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Responsive health services and quality care in settings of extreme adversity: the case of central and northern Iraq

Quality of care in low and middle-income countries (LMICs) has recently been receiving increased attention worldwide. In addition, providing responsive and good quality care in settings of extreme adversity such as the humanitarian crisis in Iraq has been recognized, but the parameters of provision have yet to be defined. This article suggests that those addressing ‘settings of extreme adversity’ should move rapidly to define and implement a basic level of responsive care of good quality for the most vulnerable in some of the most afflicted communities. Three major reports, all published in 2017–2018, focused extensively on quality of care in low and middle-income countries (LMICs). The reports thoughtfully attempt to define a shared understanding of quality of care by policymakers, organizations and providers in LMICs, and formulate recommendations to improve the performance of health systems worldwide. In June 2018 the World Health Organization (WHO), the World Bank and the Organization for Cooperation andDevelopment (OECD) released a report entitled DeliveringQuality Health Services: A global Imperative for Universal Health Coverage (WHO 2018). A second report, released in August the same year and prepared by the National Academies of Sciences, Engineering and Medicine reviewed deficiencies in quality of care in LMICs and presented data on the magnitude of morbidity and mortality worldwide. (National Academies of Sciences E and M 2018). The Lancet Global Health Commission on High Quality Health Systems (HQSS commission) published its findings in September 2017. This last report addresses: ‘structural approaches to quality improvement such as governance, management, care delivery models, professional education, and regulation, . . . .’ (Kruk, Pate, and Mullan 2017).