a unique opportunity to strengthen patient safety, capitalizing on the unprecedented momentum catalyzed by the COVID-19 response.
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Medical workers treat patient inside an emergency tent at Dr. Sardjito General Hospital in Sleman, Yogyakarta on July 4, 2021. (Antara/Hendra Nurdiyansyah)
I
n the World Health Organization South-East Asia region and across the world, the COVID-19 pandemic has accelerated improvements in the quality of health care services, especially in patient safety and infection prevention and control (IPC).
Intensified health worker trainings – both in-person and online – and additional resource allocations have not only helped protect health workers and prevent COVID-19 infection in health care facilities, but also strengthened awareness of and adherence to patient safety and IPC guidelines and protocols, from the “5 moments for hand hygiene”, to the “Know. Check. Ask” protocol for safe medication usage.
Such improvements are critically important, for patients and health workers – yes, but also to accelerate progress towards universal health coverage (UHC), which is not only about coverage and affordability, but also quality.
The numbers are staggering. Each year, between 5.7 and 8.4 million deaths in low- and middle-income countries (LMICs) globally, including in the region, are attributable to substandard care, which accounts for up to 15 percent of all deaths in these countries. An estimated 60 percent of deaths in LMICs from conditions requiring health care are due to poor quality care. The remaining 40 percent result from non-utilization of the health system.
Globally, healthcare associated infections (HAIs) affect an estimated 15 out of every 100 patients in LMICs, killing around 1 in every 10 affected patients. HAIs are often caused by inadequate hand hygiene, which is in turn caused by insufficient awareness of and access to safe water, sanitation and hygiene (WASH) in health care facilities.
At present, both the Region and world are off-track to achieve the 2022 global target of ensuring that at least 60 percent of all health care facilities provide basic WASH services. However, six countries of the Region are now implementing the WHO/UNICEF WASH FIT tool, which all countries should urgently adopt.
Commendably, most countries of the Region now have in place national patient safety and/or quality strategies that are aligned with the Region’s Strategy for Patient Safety 2016–2025, as well as the new Global Patient Safety Action Plan 2021–2030. In all countries, policy makers and program managers continue to incorporate patient safety into disease-specific and clinical program areas, and several countries now have in place specific administrative structures tasked with ensuring health care quality and safety.
However, health leaders continue to face an array of challenges, not least lack of political support and funding, inadequate equipment and infrastructure, poor or non-existent monitoring and evaluation, and a disconnect between national level programmes and implementation at the community level, in primary health care facilities.
And it is in those facilities that action is especially needed – a point repeatedly highlighted at a WHO-convened regional meeting in Bangkok in October. For that, policy makers can intensify action in several key areas, accelerating region-wide efforts to reorient health systems toward quality, resilient primary health care to achieve UHC, health security and Health for All.
First, leveraging increased awareness of the importance of quality of care, patient safety and IPC to ensure that key guidelines and protocols are adequately integrated into national, subnational and facility-level planning. Political commitment must continue to be strengthened and should complement efforts to better protect health workers and improve occupational health and safety standards.
Second, enhancing ownership, engagement and collaboration among the full range of primary care stakeholders. Private providers, professional bodies, academic institutions, patient advocacy and other civil society and community groups must continue to be brought together, engaged and empowered. Patients must be encouraged not only to be aware of their rights, but also of how they can contribute to quality of care, patient safety and IPC, including by complying with facility protocols and directives.
Third, ensuring accountability and compliance. For this, data on implementation of core components of quality of care, patient safety and IPC should be standardized as per WHO guidelines and fed into centralized digital health information systems. It should then be rapidly analyzed to identify gaps and challenges, and to guide additional investments for maximum impact.
Fourth, continuing to facilitate collective learning and innovation. Primary level providers in particular face challenges that are often unique, and which require innovative, out-of-the-box thinking to address. To enable those providers to share experiences, innovations and ideas, digital technology is especially useful, and must be harnessed and applied to maximum effect.
Patient safety is everyone’s business. Amid the intense fiscal pressures imposed by the COVID-19 crisis, as well as broader geopolitical events and challenges, investments in the region to strengthen quality of care, patient safety and IPC will pay for themselves many times over.
Action cannot and must not wait. For a South-East Asia region in which no one is harmed in health care, WHO will continue to provide member states its full technical and operational support – because every patient deserves safe and respectful care, every time, everywhere.
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The writer is regional director, WHO South-East Asia.
