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In addition to strong foundations, health systems need to develop the capacity to measure and use data to learn. The foundations of high-quality health systems include the population and their health needs and expectations, governance of the health sector and partnerships across sectors, platforms for care delivery, workforce numbers and skills, and tools and resources, from medicines to data. We propose that health systems be judged primarily on their impacts, including better health and its equitable distribution on the confidence of people in their health system and on their economic benefit, and processes of care, consisting of competent care and positive user experience. Furthermore, the human right to health is meaningless without good quality care because health systems cannot improve health without 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.

What is needed are high-quality health systems that optimise health care in each given context by consistently delivering care that improves or maintains health, by being valued and trusted by all people, and by responding to changing population needs. But staying on current trajectory will not suffice to meet these demands. Changing health needs, growing public expectations, and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value.

Although health outcomes have improved in low-income and middle-income countries (LMICs) in the past several decades, a new reality is at hand.

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