ABSTRACT
Universal health coverage (UHC) is intended to ensure all people receive necessary health services without financial hardship. UHC without high-quality health systems is a promise without substance. In 2016, an estimated 2.4 million cardiovascular disease (CVD) deaths were attributable to poor-quality care for individuals who had accessed health services. Preventing avoidable death and disease demands a high-quality health system premised on the foundations of an informed population; committed governance to create an environment of continuous improvement; platforms of care organized to provide prevention, management, and interventions; a competent health workforce; and adequate tools for care delivery. Available evidence on the quality of clinical care has identified deficits in care competence and patient experience across many countries and at multiple levels of the health system. Interventions to address the quality of CVD care have demonstrated some success in addressing health system foundations, such as supporting community health workers to extend detection and prevention services and improving processes of care, like the use of decision support systems to bolster disease management. Considering the scope of the challenge facing health systems—many of them designed for episodic treatment rather than ongoing disease management—achieving UHC with high quality will require broader action. Service delivery can be redesigned to prioritize user needs and ensure quality of care; workforce interventions should focus on pre-service education to ensure a competent workforce. Such foundations are essential for sustainable change in CVD care quality and for the development of an environment where point-of-care interventions can provide continuous improvement.
