key: cord-0886472-8270acwj authors: Ezequiel, GarciaElorrio; Jafet, Arrieta; Hugo, Arce; Pedro, Delgado; Maria, Malik Ana; Carola, Orrego Villagran; Sofia, Rincon; Odet, Sarabia; Teresa, Tono; Jorge, Hermida; Enrique, Ruelas Barajas title: The COVID-19 Pandemic: A Call to Action for Health Systems in Latin America to Strengthen Quality of Care date: 2020-05-30 journal: Int J Qual Health Care DOI: 10.1093/intqhc/mzaa062 sha: 367be1e152b59a06f40a2acae4d812e6308d13a6 doc_id: 886472 cord_uid: 8270acwj nan The COVID-19 Pandemic: A Call to Action for Health Systems in Latin America to Strengthen Quality of Care The experience in the Latin American and Caribbean region with public health emergencies (PHE), such as the current COVID-19 pandemic and the previous Zika, and H1N1 Influenza has highlighted existing weakness in health systems across region to effectively prepare for and respond to PHEs (1)(2). Furthermore, PHEs have underscored pre-existing gaps and heterogenous behaviors in access to and quality of care (QoC). Learning had been limited and there is an opportunity for change. Based on data from 2016, Latin-America has high percentage of mortality amenable to poor QoC (3) . It has been projected that countries or regions with lower levels of QoC will have higher COVID-19 mortality rates(4). In the LAC region, the failures of health systems to prevent and adequately control chronic diseases is likely to result in a greater percentage of the population at risk of developing complications related to COVID-19. Furthermore, in addition to the response specific, PHEs present significant challenges for health systems to meet the essential health needs of the population and QoC gaps tend to be wider. More comprehensive and system level strategies are required across the LAC region to address the challenges that we face now. These must focus on redesigning and strengthening health The COVID-19 Pandemic: A Call to Action for Health Systems in Latin America to Strengthen Quality of Care systems to make them more resilient to the changing needs of populations affected by the short and long-term consequences of the COVID-19 and future PHEs. QoC approaches have been shown to improve health outcomes, to achieve public confidence in the healthcare system and to obtain a better return on investment (5), Quality improvement (QI) methods based on implementation science enable the effective use of limited resources by focusing on systematically improving care processes and care delivery systems. These will be critical elements of the response and recovery phases of the COVID-19 pandemic. Several examples highlight the feasibility and effectiveness of using QI methods for a myriad of clinical topics at a large scale across the LAC region (6) Units (8) . Since then, there has been more commitment for QI and policy-level activities to improve QoC in different settings (9) . The current COVID-19 pandemic presents an opportunity to adopt a comprehensive approach to QoC that integrates quality planning, quality control and quality assurance with improvement The COVID-19 Pandemic: A Call to Action for Health Systems in Latin America to Strengthen Quality of Care science to achieve sustainable, large-scale adoption. We make a call to action to all stakeholders in the LAC region to incorporate quality and patient safety policies and implementation strategies into national health sector plans as part of the response to the COVID-19 pandemic. This will enable the systematic use of QI methods, measurement activities and redesign of care to impact health outcomes. Particular attention should be paid to strengthening care processes for vulnerable populations, re-organizing patient flow, strengthening supply chain systems, promoting self-protection as well taking care of the wellbeing of healthcare providers including second victims, and ensuring person centered care with appropriate communication between providers, patients and families. This will facilitate health systems becoming more resilient to shocks from the current and potential future waves of the COVID-19 pandemic, as well as PHEs in the future. In addition, it will make health systems to be more responsive to pre-existing unmet demands for essential services (10). As health systems start or continue to adopt these methods, it is important to assess their effectiveness rigorously, accompanied by proper management, accountability and governance systems and structures. This will guarantee their impact, institutionalization and sustainability over time. The time has come for the LAC region to incorporate learnings from past experiences and to leverage QI methods to close QoC gaps and improve outcomes for all. Authors have no conflict of interest to declare. Quality Improvement in Public Health Emergency Preparedness Quality improvement and emerging global health priorities Mortality due to lowquality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries South America prepares for the impact of COVID-19 High-quality health systems in the Sustainable Development Goals era: time for a revolution The effectiveness of the quality improvement collaborative strategy in low-and middle-income countries: A systematic review and meta-analysis Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs Strategy and Plan of Action to Improve Quality of Care in Health Service Delivery Maintaining Essential Health Services and Systems We would like to thank Dr. Rosa Suñol and Dr. Peter Lachman for their revisions. None