By Elizabeth Ekirapa-Kiracho, FHS Uganda Team Leader
Improving the effectiveness with which health services are delivered has continued to be a major concern especially in low- and middle-income countries. The ills from poor quality services have now exceeded those from non-utilization of services, with about five million deaths attributed to poor quality services. In the session that I attended at the Fifth Global Symposium on Health Systems Research in Liverpool, the Lancet Global Health Commission on High Quality Health Systems was sharing lessons on improving quality to promote equity and effectiveness in the SDG era. The Commission proposed some key actions to address the poor quality of services, including igniting demand for quality care, governance for quality and program redesign.
One of the issues that caught my attention was governance for improved quality. In my country Uganda, we have many donor projects trying to contribute to quality improvements. While these projects often have positive results, many of these changes are not sustained beyond the life of the project. National and local leaders often do not take center stage in sustaining these interventions, despite their positive results. We need to change this if we want to sustain these quality improvements. A policy maker from Malawi who gave his reflections captured exactly what I was thinking. He emphasized the importance of collaboration, meaningful engagement and strengthening the capacity of national and district leaders who are supposed to drive these quality improvements if we want to see sustainable change.
This whole situation mirrors the following scenario: Imagine coming into my home, finding my children malnourished and dirty, and choosing to teach a member of my household how to look after my children without my involvement. Worse still, you even come with your own team of people to feed and clean up my children. Your team might do a great job, but the moment you and the household member leave, my children will most likely get back to the same state in which you found them.
Those of us who work with national governments and local governments must strengthen their capacity to drive changes and improvements in the quality of services if we want to see lasting change. That is what I consider meaningful health systems strengthening. Of course, this calls for some changes in the way that we work. It also require increased investments from national governments and their partners in training and providing the necessary infrastructure and support structures within district health systems, ministries of health and other key institutions to allow continuous quality improvement driven by those in charge of ensuring that quality services are provided to the population. Judging from the momentum everyone has to achieve the SDG’s I guess this is certainly not impossible!