Quality of health care and patient safety in extreme adversity settings in the Eastern Mediterranean Region: a qualitative multicountry assessment

Background: Quality and patient safety are essential for the provision of effective health care services. Research on these aspects is lacking in settings of extreme adversity. Aims: This study aimed to explore the perception of health care stakeholders working in extreme adversity settings of the quality of health care and patient safety. Methods: This was a qualitative study conducted through semistructured interviews with 26 health care stakeholders from seven countries of the World Health Organization’s Eastern Mediterranean Region which are experiencing emergencies. The interviews explored the respondents’ perspectives of four aspects of quality and patient safety: definition of the quality of health care, challenges to the provision of good quality health care in emergency settings, priority health services and populations in emergency settings, and interventions to improve health care quality and patient safety. Results: The participants emphasized that saving lives was the main priority in extreme adversity settings. While all people living in emergency situations were vulnerable and at risk, the respondents considered women and children, poor and disabled people, and those living in hard-to-reach areas the priority populations to be targeted by improvement interventions. The challenges to quality of health care were: financing problems, service inaccessibility, insecurity of health workers, break down in health systems, and inadequate infrastructure. Respondents proposed interventions to improve quality, however, their effective implementation remains challenging in these exceptional settings. Conclusions: The interventions identified can serve as a basis for improvements in health care quality that could be adapted to extreme adversity settings.