IFC, in collaboration with the World Bank, embarked on an initiative to develop Ethical Principles in Health Care (EPIHC), due to the significance of ethical considerations in the provision of health care services, and the potential for improvements in access, quality and health outcomes through their broad application.
The World Bank Group has adopted the twin goals of ending extreme poverty by 2030 and promoting shared prosperity. To help achieve these goals, the World Bank Group supports Universal Health Coverage, aiming to ensure that people have access to the health care they need without suffering financial hardship. Access to high-quality, affordable health care is the foundation for individuals to lead productive and fulfilling lives and for economies to develop the human capital they need to grow. The private sector has an important role to play in achieving these goals. Promoting ethical conduct is essential to ensuring the private sector contributes to stronger health systems. Although many health care organizations strive to operate according to the highest ethical standards and make a positive contribution to society, some do not. Unfortunately, some aspects of the health care sector can incentivize unethical practices. The International Finance Corporation (IFC), in collaboration with the World Bank, embarked on an initiative to develop Ethical Principles in Health Care (EPIHC), due to the significance of ethical considerations in the provision of health care services, and the potential for improvements in access, quality and health outcomes through their broad application. The EPIHC are a set of 10 concise, pragmatic and universally applicable shared values/core beliefs to promote ethical conduct, and to help guide the decision making of organizations participating in private health care provision.
Health care providers operate in a highly complex, ever evolving, health care landscape. The intention is that the EPIHC could provide a compass to help them navigate this difficult terrain. The aim is that this guidance may help providers make a stronger contribution to the lives of their patients, their staff, the environment, and the communities they serve. For a private health care provider, ethical and responsible conduct is not only important for global health goals and public relations, it is also a necessary element of performance and risk management. The consequences of poor ethics or standards can be disastrous. The reputation of a health care organization is critical for attracting patients, retaining staff, and providing long-term stakeholder value.
The approach to developing the EPIHC was targeted, broadly consultative, and iterative, involving a diverse group of investors, providers, experts, and civil society stakeholders in informing the final product in aggregate without individual attributions.
It is expected that private health care providers would voluntarily commit to follow the principles and that health care investors would expect their health care investees to follow the principles. The EPIHC are designed to be relevant to all sizes of organizations, business models, and geographies. They will guide ethical practice expectations and decision-making, rather than creating specific laws or performance standards. Private health care providers and their investors are encouraged to publicly adopt, support, and reference EPIHC in their work, as well as to monitor the EPIHC usage and exchange good practices in their application. IFC disseminates and supports the EPIHC. It has tools and resources available that may assist organizations in implementing the EPIHC including, for example, IFC’s Healthcare Quality Assessment tool. IFC is also developing a supplementary EPIHC guidance document to assist EPIHC adopters to better understand the principles and how to instill them within their organizations.
High ethical standards in the health sector are important for improving the lives of people around the world. Private health care organizations have a vital role to play in promoting such standards. These principles represent an important step toward codifying the types of behaviors and values expected. Therefore, we invite ethical and like-minded health care organizations to adopt the EPIHC. For some organizations these will represent a first step toward codifying such principles and for others they will complement existing corporate codes and statements.
The organization conducts its business legally and responsibly. It ensures that all staff understand and respect the laws, regulations, policies, and standards that affect its business.
The organization considers its impact on society and the broader health system when planning and delivering services, including considerations of quality, efficiency, access, and affordability. It does not knowingly engage in activities that undermine the goals of the health system or the overall health and well-being of the population. It initiates and sustains strong and effective partnerships within the communities it serves and with other actors in the broader health system. This includes actively engaging with stakeholders on efforts to improve access to affordable care and to advance health for all.
The organization provides the highest possible quality of care, including patient safety. This includes implementing formal processes for continuous quality improvement. It refers to evidence-based internationally recognized practices to support patient care. It makes treatment and care decisions based on the best quality outcome for the patient.
The organization accurately and honestly represents and explains the services that it provides. It does not take unfair advantage of anyone through manipulation, concealment, abuse of privileged information, or misrepresentation of facts. It acts honestly and does not engage in any activity intended to defraud any individual or organization of money, property, or their time. It avoids conflicts of interest. It enacts policies and practices to fight bribery and corruption. It deals sensitively and humanely with patients who do not have sufficient funds for treatment.
The organization works in ways that minimize negative impact on the environment, including making efforts to conserve energy and reduce waste. All waste, including biomedical waste, is collected, stored, and disposed of in a safe and environmentally responsible manner.
The organization provides care respectful of patients’ personal values and beliefs. It respects patients’ rights to dignity, privacy and confidentiality. It supports patients’ rights during the care process, including informed consent and the right to refuse treatment. It implements mechanisms to oversee research activities. Any person enrolled in clinical research is fully informed of the risks and benefits, and their right to refuse to participate or drop out without risk of reprisal. All are informed about their rights and responsibilities in a manner and language they can understand.
The organization maintains appropriate administrative, technical, and physical safeguards to ensure that information is kept secure, accurate, complete, untampered with, and is unavailable to persons not authorized to have access. It follows appropriate data standards, including considering new and evolving technologies. It maintains confidentiality subject to highest standards, including data minimization and retention, use for research only on a disclosed and de-identified basis, and transfer or disclosure as necessary for some public health and claims processing purposes. Patients have the right to obtain, review, and correct their health records information.
The organization promotes a positive and respectful environment for everyone, including patients, visitors, employees, volunteers, physicians, students, and contract workers. The organization does not tolerate any form of discrimination, bullying, or harassment.
The organization promotes a safe working environment. It ensures that all staff have the training and tools they need to do their jobs safely. It does not tolerate any type of violence in the workplace or at work-related activities. It ensures that all staff are equipped with the knowledge, qualifications, skills, and experience required to meet patients’ and customers’ needs, as well as the standards of applicable professional associations.
The organization develops formal policies and procedures for areas with ethical concerns, considering accepted international norms in doing so. Staff are trained in these concerns and how to address them. In addition to activities proscribed by local laws and regulations, the organization does not participate in or condone harmful practices. The organization has mechanisms in place to address ethical concerns that may arise, including those due to new clinical technologies.