There is an emerging consensus that universal health coverage —ensuring all people have access to quality health services without suffering financial hardship—is a necessary, timely, and attainable goal for Asia and the Pacific region.

However, as developing countries in Asia and the Pacific pursue universal health coverage and expand the three dimensions of universal health coverage (who is covered, what is covered, and how much is covered), patient safety has been overlooked.

One recent study noted that "efforts to advance universal health coverage are mainly focused on improving access to services and the financing structures behind them. Quality and patient safety are largely neglected, especially in low-income and middle-income countries."

Researchers have found low prioritization of ‘patient safety culture’, which encompasses supportive work environments as well as overall perceptions of safety. This remains true in many developing countries despite national policies prioritizing patient safety.

Patient safety remains a significant problem in the region, beyond the heartbreaking stories of fatal accidents and ‘mistakes’ that routinely make it to the news. A major issue has been hospital-acquired infections with a 2022 systemic review showing a high prevalence of hospital-acquired infections in Southeast Asia.

Medication errors remain a grave problem in the region with studies identifying various kinds of errors including those on administration, prescription, preparation, dispensing, and transcribing. In addition, it is estimated that globally, 10%-15% of diagnoses are inaccurate, delayed or wrong, resulting in wrong or ineffective treatments.

The primary cost of neglecting patient safety is direct harm to patients, which can range from disease complications and depressed quality of life to disability and death.

"The severity of nearly half of patient harm extends beyond mild injuries and temporary harm. As much as 12% of harm causes permanent disability or patient death. Latest estimates indicate that unsafe care causes more than 3 million deaths every year globally, and that around half of all harm due to unsafe care is preventable, according to the World Health Organization’s Global Patient Safety Report 2024.

Neglecting patient safety undermines the effectiveness of universal health coverage, with avoidable harm causing both human suffering and substantial financial costs.

There are also financial costs for patients, healthcare providers, and entire health systems. For patients and their families and caretakers, this includes the direct costs of additional healthcare bills from prolonged hospitalizations and readmissions, as well as the indirect costs of the loss of life and livelihood.

For country health systems of countries, the cost can be staggering: in Organization for Economic Co-operation and Development (OECD) countries, it is estimated that for every 100ドル of national health expenditure, 12ドル.60 is connected with unsafe patient care.

Among health workers, there can also be an emotional impact, which is called the "second victim phenomenon" or "second victim syndrome". Characterized by sleeping difficulties, burnout, and negative feelings like guilt and shame, health workers who are involved in adverse patient events can be caught in a "vicious cycle, predisposing health workers to depression, which further increases the likelihood of committing errors and providing suboptimal care."

Finally, neglecting patient safety also contributes to distrust towards doctors and health, reinforcing the idea that people are on their own when it comes to their health needs. These societal costs include fueling mistrust towards the health system and undermining political and social support for efforts that require social solidarity, particularly, universal health coverage.

With the neglect of patient safety rooted in a lack of enabling culture, cultivating such a culture should be at the heart of ensuring patient safety. Governments therefore need to embed patient safety as a critical part of universal health coverage. Fortunately, there are global and regional experiences that developing countries can learn from to improve patient safety and quality of care.

First, improving surveillance and regulatory systems, including strengthening health information systems and building (or improving) national databases on adverse events. Whether at the level of individual patients, healthcare facilities, and health systems, monitoring and evidence on unsafe care can inform clinical decisions and policy reforms.

Second, and related to the first, supporting research to understand the barriers - sociocultural, legal, political, economic - to patient safety as well as the impacts of neglecting it. Punitive policies, for instance, can prevent the reporting of adverse events by fostering a 'culture of blame', and management structures can likewise influence the willingness of health workers to speak up. Researchers can illuminate these contextual factors and their impacts, both at the level of institutions and countries.

Third, investing in health human resources, infrastructure, and equipment to prevent, detect, and address unsafe practices. Medication errors, for instance, will require pharmacovigilance systems, which in turn will require expertise as well as communication tools, capacity-building activities, and integrating pharmacovigilance in medical and allied health curricula. Investments in health infrastructure and equipment are also needed to ensure functioning equipment and decent work conditions, which can reduce unsafe care.

Finally, empowering patients and communities. The asymmetry of social and epistemic power between patients and healthcare professionals remains wide, and this contributes to limited mechanisms for patients and communities to provide feedback, seek redress, and demand accountability for unsafe care.

The potential for large cost savings from investing in patient safety and reductions in patient harm is huge. Halving rates of diagnostic error alone, for instance, could lead to savings of 8% of healthcare expenditures. These are savings that can be used to further expand universal health coverage.

These investments require the ministries of health to work with government health purchasers, the private sector, health workers, patients and the population, and international partners.

This blog is based in part on knowledge shared at the 7th Global Ministerial Meeting on Patient Safety on April 3 and 4, 2025, which was co-organized by ADB, the Philippines’ Department of Health, and the World Health Organization.

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