Quality improvement of health systems in an epidemic context: A framework based on lessons from the Ebola virus disease outbreak in West Africa

Abstract

Summary Quality improvement (QI) in health generally focuses on the provision of health services with the aim of improving service delivery. Yet QI can be applied not only to health services but also to health systems overall. This is of growing relevance considering that due to deficiencies in health systems, the main countries affected by Ebola virus disease (EVD) outbreak in West Africa (2014–2016) were insufficiently prepared for the epidemic, and according to the WHO, epidemics are increasingly becoming a threat to global health. Our objective is to analyze QI constraints in health systems during that EVD epidemic and to propose a practical framework for QI in health systems for epidemics in developing countries. We applied a framework analysis using experiences shared at the “Second International Quality Forum” organized by the University of Heidelberg and partners in July 2015 and information gathered from a systematic literature review. Empirical results revealed multiple deficiencies in the health systems. We systemized these shortfalls as well as the QI measures taken as a response during the epidemic. On the basis of these findings, we identified six specific “priority intervention areas,” which ultimately resulted in the synthesis of a practical QI framework. We deem that this framework that integrates the priority intervention areas with the WHO building blocks is suitable to improve, monitor, and evaluate health system performance in epidemic contexts in developing countries.

Healthcare workers during the COVID‐19 pandemic: Experiences of doctors and nurses in Bangladesh

“…The research explores the issues that doctors and nurses face during the COVID-19 pandemic in Dhaka city, where 58.35% of all COVID-19 patients in the country are located. 5 The study explored two case hospitals using the 'priority intervention areas' (PIA) framework developed by Brugnara et al 6 The PIA framework also integrates the quality improvement of the WHO building blocks suitable to improve, monitor and evaluate health systems. The enquiry was made based on the PIA framework identified in six areas: 'surveillance', 'basic infrastructures and wash', 'patient and safety, infection control', 'case management', 'maintenance of other routine services' and 'cultural aspects, and community engagement'.…”

“…The research explores the issues that doctors and nurses face during the COVID‐19 pandemic in Dhaka city, where 58.35% of all COVID‐19 patients in the country are located 5 . The study explored two case hospitals using the ‘priority intervention areas’ (PIA) framework developed by Brugnara et al 6 . The PIA framework also integrates the quality improvement of the WHO building blocks suitable to improve, monitor and evaluate health systems.…”

“…The PIA framework also integrates the quality improvement of the WHO building blocks suitable to improve, monitor and evaluate health systems. The enquiry was made based on the PIA framework identified in six areas: ‘surveillance’, ‘basic infrastructures and wash’, ‘patient and safety, infection control’, ‘case management’, ‘maintenance of other routine services’ and ‘cultural aspects, and community engagement’ 6 . The PIA framework used here to explore the issues that doctors and nurses face will help hospital authorities properly integrate to the building blocks that WHO presented in 2007 to the country's health system 7 and to take preventive measures for quality improvement.…”

Act now! Covid-19 pandemic: the coordinated support of the international community to low- and middle-income countries is needed immediately

“…Staff shortages are being addressed in the UK by asking more than 65 000 retired doctors and nurses to return to the NHS [8], and WHO supports training by publications of guidelines and online courses [9]. For middle and low-income countries, nevertheless, the lack of 'human resources' remains a challenge for disease control, as the experience of former outbreaks demonstrates [10]. Problems of low incentives, brain drain or lack of training are even more exacerbated in a moment of crisis.…”

“…The world has learned with the experiences of SARS, H1N1 and the Ebola epidemics [10,18], and countries have made progress in strengthening and improving the quality of their health systems. Now, isolation and social distancing are vital to lower the virus spread and individual countries might be able to contain the outbreak for a few months.…”