Guest Post: Building ethical governance into emerging market health care
Few relationships embody and require trust quite like the one between patients and doctors. Every minute of every day, all over the planet, people put their lives in the hands of health care professionals and the facilities they work in.
Such trust is the crucial foundation for frank and open communication between patients and their care providers, which is necessary at every step of the medical process, from diagnosis to treatment to after care.
Yet like most things sacred, trust can only be built over time through consistent and ethical conduct. While good governance builds a foundation of good clinical practices and quality care matters everywhere, it is especially critical to emerging economies, where stretched incomes render patients more vulnerable, and where less mature legal and regulatory frameworks complicate the enforcement of ethical standards.
This is why we highlight ethical governance as a key pillar — along with affordability and accessibility — for building sustainable and accessible health systems in emerging markets.
Why is it important to create an environment of trust through accountable leadership? For a start, patients in lower-income countries often are already emotionally, physically and sometimes financially vulnerable. They must have confidence that the health care system is committed to their well-being and will deliver quality care.
Next, patients often must divulge highly personal and confidential information, and they need to trust that their healthcare provider will not treat them differently because of their gender, ethnicity, religion or income bracket.
Further, they must believe that the facility will protect them from wrongdoing and harm. Patients want to trust that the infrastructure of their hospitals or clinics are safe, that the people treating them are qualified and skilled, and that the products and processes they encounter are effective. After all, trust in the healer is essential to healing itself.
Because health professionals have great capacity to do so much good — or conversely, harm — health care is no stranger to governing codes and principles.
The ancient Code of Hammurabi included rewards and punishments for the medical profession, such as cutting off the hands of a doctor under which patients died.
The Hippocratic Oath, dating back to the 5th century B.C., famously sought to lay a moral and inspirational framework for practising doctors that is still relevant to this day. In one form or another, trust and accountability have long been fundamental tenets of a well-functioning and successful healthcare system.
But how should today’s health organisations ensure such ethical governance, especially in emerging markets? The International Finance Corporation, the private sector arm of World Bank Group, has developed as guidance a set of 10 core ethical principles:
- Respecting Laws and Regulations: While health care is highly regulated in most countries, in lower-income nations such regulations can be outdated or unclear, leading to inconsistent application and weak enforcement. Healthcare organisations should train staff to understand and follow applicable laws, display permits publicly, and where regulations are insufficient work with policymakers to remedy the deficiencies.
- Making a Positive Contribution to Society: Universal health goals cannot be achieved without leveraging private sector cooperation, innovation and investment. Providers should strive to complement one another, understand the community’s broader health goals, and plan services and prepare for crises in coordination with community leaders.
- Promoting High Quality Standards: High standards of care and patient safety require implementing formal processes for continuous quality improvement, in areas ranging from medication management to infection prevention, from facility administration to staff education. Besides following evidence-based, internationally-recognised practices for care, providers must establish protocols to prevent over- or under-treatment, and foster a culture committed to seeking continuous improvement.
- Conducting Business Matters Responsibly: Health care is at high risk for corruption given the asymmetrical knowledge between providers and patients, and the potential for exploitation and conflicts of interest. Providers must strive to ensure that services are represented accurately and honestly, that transactions with vendors and contractors are conducted without favours or inducements, and that there is clinical, operational and financial transparency. It is helpful to enact and uphold policies to fight bribery, corruption, and the trading of gifts and favours.
- Respecting the Environment: Because hospitals account for disproportionate use of energy and must handle and dispose of biomedical and chemical wastes, it’s important to remember that what is good for the environment is good for health. Providers can build trust by working in ways to minimise negative environmental impact, from resource conservation to pollution minimisation.
- Upholding Patients’ Rights: People receiving medical help can be especially vulnerable, especially in communities without effective protection of patient’s rights. It’s important, for example, to inform patients about all aspects of their care, promote participative decision-making about treatment options, provide recourse for the handling of disagreements, respect patients’ rights to safety and privacy, and generally reinforce the notion of informed consent.
- Safeguarding Information and Using Data Responsibly: Health care organisations have access to highly-sensitive information about patients, customers and even staff, and must maintain administrative and technical safeguards to keep confidential information accurate and safe from tampering.
- Preventing Discrimination, Harassment and Bullying: Health care is a staff-intensive sector that often puts diverse groups of people in the same room, so it’s important, for example, to promote a safe and respectful environment for patients, visitors and workers; implement zero-tolerance policies toward violence of any kind; and provide for ways to minimise and resolve conflicts and grievances.
- Protecting and Empowering Staff: Because staff skills are key to the quality of care and long working hours are common, health care providers must ensure they have enough staff for the required jobs and they are sufficiently trained and oriented. Ongoing training, fair employment practices and a safe working environment are just some key areas in which they can support and retain good workers in a field where burnout is common.
- Supporting Ethical Practices and Preventing Harm: Practising medicine involves complex scientific, ethical and legal issues, and it’s important for organisations to be guided, at a minimum, by local laws and ethical principles. For instance, participating in female genital mutilation and organ harvesting clearly violate a person’s right to health and the edict of doing no harm. Organisations should develop policies and governance in line with accepted scientific practices and international norms, proactively address issues of ethical concerns, and inform patients and workers alike about these governance.
Like clear air or potable water, trust in health care is an essential condition that can easily be taken for granted – until it is gone. Investing in ethical governance in emerging economies will help build a solid foundation toward universal health coverage for all.
Charles Dalton and Raju Narayan are global sector specialists for Health at the International Finance Corporation (IFC), the private sector arm of World Bank Group.
We would welcome your thoughts on this story. Email your views to Lee Murray or call 0207 183 3779.
