5 September 2018: The Lancet Global Health Commission on High-Quality Health Systems in the SDG Era, a group of 30 academics, health system experts and policymakers from 18 countries, published findings on the need for a “revolution” to achieve high-quality health systems to reach the SDGs. The Commission emphasizes that health systems should focus on four values: they are for people, and they are efficient, equitable and resilient.

The article titled, ‘High-quality Health Systems in the Sustainable Development Goals Era: Time for a Revolution,’ presents the findings of the Commission’s analysis on the quality of care available to people in low-income and middle-income countries (LMICs) across health needs included in the SDGs. To produce better health outcomes and increased social value, the authors call for high-quality health systems that consistently deliver care that maintains or improves health, is trusted and valued by everyone and responds to changing population needs.

The Commission presents five conclusions:

1. Poor quality care is common across conditions and countries, with the most vulnerable populations receiving the worst care. The authors recommend universal health coverage (UHC) as a starting point for improving health systems’ quality alongside expanding coverage, especially for the poor, and financial protection.
2. High-quality health systems could save eight million lives annually in LMICs. The authors explain that 60% of deaths from treatable conditions are the result of poor-quality care.
3. Health systems should measure and report on the processes and outcomes that matter to people, including competent care, health outcomes, user experience and confidence in the systems. The authors call for “fewer, but better” measures of health system quality at national and sub-national levels, such as a dashboard of key health system performance metrics.
4. New research is essential to transform from low-quality to high-quality health systems. As an example, the authors propose research to evaluate the effects and costs of recommended improvement approaches on health, patient experience and financial protection.
5. System-wide action, including structural reform, is necessary to improve quality of care. The Commission recommends specific actions to improve quality of care across the health system.

The Commission identifies a number of opportunities for national governments, civil society, global partners and researchers to contribute to achieving high-quality health systems. For national governments, the Commission recommends: investing in health systems and making them accountable to people for their performance; partnering with other sectors, including education, transport and communication sectors, to create conditions for health system reform; embedding equality of care in UHC alongside; and improving measurement, among other actions.

The authors assert that ensuring quality health systems is a political, not a technical decision, and it should not be an aspiration for the distant future or the purview of the elite, but “should be the DNA of all health systems.” Countries will know if they are on the path to an accountable, high-quality health system when health works and policymakers “choose to receive health care in their own public institutions,” the Commission writes. [Publication: High-quality Health Systems in the Sustainable Development Goals Era]