Quality (54) Between 5.7 and 8.4 million deaths are attributed to poor quality care (2)

26 June, 2021

Dear Mark, (Mark Cantor, Australia)

You ask important questions:

"- Is the data for the 5.7 - 8.4 million deaths available?

- Is the analysis that attributed those deaths to "Quality" available?

- What aspects of quality were the major contributor to those deaths? Such as; - ACCESS to facilities, resources, healthcare professionals? - ENDEMIC DISEASE, insect borne, sanitation, vaccination? - POVERTY, malnutrition? - HEALTHCARE SYSTEM FAILURE?"

The figures are based on a Lancet study in 2018 by Kruk et al which concluded that '8·6 million excess deaths [in 2016] 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

In 2019 I wrote to the corresponding author of the study to ask: how did you define the term non-utilisation of health care?. As a result we learned that this definition only includes care from the facility level upwards. It does not include home-based or community-based care. Of course, care is a continuum from home through the different levels of the health system. A broader definition of 'quality of care' would need to include the care given in the home (or on the roadside), which is partly determined by the level of basic healthcare knowledge of families, bystanders and community health workers.

I raised this on HIFA and we concluded that poor quality care - including care in the community - must therefore cause considerably *more* than 5 million excess deaths per year. Poor quality care may in fact be responsible for up to 3.4 million more deaths per year than originally reported.

WHO's current website appears to accommodate this observation by saying 'Between 5.7 and 8.4 million deaths are attributed to poor quality care each year in low- and middle-income countries'.

https://www.who.int/news-room/fact-sheets/detail/quality-health-services

(I am not sure why the precise numbers have changed from [5m and 8.6m] in The Lancet to [5.7m and 8.4m] on the WHO website. This is presumably due to data obtained since 2018, or a new interpretation of the original data, but I am unaware of such data. Can anyone help?)

We still have a lot to learn about the prevalence and causes of poor quality care, and therefore a lot to learn about how to improve care and reduce avoidable deaths and suffering.

Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Learning for Quality Health Services

https://www.hifa.org/projects/learning-quality-health-services

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org