It's interesting to reflect on how little we know about the healthcare-related causes of death and suffering. And what little we know is mostly from facility-level care situations.
A much-cited paper by Kruk et al (2018) estimated that, worldwide, '8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care'. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext
At the time I wrote to the authors and discovered their estimate was based only on care in the facility upwards. If care in the home and community had been included, the estimate would have been much higher. It's also not possible to demarcate deaths due to receipt of poor-quality care and those due to non-utilisation of health care.
Clearly we lack knowledge about the contribution of poor quality care to avoidable death and suffering. Our knowledge is even less about the relative contributions to poor qualitative care. The above paper provides no pointers. We simply don't know, for example, how many deaths are due to a lack of reliable healthcare information versus (say) lack of access to essential medicines. We know far more about medical causes of death than we know about healthcare-related causes.
Perhaps one thing on which we may all agree is that the availability and use of reliable healthcare information (including knowledge from previous learning and experience as well as immediate point-of-care information) is a prerequisite for safe and effective care.
We might also agree that the availability and use of relevant, reliable healthcare information is a prerequisite whatever the situation and whatever the current level of resources.
I invite you to look at HIFA's Theory of Change in our Strategy 2022-2024:
https://www.hifa.org/sites/default/files/other_publications_uploads/HIFA...
'HIFA uses a Theory of Change whereby HIFA’s inputs, activities and outputs translate into outcomes and impact, thereby driving progress towards universal access to reliable healthcare information. The first part of the ToC shows 'how HIFA accelerates progress towards universal access to reliable healthcare information'. The second part shows how 'Improving access to information contributes to high-level global health goals'.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
