My most vivid memories of my early childhood are twofold: lying on a hospital bed with my legs in the air, and watching my younger brother draw his last breath as a result of severe hot water burns he suffered during his hospitalization in what was then Northern Rhodesia. According to my parents, I should not have remembered these instances as I was less than five years old at the time, but these memories remain crystal clear.
What went wrong? Our family was relatively privileged and went to the best facilities at the time, but both my brother and I fell prey to poor-quality health care. He lost his life due to negligence and I suffered long-term disability from not receiving my polio vaccination at the appropriate time.
I was not alone
Unfortunately, there are still families in Zambia (and elsewhere) who can recount tales like these. Experiences that either make you bitter or give you a strong resolve to do something about health care quality. Early on, I chose to do something about it. Yet along life’s pathway, I have also seen the negative impacts of poor-quality health care in its many dimensions.
For example, a turning point for me was seeing a young child die from malaria because her mother could not access the care her daughter needed when she needed it. The death of this particular child distressed me. Her mother brought her to the facility late after waiting for her husband to give her permission and provide her with transportation money. Malaria in children becomes serious very quickly and often results in complications that are difficult to manage and a poor prognosis. She was such a cute child, the mother so helpless and distraught, and the death so needless—the amount for transport required was so small—less than a dollar! It all just seemed so pathetic and ludicrous.
The impact was greater for me because this was my first job in a health care facility coming face-to-face with a needless death. It also highlighted the complexity of providing high-quality health care, which is much more than having a health facility to go to. We must also look at broader societal issues! For example, access issues are just as important as structural and financing issues.
These are some of the key reasons why I am so passionate about the quality of health care and why I am a great believer in strengthening health systems and building up the practices of health care practitioners.
The most gratifying times can be the most trying
In the early phase of my career, I deliberately joined malaria campaigns that offered screening and treatment services—it was most gratifying and stressful at the same time. Gratifying because when all was said and done, I knew that I had made a significant difference and saved lives. Stressful because I saw how weak health systems can negatively impact health care outcomes. The issues ranged from patient referrals lacking adequate information for effective care at another health facility to stockouts of essential medicines needed to effectively manage a patient’s conditions. By improving access to high-quality data and enabling a data-use culture among health workers and decision-makers, many of these challenges can be resolved.
In 2000, I was offered a position through the US Centers for Disease Control and Prevention (CDC) at the USAID-supported Regional Center for Quality of Health Care in Kampala, Uganda, and what a rewarding adventure that was working with countries in East and Southern Africa to improve health care delivery. We used a simple framework that took a health care worker through logically identifying performance gaps and interventions to close those gaps, as well as other high-quality tools to improve health worker practices and deliver great impact. Our quality improvement motto, “In God we trust, the rest of you bring data,” encouraged evidence-based decision-making and aligns with my current work leading The BID Initiative.
Closing the gaps to better health
At PATH and through the BID Initiative, we take a holistic approach to improving data quality, collection, and use. We are empowering health workers to effectively deliver health services by designing and refining not only information system products but also policies and practices to create a culture of data use among the people who use them. We believe that better data plus better decisions will lead to better health outcomes across Africa and someday, hopefully, around the world.
It is my heart’s desire that in my lifetime I will see a change from health care providers to national governments. A change that will empower all of us to continue improving health care delivery in all the dimensions of a high-quality health care service.
- Dr. Chilunga Puta is the director of the BID Learning Network and BID Initiative at PATH.