Reflections from the National Lancet Commission meeting by Dr. Martias Joshua

National Commissioners from nine countries met in Johannesburg December 11-13 to share their work with one another and provide feedback on the global Commission Report. In this series, we share reflections from the National Commissioners from the meeting. Guest post by Dr. Martias Joshua.

I was very lucky to attend HQSS Commission in Johannesburg in South Africa in December 11-15, 2017. I was nominated as HQSS National Commissioner in November 2017. At the meeting on day one, we learned that the global health agenda is to improve health care access as well as quality. In the Millennium Development Goals period the emphasis was on health care access but not on the quality of care received when the health system is accessed. This is why there is HQSS Commission which has Global and National commissioners in different countries.

These National Commissioners made presentations on how health systems use quality data and what are the priorities for strengthening data use in health care decision making. Presentations from Ethiopia, Mexico, Senegal and Tanzania were very educative on how quality health care is being monitored using national indicators. Malawi has national indicators which are traced from districts and national level and we need to strengthen review meetings of such data and improve its quality, as evidenced in these countries presentations. There were also presentations on building foundations for quality, looking on what has worked or not. Here presentations from Argentina, Nepal, Phillipines and South Africa were very educative looking at their experiences. These presentations showed to me that Malawi needs to strengthen its data collection and analysis methods and interpretation to have quality health care. I also learned that national commissioners have varied background with some of them outside health care system.

On day two we had presentation from South Africa about ethics, equity and minimum standards for quality health. I enjoyed seeing South African ideal clinic definitions, components and checklist documents, all of which will be adapted for Malawi. The Minister of Health in South Africa emphasized that we need to focus on Universal Coverage, especially community health care, which is being neglected in South Africa and in most African countries. He was down to earth and recognized the need to build confidence in the health care we are providing by making sure to use our local health services rather than going abroad to seek treatment.

Later in the day, there were breakouts sessions on financing for quality, measuring patient experience, accountability for quality in a decentralized system, and quality for vulnerable groups. I joined a session on financing for quality. At the financing for quality session, I learned how National Health Insurances are rolling out in different countries as a way of financing for quality. Malawi runs vertical programs which are hugely financed by donors. Donor Health care financing in Malawi is at 75% and mostly covering four areas; malaria, tuberculosis, HIV and reproductive health. In such a system, the vertical programs are strengthened but leave the rest of health care with poor quality delivery. At this meeting I learnt that Malawi should encourage these donors to fund integrated health care implementation as they are assisting specific programs. They should also finance government initiatives of pooling resources to finance health care in an integrated manner.

I hope to attend more of such forums to strengthen Malawi’s ability to implement quality health care.

About the Author

Dr. Martias Chimetereni Joshua is the Hospital Director at one of referral facilities in Malawi since January 2009 with extensive management and policy development skills in health care in Malawi. Dr. Joshua serves in different strategic committees in the Ministry of Health as a chairman and committee member. He was also instrumental in arranging the establishment of Quality Management Directorate in the Ministry of Health and he was nominated as a National Commissioner from the Quality Management Directorate in the Ministry of Health in Malawi.