Why It Matters
Although more people in low- and middle-income countries are now able to reach care facilities, there is growing evidence that access to services alone cannot improve the outcomes of populations.
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Making Universal Health Coverage Whole: Adding Quality as the Fourth Dimension

By Pierre Barker | Monday, December 12, 2016

Good news: The definition of Universal Health Coverage (UHC) has been updated to acknowledge the central role of quality.

In 2005, the WHO defined UHC as “all people obtain the health services they need without suffering financial hardship when paying for them.” But seven years later, Margaret Chan, Director-General of the WHO, issued this challenge at the 2012 WHO World Health Assembly: "What good does it do to offer free maternal care and have a high proportion of babies delivered in health facilities if the quality of care is sub-standard or even dangerous?"

Although more people in low- and middle-income countries are now able to reach care facilities, there is growing evidence that access to services alone cannot improve the outcomes of populations.

It’s time to reframe the 2010 WHO UHC “cube” that currently describes only three dimensions of UHC:

  • Who is covered?
  • Which services are covered?
  • What proportion of costs are covered?

We propose that quality of care needs to be called out as a specific dimension of UHC. Others are making the same case.

The Universal Health Coverage Coalition includes quality in its updated description of UHC: “Health coverage means everyone can access quality health services without financial hardship.” And the WHO has updated its description of UHC to include quality: “UHC enables everyone to access the services that address the most important causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them.”
UHC-cube

We should continue to strive to “fill the UHC cube” in its current three dimensions — extending care to those not currently covered, extending coverage to all needed services, and reducing costs to the patient. At the same time, adding the dimension of quality will not only improve population outcomes, but will also make health services more attractive to the people they serve, accelerating progress toward UHC.

In recognition of this key role of quality, the WHO is now mainstreaming quality of care into guidance for rapidly scaling up health programs. This opens a huge opportunity for supporting the ultimate goal UHC: ensuring everyone to access quality health services without financial hardship.

IHI Chief Innovation and Education Officer Kedar Mate also contributed to this post.

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