Recent gains against the burden of illness, injury, and disability and commitment to universal health coverage (UHC) are insufficient to close the enormous gaps that remain between what is achievable in human health and where global health stands today, says a new report from the National Academies of Sciences, Engineering, and Medicine.

The report calls for urgent, comprehensive efforts led by ministries of health worldwide to transform the design of health care through systems thinking and principles of human factors, acknowledge and engage the informal care sector, focus on settings of extreme adversity, embrace digital technologies and emerging innovations, and address corruption.

In low- and middle-income countries, between 5.7 million and 8.4 million deaths occur each year from poor quality of care, which means that quality defects cause 10-15% of the total deaths in these countries, the report says.

The resulting cost of lost productivity is approximately $1.5 trillion each year. The United Nations' Sustainable Development Goals adopted in 2015 include a commitment to achieving UHC by 2030—so that all people and communities receive the quality services they need and are protected from health threats, without suffering financial hardship.

"Even if the current movement toward universal health coverage succeeds, billions of people will have access to care of such low quality that it will not help them, and often will harm them," said Don Berwick.

Emerging digital technologies

Health systems should embrace emerging digital technologies, the report says. A shift in care delivered directly to people wherever they are—for example, in schools or homes—will require new skills, attitudes, and culture among health care providers.

Specifically, the United Nations System should convene an international task force with multi-sectoral representation to provide guidance on governance mechanisms, standards, and regulatory oversight appropriate for these new technologies.

People in many parts of the world, more than 75% of the population in some countries, choose to seek care from informal providers—those who lack formal training but are often well-known in the community. This could be either because people lack access to formal providers or because they do not trust the formal system. However, little is known about the quality of this care.

National health strategies

Governments should assess and integrate informal providers into national health strategies and quality monitoring and improvement plans, and undertake efforts to improve their care through education, training, and realigning incentives.

"For billions of people, universal health coverage will be an empty vessel unless quality improvement becomes as central an agenda as universal health coverage itself," said co-chair Sania Nishtar.

"Increasing quality is not an endpoint, but an ongoing, all-hands-on-deck effort that will require investment, responsibility, and accountability on the part of health system leaders. Health systems need to embrace a vision of the patient journey that is anticipatory and preventive, and wholly centered on continually improving the experience of patients, families, and communities."

Research on these areas should be an urgent priority for governments, nongovernmental organizations, and donors, to identify common quality problems, and to tailor and implement improvement strategies to reduce both preventable deaths and the waste of scarce resources.

Ministries of health should include safeguards in their national health care quality strategies against corruption and collusion, as well as actions for improvements in integrity through prevention, detection, and enforcement. The report also includes recommendations for increased investments in future research on interventions to improve the quality of care at the system level.