February 8, 2021

Ensuring good health and well-being for populations around the world is one of the United Nations’ top Sustainable Development Goals. However, it has long been a challenge to deliver quality care to fragile, conflict-affected and vulnerable (FCV) areas. The COVID-19 pandemic has created an extra layer of complexity in these settings, which are often already unstable due to humanitarian crises, protracted emergencies and armed conflicts.

With the need for quality health care more acute than ever, researchers at the UNC Gillings School of Global Public Health have collaborated with the World Health Organization (WHO) to develop a set of resources that can help health and humanitarian agencies design an approach to quality care delivery in FCV settings.

Quality of care in fragile, conflict-affected and vulnerable settings: taking action” and the accompanying tools and resources compendium outline a non-prescriptive process to support actionable quality of care plans that include assessment of needs, challenges and assets; establishment of structures for quality; and agreement, implementation and monitoring of a set of interventions for quality improvement.

Sheila Leatherman

Sheila Leatherman

Sheila Leatherman, professor of global health policy and Gillings Global Advisor, was principal co-author of the documents along with Matthew Neilson and Shams Syed at the WHO. Much of the content draws from published and unpublished work by Leatherman and a Gillings team that included masters and doctoral students and Senior Researcher Linda Tawfik, PhD.

Addressing quality of care in FCV settings is not a one-size-fits-all task, because these areas often vary in the circumstances and complexity they face. The documents provide a starting point for developing quality of care strategies that can be adapted flexibly to a particular area’s context based on elements suggested by the WHO. Such elements include country health priorities, situational analysis, health care governance, contextually appropriate evidence for specific quality interventions and health information systems

In a forthcoming bulletin to be published by the WHO in March, Leatherman and co-authors emphasize that these elements are interdependent and that, in most settings, they can be addressed together through a purpose-driven process. By collaborating with local health experts in FCV areas, health and humanitarian agencies can implement a quality improvement plan in a manner that addresses urgent care needs while allowing interventions that demonstrate success to inform the development and roll-out of a full action plan.

The accompanying tools and resources compendium provides further guidance by cataloging support material relevant to five interventions for quality improvement that emphasize the importance of infrastructure, enforceable quality standards, safety practices, guideline-directed clinical care, and patient and family involvement.

Leatherman also recently co-authored a Viewpoint in the Journal of the American Medical Association with Donald Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement. In “Accelerating Global Improvements in Health Care Quality,” the writers argue that “the proactive improvement of quality in health services cannot be an amenity, reserved for wealthy nations and pursued at leisure. The enormous human and economic burden of poor-quality health care demands that systemic and systematic improvement of health services be elevated to high priority globally and urgently.”

Read more about the WHO resources for quality of care in FCV settings.

Read the JAMA viewpoint.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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