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July 6, 2017

Blog: Developing a national quality plan through a participatory approach - Lessons from Colombia

Region: Global Empowering and engaging people and communities, Strengthening governance and accountability, Coordinating services within and across sectors, Creating an enabling environment

This blog was authored by Germán Escobar Morales, MD. MPH; Chief of the Office of Quality of Care, Ministry of Health and Social Protection, Republic of Colombia.

I work at the Ministry of Health and Social Protection in Colombia as Chief of the Office for Quality of Care. The office is in charge of designing the national quality policy and monitoring coverage of the entire health care system. Colombia’s health care system provides universal health coverage, with one of the largest financial protection systems (among developing countries) for its users, across the world. In Colombia, health system out-of-pocket expenditure accounts for just 14% of total health expenses, with the remainder being funded almost entirely by the Government. However, despite the system’s accomplishments, the Ministry of Health, over the last five years, has initiated a necessary reform of structural and functional improvements of the system, in order to ensure financial sustainability; to improve access to health technologies that add true value to treatments; and last but not least, to achieve more equity among the population.

As part of this reform, the development of the national quality policy has followed a dynamic, comprehensive approach. My personal reflection in this blog post aims to highlight the steps taken to develop the National Plan for Quality of Care Improvement 2016-2021.

The story and lessons learned

When I enrolled in a Master’s of Public Health programme, I used to think that “fixing the world” was the obligation of all. While I am sure that most people do want a better world, I have learned that there are many different visions of how to make this happen.

When I was appointed Chief of the Office of Quality of Care, two and a half years ago, my main challenge was to guide my team into formulating a new strategic plan for the coming years. My first task was to hear, from the team at the Office of Quality of Care, what they know and mean about quality. Through this earlier team engagement, I soon realized that, the team had innovative and  “revolutionary” ideas for quality of care, which included:

  • systematically improving quality in a fragmented health care system; and
  • empowering people as a key to achieving the desired outcomes.

Our first discussions about developing the quality plan with experts in Colombia were difficult in that it was hard to find common ground, partly because of the unorthodox ways of thinking about quality. As a result, frustrations and concerns about how we were going to win overall acceptance from the national level to the facility level was a shared concern and one that fell on my shoulders. After many sleepless nights, I concluded that we had to build a shared foundation through consensus building. I worked with my team at the Office of Quality of Care to develop a consultative process in order to strengthen our capacity by gathering perspectives from experts’ and opinions of the Colombian people on the subject of quality. This was then incorporated into the National Plan for Quality of Care Improvement.

As part of the consultative process, working groups on quality were formed and people with expertise in quality of care were engaged. In addition, we decided to visit different regions in Colombia in a systematic manner, to engage in structured dialogue and feedback. By doing this, we were able to interact with more than 9500 people across Colombia. The team visited 27 of the 32 Colombian “Departments” (political internal division). Examples and experiences from many different places within Colombia were shared and wonderful people were met. I must say that it was one of the most fulfilling experiences I have had in this role.

There were many challenges encountered during development of the national policy, but despite these, the most important thing we achieved was working with communities and engaging people in a participatory way. As a result, we now have a national plan that belongs to and is owned by the people of Columbia. We expect that this collective participatory and systematic approach will be key in helping with implementation and acceptance of the plan.

As a personal reflection and in closing, through building consensus and listening to different people with innumerable backgrounds, we were able, as a country, to find a way to join together by bringing in diverse opinions to improve overall health quality in Colombia.