The Lancet Global Health Commission and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts. In this Commission, we assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. Moving to a highquality health system-one that improves health and generates confidence and economic benefits-is primarily a political, not technical, decision. National governments need to invest in high-quality health systems for their own people and make such systems accountable to people through legislation, education about rights, regulation, transparency, and greater public participation. Countries will know that they are on the way towards a high-quality, accountable health system when health workers and policymakers choose to receive health care in their own public institutions. Components Quality impacts Better health Level and distribution of patient-reported outcomes: function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering Confidence in system Satisfaction, recommendation, trust, and care uptake and retention Economic benefit Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection Processes of care Competent care and systems Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, counselling, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management Positive user experience Respect: dignity, privacy, non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use Foundations Population Individuals, families, and communities as citizens, producers of better health outcomes, and system users: health needs, knowledge, health literacy, preferences, and cultural norms Governance Leadership: political commitment, change management; policies: regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioural architecture, and public health functions; financing: funding, fund pooling, insurance and purchasing, provider contracting and payment; learning and improvement: institutions for evaluation, measurement, and improvement, learning communities, and trustworthy data; intersectoral: roads, transport, wa...

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We may emerge from this with a healthier respect for our common humanity

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Embedding quality at the core of universal health coverage in South Africa South Africa's White Paper on National Health Insurance 1 represents the government's statement of intent on achieving universal health coverage (UHC)ie, to provide all people with access to a common set of comprehensive health services of sufficient quality, while also ensuring that the use of these services does not expose the user to financial hardship. The White Paper recognises that the health and development of South Africans is largely dependent on the social determinants of health, and that the best way to obtain improved health outcomes is through a multisectoral, multistakeholder primary health-care (PHC) approach that puts the individual at the centre of health and development programmes. The White Paper recognises that service coverage and affordability are crucially important, but not sufficient, to ensure achievement of UHC. As such, a strong emphasis is placed on improving the quality of care at the entry point into the health care system (ie, the PHC system). In South Africa, although PHC facilities are the communities' first point of contact with the health system, inadequate service provision, overburdened clinics with long queues, and poor quality of services has resulted in many people bypassing PHC facilities and going straight to hospital outpatient departments where services are perceived to be better. The National Department of Health thus started preparation for UHC through National Health Insurance by improving the quality of PHC services. The Department's rationale was that improved PHC services would increase communities' confidence in these services, and decrease the occurrence of PHC services being bypassed. The Ideal Clinic Realisation and Maintenance (ICRM) programme was designed in response to the deficiencies in the quality of PHC services, and to lay a strong foundation for the implementation of National Health Insurance. An ideal clinic is defined as a clinic with good infrastructure (ie, physical condition and spaces, essential equipment, and information and communication tools), adequate staff numbers, adequate medicines and supplies, good administrative processes, and adequate bulk supplies; such a clinic uses applicable clinical policies, protocols, and guidelines,