High quality health systems in the SDG era: Country-specific priorities for improving quality of care

Résumé

Long a concern in high-income countries, health system quality emerged as a truly global priority in 2018.Three major reports [1-3] and an increasing body of empirical work (e.g., [4][5][6]) identified deep and pervasive deficits in quality undermining progress toward the Sustainable Development Goal (SDG) of health and wellness for all by 2030.Whether this attention translates into effective action in the near future will depend on national leaders seizing the opportunity to change health systems for improved outcomes.How can policymakers and researchers coordinate to ensure that action is informed by evidence and that policy changes are assessed for generalizable insight?To address this question, we gathered leaders in global health active along a spectrum from generating insight in individual studies to making policy that affects millions of individuals and present some of their thoughts here.All have identified health system quality as a key element of progress; each brings a distinct perspective on what change will require in their country or context.As those setting the agenda in countries from India to Mexico, how do they see the future for health system quality?What is needed from the research community to accelerate progress towards improved health?From Nepal, Gagan Thapa argues that strong political commitment is required to ensure that each individual has access to affordable and quality healthcare.Political actors need to be informed about issues related to affordability and other quality issues related to health services and have the political will to resolve them.Critical reform areas such as medical education, procurement of medicines, minimum quality standards, regulation, and partnerships with the private sector will require meaningful engagement of lawmakers as well as their commitment to increases in national budgets for health.People in all countries must be empowered to demand health services that are responsive to their health needs.We have to be better at giving people platforms to express their health needs by including citizen voices during policymaking, budgeting, and planning processes of governments.Yet people are ill-informed about their rights to access quality and affordable healthcare.All too often, people do not access care because it is too expensive, inconvenient, remote from their household, or insensitive to their cultural practices.Many face catastrophic expenditures because of the high costs of surgery, medicines, and related costs for travel and accommodation.We need to have the political courage to include citizen voices in government

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