Quality, Equity, Dignity in health services – It’s everybody’s job: national leaders, citizens, health professionals

There can be no Universal Health Coverage (UHC) without quality, equity, dignity and sexual and reproductive health and rights ‘– that statement by Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus captures one of the key takeaways from the 71st World Health Assembly side event ‘Why women, children, adolescents and youth are central to advancing UHC, Quality, Equity, Dignity (QED), and Sexual and Reproductive Health and Rights (SRHR)’, on the 23rd of May in Geneva.

The event, co-organized by the Governments of Malawi and Sweden[1] and co-chaired by the Hon. Atupele Muluzi, Minister of Health, Malawi and Dr Anders Nordström, Swedish Ambassador for the Global Health Ministry for Foreign Affairs, provided a forum for citizens to articulate their experiences in citizen-led accountability processes in relation to UHC, gender equality, sexual reproductive health and rights, and for government representatives to share how they are building systems and structures able to sustain quality of care and achieving UHC, gender equality and health equity.

Three citizens took the floor to share their experiences of direct participation through citizens hearings, how their engagement brought change and held governments accountable to provide better quality, more equitable healthcare. Jean Daryl Ampong, National Youth Representative, Family Planning Organization of the Philippines shared how citizen hearings in the country contributed to lift a ban on family planning. Dr Mahamadou Diakite, Advocacy Project Manager from Mali explained how community hearings were instrumental to address inequities in payment for services and develop structures that engage with communities in the Ministry of Health. Aparajita Gogoi from India, National Coordinator for WRA India clearly voiced that people who have lived in margins of society, including women and children, are often not listen to. These voices are to be heard and protected. They are the basis for accountability and achievement. Governments must embrace them, establish and invest in processes that facilitate getting citizens voices into the public space, imbedding them into the systems and policy development process, including streamlining them into the programme design, implementation and solutions.

Ministry of Health officials talked about their efforts towards institutionalizing quality of care to deliver quality services for women, children and adolescents.  Hon. Minister Muluzi of Malawi, one of ten pathfinder countries that are part of the Network for Improving Quality of Care for Maternal, Newborn and Child Health, shared the story of the exceptional progress of the District Hospital is Thyo which has not registered a maternal death in over 130 days. Dr Emmanuel Ankrah Odame, Director for Policy, Planning, Monitoring and Evaluation at the Ministry of Health in Ghana, another Network pathfinder country, discussed their decade long efforts to redesign the health system to make UHC a reality, in which quality of care has become the new frontier. This will require a national healthcare quality strategy, leadership at national, subnational and facility level, community engagement and efforts to improve the health infrastructure. Dr Maaroufi Abderrahmane, Director of Public Health, Morocco explained how they have made investments in assessing the quality of care at the facility level and accrediting health facilities based on well-defined quality criteria efforts towards improving quality of care in health services, a strategy that has resulted in ongoing improvement of the quality of care in health facilities, and an increase in trust from the communities they serve.

The Quality, Equity and Dignity Advocacy Working Group organized a second event, on 24th May, bringing together a broad range of stakeholders to discuss and explore ‘what works’ for UHC with quality, equity and dignity in health services.  Representatives of government, civil society, the private sector and the health workforce shared best practices in advancing action and accountability to improve both access and quality of care for women, children and adolescents, and increase commitment to QED across all constituencies.  During the event, Dr Andrew Likaka, Director, Quality management Directorate in the Ministry of Health in Malawi, explained why quality, equity, dignity is not a whim, or a pilot project sure to be replaced by a new concept: ‘Sustainability of QED lies on the fact that the global Network for Improving Quality of Care for Maternal, Newborn and Child Health is a movement, not a pilot’, he said. He mentioned that since the Network’s launch, the ten countries leading it have set up guidelines on what quality of care requires, established policies and strategies on quality of care and the institutional structures to implement them. For him, collaboration, partnership, strong leadership and passion are key, and investing in quality is smart: ‘I don’t believe that quality is very expensive. But low quality is costly.’

Dr Michelle Bachelet, Former President of the Republic of Chile, Board Chair of PMNCH in her closing remarks at both events said that policies need to be tailored to the people, and not people to policies. She reiterated the importance of listening to citizens’ demands for quality healthcare, and encouraged the audience to support the What Women Want campaign which aims to hear directly from at least 1 million women and girls worldwide about their one ask for quality maternal and reproductive health care. She stressed that accountability is essential to sustain institutions, including quality, and that governance should facilitate the creation of spaces for dialogue to advance and lead to accountability.