Progress on HRH: Quality
Anthony is the clinician in charge of the Health Centre in Kilolambwani village, Lindi Rural District, Tanzania. His duties involve advising mothers on the importance of feeding children a diversified and nutritious diet.
Credit: Caroline Trutmann/Save the Children
The quality dimension of human resources for health (HRH) is about whether health workers have the competencies, skills, knowledge and behaviour to meet and deliver quality services. Universal Health Coverage (UHC) also places importance on all people obtaining the quality services that they need.
Quality is a major challenge in all countries. Even when well-established quality assurance mechanisms exist, poor quality care can be provided. For example, the poor habits of health professionals can result in nosocomial (hospital-acquired) infections.
The 2013 report of the independent Expert Review Group (iERG) noted with concern that the quality of care (and implicit within this, the quality of healthcare workers) is “either ignored or sits at the margins of discussions”.
The measurement of quality is hindered by the lack of universally accepted definition or indicators. There are some proxy measures for quality (for example the existence of an accreditation system is used in the country profiles) but this is no substitute for direct observation of the activities of health workers and feedback mechanisms from those receiving care.
Quality should be assessed by both professional norms and as it is perceived by users. Quality is often deemed to be acceptable unless a complaint is made. This requires individuals being aware of their entitlement to the highest possible quality of care and feeling empowered to raise concerns if they do not feel that they received it.
There are many factors that can influence a health worker’s effectiveness and efficiency. Some are related to the duration and scope of their training, others relate to their working environment – infrastructure, equipment, continuing education and training, regulation, management, supervision and performance incentives.
The perceptions of colleagues and the wider community towards health workers can also be a key factor influencing motivation and quality of care. That is why Save the Children is working with partners to ensure that more health workers, particularly frontline health workers, are recognised for their life-saving work.