CITATION: The Lancet, Volume 407, Issue 10540 p1668 May 02, 2026
Offline: Ten lessons for women's and children's health
Richard Horton
Richard Horton, editor-in-chief of The Lancet, proposes 10 lessons for women's and children's health.
Lesson 6 is: We need to go beyond mortality. Progress has been made. Early child development. Adolescent health. But the movement for RMNCAH must go further. Healthy growth. The commercial and digital determinants of health.
I would add that we need to go beyond medical causes of morbidity and mortality. We know a lot about medical causes of death but very little about morbidity and mortality caused by inadequate quality of health care, from the home through to the referral hospital. In 2018 Margaret Kruk and colleagues estimated that '8·6 million excess deaths [in LMICs] were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care'. https://pubmed.ncbi.nlm.nih.gov/30195398/ HIFA subsequently learned from the lead author (personal communication) that these numbers estimated facility-based deaths only and did not consider poor quality care in the home and community.
Our discussions on HIFA have demonstrated that lay and professional healthcare providers must be empowered with reliable healthcare information and several other factors for which we use the acronym SEISMIC: https://www.hifa.org/about-hifa/hifa-universal-health-coverage-and-human...
Arguably the greatest harms to patients result not from errors or even poor communication, but from a pervasive failure to empower healthcare providers with their basic SEISMIC needs. I believe there is a strong case for making the needs of healthcare providers central in health systems improvement. To create health services that are as much healthcare-provider-centred as they are patient-centred.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org