Getting Hospitals Right: Dispatches from Our Cape Town Consultation Session

The Ebola epidemic has made the entire world aware of the importance of hospitals within a health system and the dearth of hospitals altogether in the hardest-hit counties in West Africa.  CGD’s Hospitals for Health working group is exploring ways the global community can foster more safe and efficient hospitals in low- and middle-income countries without crowding out investments in primary care.  We recently hosted a public consultation session at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, to discuss our draft report and get feedback on its proposal for a Global Hospitals Collaborative.  

Our distinguished panel featured CEO of Discovery Health, South Africa Jonathan Broomberg, plus Hospitals for Health working group members Jerry La Forgia (World Bank) and Maureen Lewis (Georgetown University). We thank our panelists and all those who attended for a lively and productive session. In case you couldn’t make it to Cape Town, here are a few takeaways from the discussion that stand out:

• Universal Health Coverage (UHC) “could be an empty term if we cannot get hospitals right,” warned Broomberg.  Hospitals are extremely complex institutions—difficult to turn around once they’ve gone the wrong way, and too often serving their own staff and administrators at the expense of patient care. Without dramatic remedial action, decades of global and country-level neglect could create a “perfect storm”, undermining countries’ ability to achieve UHC. 

• The debate between primary health care vs. hospitals is a false dichotomy.  Too often, investing in primary care and hospitals is positioned as an either/or debate in the global health space. (Perhaps literally – our panel was held across the hall from a simultaneous session on expansion of primary care!)  But our panelists and audience repeatedly emphasized that this is a false dichotomy representing an outdated and counterproductive way of thinking.   But both are needed for a pro-poor health system and countries must strive to provide a continuum of care that fosters coordination across all levels.  Likewise, a Global Hospitals Collaborative must focus on situating hospitals as one component within the broader health system.

• Data has the power to transform health systems. Both Broomberg and La Forgia observed that simply measuring and comparing performance across hospitals – ‘benchmarking,’ in technical speak — can prove highly motivational for hospital managers. We at CGD agree, and our draft report proposes that a Global Hospitals Collaborative could play a catalytic role in benchmarking hospital performance, management practices, and governance arrangements. In the long run, it could help develop standardized data systems detailing inputs, quality, outcomes, and other performance measures.

• Donors lack the technical and fiscal resources needed to meet demand for help with hospitals. According to La Forgia, the World Bank is one of the only donor organizations willing to put up funding in this area, providing roughly $750 million for hospital-related work over the last 12 years. Even so, the Bank has few systems in place to answer clients’ questions  on improving hospital management, quality, and governance – and La Forgia with a small group of Bank staff runs a ‘hospital thematic group’ on a voluntary and often after-hours basis –  to address them as they arise. The panelists hoped that a Global Hospitals Collaborative could serve as a one-stop-shop for hospital-related expertise, helping to collect and systematize diverse evidence and experiences for the benefit of country governments and hospital managers who want to improve their own performance.

Our enthusiastic audience confirmed our report’s major conclusion: hospitals matter for health and health systems – and improving their performance needs to be a major part of the global health agenda. We hope our draft report sparks more discussions like this and we’re optimistic that a Global Hospitals Collaborative could be an important first step towards improving hospital performance in low- and middle-income countries.

There’s still time to send your feedback on the consultation draft (by November 1). We’d love to hear about your experiences and ideas about what the Global Hospitals Collaborative might do.