Imagine a world where the sanctuaries of healing become the silent arenas of suffering. This is not a dystopian fiction but a reality for millions in the developing world, where healthcare facilities, instead of being safe havens, are fraught with hidden dangers. Over 5 million lives are lost each year to the silent epidemic of poor-quality healthcare—an epidemic that claims more lives than HIV, malaria, and diabetes combined. Yet, it remains a shadowy presence, often overlooked in the global health discourse.

Behind the staggering statistic of 5 million are human stories of shattered dreams and futures dimmed. From Lahore to Lagos, poor-quality healthcare knows no borders, thriving in systems that fail to fulfil their fundamental purpose. My visits to hospitals and clinics, both urban and rural, coupled with my direct interactions with patients and personal experiences, have exposed the dire consequences of inadequate care—misdiagnoses, medical errors, and a lack of basic infection prevention and control, all compounded by insufficient training and support for health workers.

The human and economic toll of this silent epidemic is profound. As we strive for global health, it is disheartening to see such a critical issue obscured and unaddressed. We must demand accountability from healthcare systems and invest in solutions that prioritize quality care. It is time to bridge the gap between the ideal of healthcare and the grim reality faced by millions.

To combat this crisis, I would like to put forth five priority actions:

1. Quality must become an explicit focus of universal health coverage efforts. Governments must bring high quality care to the foreground. There must be a concerted effort to actively monitor and address quality gaps across health systems, ensuring that high quality care is not an afterthought in the pursuit of affordable care for all. As Dr Muhammad Ali Pate memorably emphasized: “Providing health services without guaranteeing a minimum level of quality is ineffective, wasteful and unethical.”

2. Empowering frontline health workers, who are often blamed when quality is poor, is key to improving the quality of care (QoC). There is a need to stop the blame game and instead focus on ways to proactively support them. Providing health workers with adequate guidance, tools, and resources will contribute to strengthening the quality of healthcare services across all levels and geographies. 

3. Facilities in lower- and middle-income settings need quality improvement programs adapted to their resources. Quality Improvement approaches like SafeCare provide practical guidance for health workers to systematically improve care quality in resource-constrained settings. Initiatives like these should be explored and scaled up.

4. Engaging communities and putting the patient at the centre is crucial for improving health outcomes. We need to refocus our systems on the clients by listening to their experiences, respecting their views, and responding to their needs. This approach will not only rebuild trust but also significantly enhance the quality of care provided. 

5. Leveraging digital innovations and fostering collaboration can accelerate quality improvement in healthcare. Governments and the private sector must work together to utilize technological advancements to improve healthcare quality.

Quality care is an ethical imperative and a human right. As we move towards 2030, we must build quality into the foundation of every health system to save lives, improve health outcomes, and uplift communities worldwide. As Dr Margaret Kruk and colleagues wisely put it: ‘Quality should not be the purview of the elite or an aspiration for some distant future; it should be the DNA of all health systems.’ We must, therefore, break the cycle of poor healthcare quality and advocate for systemic reforms to make quality healthcare a fundamental human right for all.

The need for passionate advocates has never been greater. Join me in demanding better for our loved ones and fighting for a future where high-quality care reaches even the most marginalized communities. The change starts with us. Together, we can transform healthcare quality from aspiration to reality, ensuring access to excellent care as a fundamental human right across borders. Let us unite in this cause and usher in a new era of equitable, compassionate, and dignified healthcare for all global citizens.