Reducing harm in health care for quality health

By Mohambry Nadesan (Morgan) Chetty

The inability of health systems to put people first and mitigate harm requires all stakeholders to refocus and revise public health policies. On an international scale, the COVID-19 pandemic has shown the world the need for a health system for all, prioritizing saving and improving lives.

However, research conducted before the pandemic showed that there was an urgent need to improve the quality of healthcare, especially in low- and middle-income countries.

The joint report of the Organization for Economic Co-operation and Development (OECD), the World Health Organization and the World Bank, released in 2018, titled Providing quality health services: a global imperative for universal health coverageit was clear that poor quality health services are holding back progress in improving health in countries at all income levels.

The report found that inaccurate diagnoses, medication errors, inappropriate or unnecessary treatments, inadequate or unsafe clinical facilities or practices, or providers lacking adequate training and skills, prevail in all countries.

The situation is worse in low- and middle-income countries, where 10% of hospitalized patients can expect to contract an infection during their stay, compared to 7% in high-income countries, the report said.

The report also revealed significant findings, including health care workers in low- and middle-income African countries with limited accuracy in diagnoses, poor adherence to clinical guidelines for common conditions, and a mismatch between access to services and availability of effective maternal and child health services. in high mortality countries in the Caribbean and Africa.

He also proposed a way forward aimed at health policy makers. He said role actors in critical areas need to work together with a sense of urgency to enable the promise of the Sustainable Development Goals for better and safer health care to be realised.

Governments have been called upon to lead the way in the formation of new stronger and more robust national policies and strategies for health care quality. However, these calls have been made previously and continue to be made.

The transformation of the South African health system: progress and challenges

In 1997, the Department of Health released a white paper outlining the transformation of the South African health system. The paper proposed policies to radically reshape health care delivery, recognizing the need for further improvements despite some initial gains.

The main areas of interest included the management of health services, with particular attention to the district health system to improve access to primary health care for all citizens. The document also highlighted the importance of ensuring the availability of safe and high-quality essential medicines in health care settings, as well as streamlining health care financing through reprioritisation of budgets.

Furthermore, the white paper emphasized the development of a National Health Information System, with the aim of strengthening health planning and management. Disease prevention and health promotion initiatives were also emphasized, particularly in addressing areas such as HIV/AIDS, sexually transmitted diseases, and children\’s and women\’s health.

The Department of Health has recognized the need to leverage public and private resources, presenting implementation strategies to meet the basic needs of all people despite limited resources.

However, more than two decades later, the ranking of South African health systems remains a cause for concern, falling in the middle or relatively low depending on which index is used. This troubling statistic reflects the failure to provide all citizens with their basic human rights through an effective and equitable health care system.

National Health Insurance is a funding system designed to pool funds to provide access to quality, affordable personal health care services to all South Africans based on their health care needs, regardless of their socio-economic status.

In this decade, calls for national health insurance have strengthened, although it was first advertised in 1997. But due to the fragmented, burdened and highly complex system created over the years, progress is very slow.

It is evident that the gap between those who can afford health care and those who cannot afford it is widening. This reality has attracted attention during the Covid-19 pandemic.

The Department of Health has noted that one of the driving needs of the system is that, although eight out of 10 patients use public clinics and hospitals, the majority of doctors, dentists and specialists in the country work in the private health sector serving a small part of the la population leaving the largest population in public hospitals unattended.

But that\’s just the tip of the health iceberg. Poor, outdated and inadequate health policies have created a breeding ground for lack of resources, including personnel. This is also the breeding ground for preventable deaths.

Quality of health care, burden of care, political challenges

Two years ago, Andrea Gaspar and J Jaime Miranda conducted a study entitled Treatment Burden as a Measure of Healthcare Quality: An Innovative Approach to Addressing Global Inequalities in Multimorbidity. Their findings revealed that quality system failures contribute to more deaths than those caused by HIV, tuberculosis and malaria.

The study highlighted the profound impact of poor quality care in low- and middle-income countries, stating that nearly 60 percent of the 8 million preventable deaths that occur in these regions each year are attributed to quality deficits.

Gaspar and Miranda underlined the urgent need to improve the quality of primary health care in order to prevent the negative downstream effects of poorly managed multimorbidity. They highlighted negative consequences, including a decreased quality of life, impaired functional status, increased pressure on already resource-limited health care systems, economic burdens, and a widening equity gap for people living with chronic conditions.

Patients will suffer from a worse quality of life and reduced functional status. Healthcare systems that are already strapped for resources and money will become even more strained, negatively affecting economies and widening the equity gap among those living with chronic conditions.

I believe that reducing harm in healthcare can improve patient safety in Africa.

This can be done by examining the concept of harm reduction beyond substance abuse to encompass various health risks and the broader healthcare public.

Examples include substance abuse, medical errors, hospital-acquired infections, poorly equipped and under-resourced health platforms, insufficient human resources for health, and poorly resilient health systems.

In answering whether scientists, industry, doctors and government in South Africa work together to ensure science informs policy, I am of the view that scientists\’ views are often overshadowed by political leanings.

There is no balanced working group to discuss their issues whose vision keeps its distance and ultimately dominates politics. The perception of the population is that we are politically driven. Equally worrying are unfinished policy directives and legislation, such as the National Health Insurance Act, which has yet to be signed, and the Tobacco Products and Electronic Delivery Systems Control Act, which is rather confusing.

The change needed to ensure that the health sector actually delivers adequate health care for all must be led by a government that will involve all stakeholders and give them fair hearings. We have seen how the multidisciplinary effort of all stakeholders has strengthened the state\’s response to the COVID-19 pandemic. South Africa\’s response to the pandemic has not been perfect. However, it was far superior to many developed countries because, for once, the country has truly pooled all of its resources, researchers and technological tools and pushed legislative and policy changes faster than we\’ve ever seen it happen. .

If we could once again pool all these resources and be led, South Africa could have a thriving, somewhat equitable and adequate healthcare renaissance that would positively impact our economy, fight the inequality gap and truly uplift and recognize the right a basic health care enshrined in our Constitution.

Professor Mohambry Nadesan (Morgan) Chetty is the President of the IPA Foundation. Dr. Chetty is a physician and has been at the helm of family medicine for nearly 40 years.