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Safe, Effective, Timely, Efficient, Timely, Equitable and People centered.

• Safe – delivering health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors

• Effective – providing services based on scientific knowledge and evidence-based 

• Timely – reducing delays in providing and receiving health care

• Efficient – delivering health care in a manner that maximizes resource use and avoids waste

• Equitable – delivering health care that does not differ in quality according to personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status

• People-centred – providing care that takes into account the preferences and aspirations of individual service users and the culture of their community

Provision of Care and Experience of Care

• Evidence-based practices for routine care and management of complications
• Actionable information systems
• Functional referral systems

• Effective communication
• Respect and preservation of dignity
• Emotional support

1. Evidence-based practices for routine care and management of complications;

2. Actionable information systems;

3. Functioning referral systems;

4. Effective communication;

5. Respect and preservation of dignity;

6. Emotional support;

7. Competent, motivated personnel; and

8. Availability of essential physical resources.

There is evidence that despite the progress made in increasing access and coverage, the gap in quality of care is contributing to unnecessary complications and deaths among women, newborns and children. (See Trends in maternal mortality 2000 to 2020 Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division)

Focusing on the quality of care in healthcare settings is crucial for several reasons, as it directly impacts patient outcomes, satisfaction, and the overall effectiveness of healthcare systems. Here are some key reasons why there is a strong emphasis on the quality of care:

Patient Safety:

• Ensuring the quality of care is paramount for patient safety. High-quality care minimizes the risk of medical errors, infections, and adverse events, contributing to a safer healthcare environment for patients.

Improved Patient Outcomes:

• Quality care leads to better health outcomes for patients. When healthcare providers adhere to evidence-based practices, guidelines, and standards, patients are more likely to experience positive results from their treatment and care.

Patient Satisfaction:

• The quality of care significantly influences patient satisfaction. Patients are more likely to be satisfied when they receive care that is timely, respectful, and aligns with their needs and preferences. Positive patient experiences contribute to better healthcare relationships and adherence to treatment plans.

Efficiency and Resource Utilization:

• Quality care is often associated with efficient and effective healthcare delivery. When healthcare providers follow best practices and use resources wisely, it contributes to the overall efficiency of healthcare systems, reducing unnecessary costs and improving resource utilization.

Prevention and Early Detection:

• High-quality care emphasizes preventive measures and early detection of illnesses. Regular screenings, vaccinations, and health education contribute to preventing diseases or detecting them at early stages when interventions can be more effective.

Trust and Credibility:

• Quality care enhances the trust and credibility of healthcare providers and institutions. When patients have confidence in the quality of care they receive, they are more likely to trust their healthcare providers, follow medical advice, and engage in shared decision-making.

Health Equity:

• A focus on quality care contributes to achieving health equity. Ensuring that all patients, regardless of their background, receive high-quality care helps address disparities in healthcare outcomes and access.

Mothers, newborns and children continue to die from preventable causes, even when they are in the care of health services. Poor quality care also increases the risk of illness and life-long disability. For states that have committed to achieving the Sustainable Development Goals, improving the quality of care will be critical to end preventable maternal, newborn, and child deaths by 2030.

The consequences of poor-quality care in healthcare settings can have far-reaching and serious implications for patients, healthcare providers, and the broader healthcare system. Here are some key consequences:

Patient Harm:

• Poor quality care can result in direct harm to patients, including medical errors, complications, and adverse events. This can lead to prolonged recovery times, additional treatments, and sometimes irreversible damage to patients' health.

Increased Morbidity and Mortality:

• Suboptimal care may contribute to higher rates of morbidity and mortality. When healthcare providers deviate from established standards and best practices, patient health outcomes are negatively affected, leading to increased illness and, in severe cases, death.

Decreased Patient Satisfaction:

• Patients are likely to be dissatisfied when they perceive the care they receive as of poor quality. Negative experiences can erode trust in healthcare providers and institutions, impacting patient satisfaction and potentially leading to reluctance to seek timely care.

Increased Healthcare Costs:

• Poor quality care can contribute to increased healthcare costs. Patients may require additional treatments, hospital readmissions, or interventions to address complications that arise from suboptimal care. These additional costs strain healthcare systems and may result in inefficiencies.

Workforce Disengagement:

• Healthcare providers working in an environment where quality of care is compromised may experience burnout, dissatisfaction, and disengagement. This can lead to higher rates of turnover, impacting the stability and effectiveness of healthcare teams.

Public Health Risks:

• Consistent poor-quality care can erode public trust in healthcare systems. When patients and communities lose confidence in the ability of healthcare providers to deliver safe and effective care, they may delay seeking necessary treatments or avoid healthcare altogether.

Health Inequities:

• Poor quality care may contribute to the spread of infectious diseases and other public health risks. Failure to adhere to infection control measures or timely interventions can lead to outbreaks and pose risks to the broader community.

The Sustainable Development Goals place a clear emphasis on achieving Universal Health Coverage (UHC) by ‘ensuring that all people and communities can access and use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality, while also ensuring that the use of these services doesn’t expose the user to financial hardship’. Achieving UHC will require more than just increased coverage. The success of UHC depends on its ability to provide quality services to all people, with dignity, everywhere. In addition, for those who have access to services, poor quality has been the cause of morbidity and mortality. So, access without quality results in morbidity and mortality!

Quality of care is intricately linked to the achievement and sustainability of Universal Health Coverage (UHC). Universal Health Coverage aims to ensure that all individuals and communities receive the health services they need without suffering financial hardship. Quality of care plays a critical role in the effectiveness, acceptability, and overall success of UHC for several reasons:

Ensuring Access to Effective Services:

• UHC aims to provide access to essential health services for everyone. However, merely expanding access is not enough; the services provided must be of high quality to be effective. Quality of care ensures that individuals not only have access to healthcare services but also receive care that meets established standards and improves health outcomes.

Preventing Financial Hardship:

• UHC aims to protect individuals and communities from financial hardship related to healthcare costs. Poor quality care can lead to adverse outcomes, necessitating additional treatments, hospital readmissions, or corrective interventions. High-quality care, on the other hand, minimizes the risk of complications and reduces the financial burden on individuals.

Promoting Health Equity:

• Quality of care is essential for achieving health equity, a key principle of UHC. Ensuring that all individuals, regardless of their socioeconomic status, geographic location, or other factors, receive high-quality care helps address disparities in health outcomes and contributes to a more equitable distribution of health services.

Building Trust in Health Systems:

• Trust is a fundamental component of successful health systems. Quality of care is a major determinant of trust. When individuals have confidence in the healthcare services they receive, they are more likely to engage with the health system, seek preventive care, and adhere to treatment plans—all of which are essential for the success of UHC.

Promoting Population Health:

• UHC seeks to improve population health outcomes. High-quality care contributes to achieving this goal by focusing on preventive measures, early detection, and evidence-based interventions. Quality care is not only about treating illnesses but also about promoting overall health and well-being.

Efficient Resource Utilization:

• Quality of care is often associated with efficient healthcare delivery. Effective and evidence-based practices help optimize resource utilization within health systems. This is crucial for the sustainability of UHC, ensuring that resources are used wisely to provide the greatest benefit to the population.

Reducing Unnecessary Expenditures:

• Poor quality care can result in avoidable complications, hospital readmissions, and other adverse events, leading to unnecessary healthcare expenditures. By focusing on quality, UHC initiatives can reduce these avoidable costs, freeing up resources for other essential health services.

Encouraging Public Participation:

• UHC emphasizes the involvement of communities and individuals in decision-making processes. Providing high-quality care promotes active engagement and participation by instilling confidence in individuals that their health needs will be met effectively.

In summary, the pursuit of Universal Health Coverage is not just about expanding access to healthcare; it also requires a commitment to delivering high-quality, equitable, and efficient health services. Quality of care is both a means to achieve UHC and an outcome of successful UHC implementation. By prioritizing quality, countries can enhance the impact and sustainability of their efforts toward universal and equitable health coverage.

Nigeria join the global quality of care Network in the year 2017

Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania and Uganda – are pathfinder countries that are already taking the lead in improving quality of care for maternal, newborn and child health. Nine of them joined the Quality-of-Care Network at the onset, in 2017, while Sierra Leone joined in 2018.

• It will reduce maternal/newborn mortality and general health outcome of the population if successful and the country will see rapid progress towards the achievement of Sustainable Development Goals 3.
• The establishment of a Quality-of-Care Network has a significant and positive impact on various levels. The specific impact will depend on the goals, strategies, and implementation of the network.
• The impact of a Quality-of-Care Network is comprehensive, spanning from individual patient outcomes to broader healthcare system improvements. It reflects a commitment to excellence, safety, and continuous improvement, leading to improved patient outcomes, reduced complications, and better overall health for individuals receiving care.
• Quality of Care Network focuses on delivering standards and best practices, seamless transitions between different levels of care, and effective communication between States. The network provides a platform for States and healthcare professionals to collaborate, share best practices, and engage in continuous learning. This fosters a culture of professional development, reducing unnecessary procedures, avoiding duplicative tests, streamlining processes, knowledge exchange among healthcare teams, adhering to established standards, guidelines, and regulatory requirements, and enhancing compliance with Standards and Regulations
• The network stays at the forefront and serves as a hub for innovation and continuous improvement. By regularly evaluating and adapting practices, incorporating new technologies, and fostering a culture of innovation, in delivering high-quality care.
• A well-functioning Quality of Care Network contributes to the overall improvement of healthcare systems. This includes strengthening the resilience of health systems, improving efficiency, and promoting the sustainability of healthcare services.

Patient satisfaction is a key component of quality of care, reflecting the patient's experience with the healthcare system, including communication, respect, and the effectiveness of treatments received.

Evidence-based medicine involves using the best available scientific evidence to make healthcare decisions. It ensures that healthcare practices are based on sound research, leading to improved outcomes and patient safety. 

Measures include patient safety indicators, readmission rates, adherence to clinical guidelines, infection rates, and patient-reported outcomes. These metrics help evaluate and improve the quality of care.

Cultural competence involves understanding and respecting diverse cultural backgrounds. Healthcare providers can enhance quality of care by promoting cultural competence, ensuring that services are tailored to individual patient needs.

Care coordination involves organizing and coordinating healthcare services to improve efficiency and effectiveness. It plays a crucial role in preventing gaps in care, reducing errors, and enhancing the overall quality of healthcare.

Health information technology, such as electronic health records, facilitates better communication, reduces errors, and improves coordination among healthcare providers. It enhances the overall quality and safety of patient care.

Patient safety initiatives focus on preventing errors, infections, and other adverse events in healthcare settings. They are essential for ensuring a safe environment and improving the quality of care provided to patients.

Continuous quality improvement involves ongoing efforts to improve processes, outcomes, and patient satisfaction. It can be implemented through regular assessment, feedback, and the adoption of best practices to enhance the overall quality of care.

Learning sites are health facilities selected for the purpose of learning, to serve as “laboratories” to test ideas, develop contextualized models of implementation and inform the scaling up of QI at national level. (QoC Implementation guide, WHO 2022). These are the facilities reporting to the global network.

 QoC Sites are health facilities where quality of care has been scaled up based on lessons learned from the learning site as agreed by the country RMNCAEH+N QoC technical working group.

Maternal death is death of a woman arising from complications of pregnancy or delivery of a baby. This can occur while the woman is pregnant or within six weeks of delivery of the baby. It can be due to the complications related to the pregnancy, or underlying conditions worsened by the pregnancy or management of these conditions. This is the WHO definition. The CDC extends the period to one year from the resolution of the pregnancy. It is calculated as the number of maternal deaths in a population during a specified time period, typically one calendar year.

Is defined as the number of maternal deaths during a given time period per 100 000 live births during the same time period; thus, it quantifies the risk of maternal death relative to the number of live births.