SafeCare launched to raise basic standard of healthcare in Africa

So says Dr Nicole Spieker, programme director for quality for PharmAccess Foundation, at the launch of the SafeCare Initiative, a global quality think tank that will provide healthcare facilities in resource-restricted settings with a means to improve service delivery.

The SafeCare Initiative is a quality improvement and accreditation system that will work with district hospitals and clinics across the continent to offer basic acceptable healthcare standards. Tertiary level hospitals will not form part of the initiative in the short term.

The initiative is a partnership between the locally based Council for Health Service Accreditation of Southern Africa (COHSASA), PharmAccess Foundation of the Netherlands and the Joint Commission International, the United States-based quality standards authority.

The aim is to ensure Africans and others in resource-restricted countries have access to safe, quality healthcare.

Through the SafeCare Initiative, primary healthcare providers - even those with very few resources - will be able to improve their service delivery and, in so doing, reach international standards of care for patients.

Spieker said healthcare in many parts of Africa was "not up to scratch". Safe care in hospitals has to do with attitude. Improving Africa's basic healthcare needs resources as well as a change of mindset. "People tell me I am trying to bring a Rolls Royce to Africa, but I believe this initiative is a sturdy Land Rover that will be able to get through the mud to a place that offers safe healthcare."

The SafeCare upgrading Initiative will have five levels of recognition, each with a certificate. Every time a facility improves or meets the next level of standards it will achieve a new grading. The level of its grading can be linked to financial incentives. SafeCare certified and accredited sites will also be branded so that patients can identify the standard of care offered at different facilities.

"This initiative is about helping people through the process and encouraging them to do better," said Spieker. A graded facility will build trust with patients and encourage funders who will have confidence that funds are used wisely, responsibly and optimally, so they can measure results.

Professor Stuart Whittaker, CEO of COHSASA and first Chair of the SafeCare Initiative, said the shortage of qualified personnel and funds and the enormous burden of disease in Africa, particularly in the rural areas, stopped health workers from being effective.

"If the SafeCare Initiative is properly applied it will mean that health workers will be able to meet professional and internationally accredited standards of safety and quality and therefore be in a position to provide quality and safe care to their patients."

He also said that everything would be computerised so that information about facilities could be generated in a minute and comments and recommendations made quickly.

"The level and detail of the report will depend on who will use it and what their needs are."

This system would be able to find out precisely what is going on by isolating specific problems and where intervention was urgently needed.

An assessment of the baseline situation in facilities at the start of a programme for accreditation was really "when the rubber hits the road", said Whittaker, with the facility being looked over from the emergency room right through to what was happening in its kitchen (special meals for diabetics or other food-based care).

Assessors went into individual departments scratching beneath the surface and asking questions that flagged whether or not basic procedures were followed.

"We want to know what's going on in the operating theatre, because that is where things could go wrong. We look at the post-operative area, which can potentially be a high risk area."

"This initiative is not a quick fix but rather an incremental process towards excellence," Whittaker said.
A process will be adopted that combines all the skills and experience of the three organisations, including a system that recognises certified levels of achievement. The healthcare facilities, some of them coming in at very poor baselines, will gradually improve their ability to provide safe and quality healthcare and along the way - as a means of encouragement - they will be awarded certificates that mark their progress towards achieving excellence.