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Delivering complex, high-quality solutions requires intense inter-team cooperation and collaboration. To support this, teams work on a common ART cadence and publish and communicate iteration goals at the beginning of each iteration. They also update other teams during the ART sync and actively manage dependencies by interacting with team members of other teams.
Description: Post Planner wants to help social media marketers with three key jobs: find high-quality content, plan the perfect publishing calendar, and post consistently. It curates and rates content suggestions and allows you to create a content-type-based schedule (more below).
Altium Designer offers a unified environment that empowers engineers with a single view of every aspect of the PCB design process including schematic, PCB layout, harness design, and documentation. By accessing every tool in one place, engineers can complete their entire design within the same intuitive environment and quickly deliver high-quality products.
We propose that health systems be judged primarily on their impacts, including better health and its equitable distribution; on the confidence of people in their health system; and on their economic benefit, and processes of care, consisting of competent care and positive user experience. The foundations of high-quality health systems include the population and their health needs and expectations, governance of the health sector and partnerships across sectors, platforms for care delivery, workforce numbers and skills, and tools and resources, from medicines to data. In addition to strong foundations, health systems need to develop the capacity to measure and use data to learn. High-quality health systems should be informed by four values: they are for people, and they are equitable, resilient, and efficient.
This Commission endorses four universal actions to raise quality across the health system. First, health system leaders need to govern for quality by adopting a shared vision of quality care, a clear quality strategy, strong regulation, and continuous learning. Ministries of health cannot accomplish this alone and need to partner with the private sector, civil society, and sectors outside of health care, such as education, infrastructure, communication, and transport. Second, countries should redesign service delivery to maximise health outcomes rather than geographical access to services alone. Primary care could tackle a greater range of low-acuity conditions, whereas hospitals or specialised health centres should provide care for conditions, such as births, that need advanced clinical expertise or have the risk of unexpected complications. Third, countries should transform the health workforce by adopting competency-based clinical education, introducing training in ethics and respectful care, and better supporting and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts.
What should a high-quality health system look like in countries with resource constraints and competing health priorities that aspire to reach the SDGs? The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era, comprised of 30 academics, policy makers, and health system experts from 18 countries, seeks to answer this question.18 In this Commission, we propose new ways to define, measure, and improve the performance of health systems. We review evidence of past approaches and look for strategies that can change the trajectory of health systems in LMICs.
This report is arranged in the following manner: in section 1, we propose a new definition for high-quality health systems; in section 2, we describe the state of health system quality in LMICs, bringing together multiple national and cross-national data on quality of care for the first time; in section 3, we tackle the ethics of good quality of care and propose mechanisms for ensuring that the poor and vulnerable benefit from improvement; in section 4, we review the current status of quality measurements and propose how to measure better and more efficiently; in section 5, we reassess the available options for improvement and recommend new structural solutions; in section 6, we conclude with a summary of our key messages, our recommendations, and a research agenda.
Building on this and other work, this section sets out our rationale for an updated definition of high-quality health systems and a conceptual framework ready for the health challenges, patient expectations, and rising ambitions of today.27,28
The improvement of health outcomes is the sine qua non of health systems; these outcomes include longer lives, better quality of life, and improved capacity to function. In addition to better health, people derive security and confidence from having a trusted source of care when illness renders them most vulnerable. In this way, health systems also function as key social institutions, both deriving from and shaping social norms and able to promote or corrode public trust.29,30 Finally, health systems cannot be static and must adapt to changing societal needs. This Commission defines a high-quality health system as the following:
A high-quality health system is one that optimises health care in a given context by consistently delivering care that improves or maintains health outcomes, by being valued and trusted by all people, and by responding to changing population needs.
The foundations of high-quality health systems begin with the populations that they serve: individuals, families, and communities. People are necessary partners in providing health care and improving health outcomes; they are not only the core beneficiaries of the health system, but also the agents who can hold these systems to account. The health needs, knowledge, and preferences of people should shape the health system response. High-quality health systems require strong governance, and financing, to promote the desired outcomes and policies to regulate providers, organise care, and institutionalise accountability to citizens. However, regulation will not be enough; health system leaders will need to inspire and sustain the values of professionalism and excellence that underpin high-quality health care. In most countries, health care is provided by three platforms: community health, primary care, and hospital care. An appropriate facility and provider mix, quality-centred service delivery models, and functioning connections between levels of care (eg, referral, prehospital transport) will be required to ensure that the whole system maximises outcomes and the efficient use of resources. Providers, from health workers to managers, are fundamental for health systems, and require adequate numbers, preparation, professionalism, and motivation. Providers need high-quality, competency-focused clinical education, with training in ethics, and a supportive environment for achieving the desired performance. Finally, health systems require not only physical tools, such as equipment, medicines, and supplies, but also new attitudes, skills, and behaviours, including quality mindsets, supervision and feedback, and the ability and willingness to learn from data. The foundations alone will not create good care, and the system will not be able to adapt to new challenges without built-in mechanisms for learning and improvement, including having timely information on performance, assessment of new ideas, and the means to retire ineffective approaches.
The prevention and early detection of diseases, including through recommended screenings, is an important function of high-quality health systems. Across six Latin American and Caribbean countries, less than half of adults reported having had their blood pressure checked in the past year and their cholesterol checked in the past 5 years.76 Rates of cervical and breast cancer screening also vary widely.54 Across six LMICs surveyed by the WHO study on global ageing and adult health (SAGE), mammogram coverage averaged 20% of all women of screening age and was as low as 1% in India and 2% in Ghana (appendix 2).63 Across nine countries in the Americas, average Pap smear coverage was 36% of women in need, ranging from 10% in Nicaragua to 97% in Panama.77 Even people in the health system might not receive the needed screening or early detection. In countries with HIV prevalence higher than 5%, WHO recommends that all pregnant women be tested for HIV.78 In five of nine high-prevalence countries, more than 95% of pregnant women attending antenatal care were tested for HIV. However, despite a HIV prevalence of 27% in Swaziland and 12% in Mozambique, only 56% of women in Swaziland and 69% in Mozambique are tested during antenatal care (appendix 2).
Cardiovascular deaths make up 33% of deaths amenable to health care (figure 5).94 Ischaemic heart disease is the largest contributor to amenable cardiovascular disease deaths, with 1·4 million deaths due to poor-quality care and 260 000 due to non-utilisation of health systems. Of the 2 million deaths from neonatal conditions and tuberculosis that are amenable to health care, 56% occurred in people who used the health system, but did not receive good quality care. Across several other health priorities for which coverage is still low, including chronic respiratory disease, cancer, mental health, and diabetes, non-utilisation of health systems plays a larger role than poor-quality care, but this will change as access increases. Our results highlight that health systems could be more effective in saving lives across a spectrum of conditions by improving quality of care along with expanding coverage. An analysis done with similar methods for a shorter list of conditions found that, globally, 8·0 million deaths could be averted with access to high-quality care.95 2b1af7f3a8