High-quality health systems in the Sustainable Development Goals era: time for a revolution

There is a word missing from the 1978 Declaration of Alma Ata: a close examination reveals that “quality”, the adjective, does not appear in it. True, the stated definition of primary health care includes the notions of practicality, scientific soundness, and social acceptability, all elements of quality when referring to the provision of health care. But the omission of the actual term could almost be taken as a foretelling sign of what happened in the four decades following the Alma Ata conference—the attainment of Health for All through community-led and participative primary health care did not come as a natural evolution for most health systems, and most importantly, health-care delivery suffered from such deficiencies that poor-quality care ultimately became a more formidable obstacle to reducing mortality in low-income and middle-income countries than insufficient access to care.

In 2018, we published our first Commission entitled High-quality health systems for the Sustainable Development Goal era: time for a revolution. The Commission argued that, in the drive towards universal health coverage (UHC), there was a moral imperative to consider a basic level of quality, showing that more people globally die from poor quality care than from lack of access to it. One of the four main recommendations of the Commission was that countries should redesign service delivery to maximise health outcomes, not geographical access, and one of the key elements of service redesign was a greater focus on primary health care (PHC).

The Lancet Global Health Commission on High Quality Health Systems-where's the complexity?

Managing medical (mis)information

Framing an agenda for children thriving in the SDG era: a WHO–UNICEF–Lancet Commission on Child Health and Wellbeing

The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

Putting quality and people at the centre of health systems

SummaryBackgroundPrimary care has the potential to address a large proportion of people's health needs, promote equity, and contain costs, but only if it provides high-quality health services that people want to use. 40 years after the Declaration of Alma-Ata, little is known about the quality of primary care in low-income and middle-income countries. We assessed whether existing facility surveys capture relevant aspects of primary care performance and summarised the quality of primary care in ten low-income and middle-income countries.MethodsWe used Service Provision Assessment surveys, the most comprehensive nationally representative surveys of health systems, to select indicators corresponding to three of the process quality domains (competent systems, evidence-based care, and user experience) identified by the Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Goals Era. We calculated composite and domain quality scores for first-level primary care facilities across and within ten countries with available facility assessment data (Ethiopia, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda).FindingsData were available for 7049 facilities and 63 869 care visits. There were gaps in measurement of important outcomes such as user experience, health outcomes, and confidence, and processes such as timely action, choice of provider, affordability, ease of use, dignity, privacy, non-discrimination, autonomy, and confidentiality. No information about care competence was available outside maternal and child health. Overall, scores for primary care quality were low (mean 0·41 on a scale of 0 to 1). At a domain level, scores were lowest for user experience, followed by evidence-based care, and then competent systems. At the subdomain level, scores for patient focus, prevention and detection, technical quality of sick-child care, and population-health management were lower than those for other subdomains.InterpretationFacility surveys do not capture key elements of primary care quality. The available measures suggest major gaps in primary care quality. If not addressed, these gaps will limit the contribution of primary care to reaching the ambitious Sustainable Development Goals.FundingBill & Melinda Gates Foundation.

Moving ahead: what will a renewed Countdown to 2030 for Women and Children look like?

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

This article aims to discuss the roles of local governments in the era of Sustainable Development Goals (SDGs), with a case study of Gyeongsangbukdo Province and Daegu Metropolitan City in South Korea. The study looks at the main official development assistance (ODA) policies and activities of these two local governments, and how these two local governments have adopted the SDGs framework. In doing so, this study has employed the approach of network governance regarding the establishment of partnerships between a central authority and local governments and between local governments and other aid stakeholders at the local level. The findings of the study suggest that local governments’ ODA policies and activities in South Korea are barely commensurate with recent norm change at the international level. Given this, this study argues that local governments in South Korea need to develop their ODA capacity building in order to be in line with international norms.

—Initially defined for overall public purposes, the concept of fiscal space was subsequently developed and adapted for the health sector. In this context, it has been applied in research and policy in over 50 low- and middle-income countries over the past ten years. Building on this vast experience and against the backdrop of shifts in the global health financing landscape in the Sustainable Development Goals (SDG) era, the commentary highlights key lessons and challenges in the approach to assessing potential fiscal space for health. In looking forward, the authors recommend that future fiscal space for health analyses primarily focus on domestic sources, with specific attention to potential expansion from the improved use and performance of public resources. Embedding assessments in national health planning and budgeting processes, with due consideration of the political economy dynamics, will provide a way to inform and impact allocative decisions more effectively.

This study investigates the impact of corporate governance mechanisms (namely board meeting, board independence, board gender diversity, CEO duality, ESG-based compensation and ESG committee) on carbon emissions performance of multinational entities (MNEs). The study analysed international sample of 336 top MNEs operating in 42 non-financial industries from 32 countries over a 15-year period. Result shows that board gender diversity, CEO duality, and ESG committee are negatively associated with carbon emissions rate, whilst board independence and ESG-based compensation have significant positive impact. Whereas board gender diversity and CEO duality have significant negative impact on carbon emissions rate in carbon-intensive industries, the impact of board meeting, board independence and ESG-based compensation is significant and positive. In the non-carbon-intensive industries, board meeting, board gender diversity and CEO duality have significant negative impact on carbon emissions rate, whilst the impact of ESG-based compensation is positive. Further, there is a negative association between the millennium development goals (MDGs)/sustainable development goals (SDGs) era dichotomy and carbon emissions rate, implying that the United Nations agenda for sustainable development significantly affected carbon emissions performance of MNEs, with the SDGs era generally witnessing better carbon emissions management in comparison to the MDGs era in spite of the higher emissions level in the SDGs era. The study contributes to knowledge in several ways. First, it adds to the limited literature on the determinants of carbon emissions reduction within an international context. Second, the study addresses mixed result reported in prior studies. Third, the study adds to knowledge on the governance factors affecting carbon emissions performance in the MDGs and SDGs periods, thus providing evidence on progress MNEs are making towards addressing climate change challenges through carbon emissions management.

African Journal of Midwifery and Women's HealthVol. 17, No. 2 EditorialInterprofessional collaboration in maternity careUnice GoshomiUnice GoshomiCorrespondence to:E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:16 Jun 2023https://doi.org/10.12968/ajmw.2023.0019AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Behruzi R, Klam S, Dehertog M et al.. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy Childbirth. 2017;17(1):1–4. https://doi.org/10.1186/s12884-017-1381-x Crossref, Google ScholarCharalambous C, Rampton B. Language learning, identity, and intercultural communication in contexts of conflict and insecurity. In: Jackson J (ed). The Routledge handbook of language and intercultural communication. Abingdon, Oxfordshire: Routledge; 2020 Crossref, Google ScholarKruk ME, Gage AD, Arsenault C et al.. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 17Issue 2ISSN (online): 2052-4293 Metrics History Published online 16 June 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

At the conclusion of the Millennium Development Goals (MDGs) campaign in 2015, stunting among under 5-year-olds remained a major challenge in South Asia and Southeast Asia, with South Asia lagging behind—a phenomenon known as the “Asian enigma.” This paper revisits the issue, focusing on progress achieved during the first half of the Sustainable Development Goals (SDGs) era. Using microdata from eight countries in South Asia and Southeast Asia, each with at least one pre-2015 and one post-2015 round of Demographic and Health Surveys, we compare stunting outcomes across pre-MDG, MDG, and SDG cohorts. Our findings indicate that children born in the SDG era exhibit better height-for-age outcomes compared to earlier cohorts, although significant disparities persist across countries. In particular, we provide new evidence of the “Indian enigma,” characterized by a persistently high prevalence of child stunting in the SDG era compared to Bangladesh, Cambodia, and Nepal. The paper concludes with a preliminary exploration of policy-related factors that may explain the observed country-level differences in progress.