Lancet Commission 2018: High-Quality Health Systems in the Sustainable Development Goals Era

This report from The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Goals (SDG) Era shows that health outcomes have improved in low-income and middle-income countries (LMICs), but higher quality health systems are still urgently needed. The Commission asserts that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. The authors offer a conceptual framework for high-quality health systems with three integral domains: foundations, processes of care, and quality impacts. More specifically, the report emphasizes that better quality health systems need strong foundations that are based on equitable distribution of care, economic benefit, competent care, positive user experience, and patient trust – however, equally important is the need to develop capacity to measure efficiency and to collect data from which health systems can learn.

The Commission calls upon national governments to invest in health systems and make them more accountable to people, while also looking beyond the government sector and building strong primary and secondary health systems, improving professional education, developing solid road and transportation networks, and supporting reliable communication infrastructure. Unique solutions will need to be tailored for different settings, however, health systems cannot focus on simply providing health care—they need to be informed by four values: these systems should be made for people, and they must be equitable, resilient, and efficient. This Commission report and related comments published in The Lancet Global Health are accompanied by an additional report documenting civil society response to the Commission and two supplementary appendices.