Countries around the world have greatly expanded access to health care. But access has not delivered better health: 5 million people die each year from treatable conditions despite seeking health care. These numbers will grow as more people utilize care and as the burden of disease shifts to complex and chronic conditions. This low level of performance reflects structural problems that require structural solutions; current quality improvement approaches are insufficient.
Measurement of health system performance is out-of-date, slow, and incomplete. These findings were outlined in the Lancet Global Health Commission on High Quality Health Systems (HQSS) and resonated widely across countries and among global development partners. Moving forward will require new ways to measure and improve quality system-wide.
While significant sums are spent on improving health technology, there is little investment in research & development for measuring and improving health system quality.
The Quality Evidence for Health Systems Transformation (QuEST) Network was launched in 2020 as a research consortium with five core Centers and a global network of researchers, policymakers, multilateral organizations, national governments, and development partners. QuEST's research responded to the findings of the Lancet Global Health Commission on High Quality Health Systems.
QuEST's Phase 1 was funded primarily by the Gates Foundation and the Swiss Agency for Development and Cooperation.
In Phase 1, QuEST Centers developed the People’s Voice Survey (PVS), eCohorts, Service Delivery Redesign analytics, and COVID-19 health system tracking using routine data. Phase 1 concluded in December 2025.
In October 2025, we convened QuEST members at Washington University in St. Louis to discuss the future of the Network. Building on a successful Phase 1, we agreed to pursue collaborative research and support joint and individual fundraising.
Working through a decentralized approach, the Network will support high quality health systems research that is: responsive to local priorities, advances health systems science, and is policy relevant.
Produce high quality evidence to direct and justify new health system investments.
Collaborate at all stages of research and development with relevant institutions and organizations
Disseminate clear, policy-relevant results to policymakers and implementers.
Ensure all products are global public goods, freely available to the public.
Address major health system deficits through research that directly informs policy transformation.