Beyond this terrible human cost, poor quality health systems represented enormous economic losses to countries due to lost productivity each year. The report published as part of the The Lancet Global Health Commission on High Quality Health Systems urges for global investment in high-quality health systems that put people first and that deliver care that improves health.

Dr Tanya Marchant, from the London School of Hygiene & Tropical Medicine, was part of the global study that examined how to measure and improve health systems worldwide. Dr Marchant, who co-led a working group on measurement, highlights the importance of the research findings in the context of universal health coverage: “The discourse around high quality health systems has been fragmented and dominated by access rather than quality.  But this report brings together evidence on why, where and how quality can be improved for everyone.”

Current health systems fail to treat patients with the degree of quality care, courtesy and dignity one expects from a good health system. One of the first steps to improve health systems is to re-think the way quality is measured. Health systems need to be judged on performance – patients’ experience and confidence in the system – not just inputs alone.

The study suggests four key actions to improve health systems. First, countries must govern for and be held accountable to a shared vision of health system quality.  Second, systems should be strategically reorganised to ensure appropriate care is provided at each level: preventative, less urgent care at primary level and more complex urgent care at a higher level hospital.  Third, countries must invest in helping their health workforce meet the needs of today’s complex health needs.  And last but not least, the report calls for people to ignite their demand for better quality health systems that they can trust.