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Quality improvement in the health sector is everybody's business

The story of the under-resourcing in Africa's public health sector is well documented, yet implementing and adhering to quality management systems can significantly to improve health outcomes.
Jacqui Stewart, CEO of Cohsasa
The Council for Health Service Accreditation of Southern Africa (Cohsasa) was established for precisely this reason and for the past 18 years has been offering a healthcare accreditation programme for hospitals, sub-acute care, psychiatric facilities and programmes, primary healthcare clinics, ambulance services, medical emergency centres and general practitioners.

The aim of these standards, is to improve service delivery at both public and private health facilities. "Accreditation is only the first step in enhancing medical care on the continent, the challenge is sustaining quality management over the long term.

Systems based standards


“The standards go further than minimum national standards and allow the personnel in health facilities to create the best possible environment for optimum quality of care to be delivered. This includes ensuring that the facility has the correct policies and procedures in place, a good maintenance plan, sound record keeping policies and that they follow all relevant clinical protocols,” says Jacqui Stewart, chief executive officer of Cohsasa.

"The standards are systems based and encompass everything from leadership to patient care, housekeeping, waste management, equipment and building maintenance to ongoing training and development of staff.

Stewart explains that in addition to assisting facilities to implement quality improvement plans and programmes, Cohsasa also assists healthcare facilities to appreciate the value of quality improvement methods.

“Staff are guided in terms of what needs to be done to achieve compliance with the standards and what evidence is required to support this. Only once a facility is compliant with the Cohsasa standards is it accredited.”“Many healthcare facilities, particularly in the public sector, are resource challenged environments and there is evidence that health workers operating in a poor environment tend to have poor outcomes with the level of care not always as optimal as it could be.”

Maintenance programme


A starting point is to ensure that buildings and equipment are maintained.“In many countries equipment is donated by well-meaning benefactors but with no maintenance provision made. What then typically happens is that the first time the equipment malfunctions it’s pushed into a corner and forgotten about. One of our focus areas, therefore, is to encourage healthcare facilities to invest in maintenance programmes. It’s all very well to have a back-up generator, for example, but it must be regularly tested at full load and regularly maintained if it is to function effectively in the event of a power failure.”

“Resilient care refers to how service providers in the health sector relate their environments to the care they give. Despite staff shortages – an issue for many public healthcare facilities – if the staff that are there are provided with the correct training, practice good record keeping, housekeeping and manage their supplies carefully, then this positively impacts the level of care provided.”

Stewart maintains that quality management, a focus on improving processes and appropriate training results in reduced wastage and improved health service delivery both in the public and private sectors.

“We need to instil the idea that quality improvement in the health sector is everybody’s business because if every healthcare facility adheres to high standards it will positively impact the quality of care being provided,” she concludes.
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