Quality at the centre of universal health coverage

ABSTRACT: The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).


– The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries (LMIC).

– There is a compelling need to shift what has been an inordinate emphasis on reducing financial risk burden towards policy and increased coverage to expand quality of services.

– As the SDG era emerges onto the global scene, countries will be increasingly called upon to address long-standing challenges.


In contrast to common perceptions, quality usually means basic services and interventions, not high tech/high cost care. Poor hand hygiene is rampant among health workers in lower- and middle-income countries and is a grossly underestimated cause of deaths of babies and mothers alike. For simplicity, quality means providing an appropriate health-care service in the right quantity and at the right time.

The Know-Do gap, i.e. what health workers know vs what they do, is large. Clinicians in Delhi, India were found in public clinics to practice just over one-tenth what they described as their standard practice. The same clinicians practiced one-third what they described in private clinics (Das and Hammer 2014).

Meanwhile, overuse of technology often increases the risk of death. For example, keeping a stable pre-term baby in an incubator doubles the risk of death compared with in direct skin contact with the mother (‘Kangaroo Mother Care’)

In the context of our current discussion on Achieving the new global health targets, I was interested to read this paper, which argues for a shift of emphasis from coverage to quality and ‘methodologies to improve health worker competencies’.

CITATION: Quality at the centre of universal health coverage

Howard L. Sobel, Dale Huntington and Marleen Temmerman

Health Policy Plan. (2015) doi: 10.1093/heapol/czv095

First published online: September 29, 2015 The full text is freely available here:


Contact E-mail: sobelh@wpro.who.int

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

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