Patient safety in Africa - Vision and realism
Feature by guest writer Sam Zaramba
A few years back when I was practicing as an ENT surgeon in Uganda, I was faced with a range of situations that I now know concern patient safety. At the time, I knew that necessary systems were not in place to detect and prevent harm caused by the health-care system – I also knew that it was my personal responsibility as a surgeon to keep the patients I treated safe. Today I realize that it is the entire health system that needs to be strong enough to keep all the patients receiving care safe, each and every time they receive treatment and care. This, I believe, is a fundamental right of each individual receiving treatment and care – babies, children, mothers, adults, elders – everyone.
The health of the people of Africa is dependent on many things. Sometimes the challenges seem overwhelming. Yet I am convinced that there are huge opportunities to lay the foundation for patient safety in rapidly evolving health systems across the continent. A safe, effective health system that places emphasis on both disease prevention and treatment is critical to population health. Patient safety is a clear entry point for making progress on the health-related Millennium Development Goals.
In 2008, I was the vice-chairperson at the Regional Committee Meeting of the African Region in Yaoundé, Cameroon, which brought together all 46 WHO Member States. It was at this meeting that ministers from all Member States in the Region committed to tackle patient safety problems. Twelve patient safety action areas were agreed, providing a clear mandate across the continent for action at the regional, country and institutional levels. African health ministers were reminded that unless their governments implemented the Abuja Declaration of 2000, committing substantial resources to the health sector, it would be difficult to address these patient safety action areas in the African region. It is now a decade since the declaration, one wonders how many African countries have achieved the Abuja targets. But where do we start? How do we translate this high-level policy into concrete action? Careful reflection suggests five potentially ripe areas.
First, there is an urgent need for national policy-makers in Africa to recognize that patient safety is a critical and cross-cutting component of an effective health system – both in hospitals and primary care. The global patient safety community needs to do a better job at communicating this to decision-makers at all levels. We need clear advocacy materials that make the case for patient safety in Africa.
Second, we need to test integrated approaches to patient safety improvement in real-life African settings, recognizing that African systems are not one homogenous entity. Establishing a clear baseline using structured patient safety situational analysis followed by focused action is vital. Local adaptation, learning and doing at the same time is critical. Sharing across Africa is essential – we need a platform to allow this South-South learning in addition to the already existing South-North cooperation.
Third, patient safety is not a separate entity and we must advocate for it to be considered integral to health systems. Patient safety interventions such as use of the WHO Surgical Safety Checklist, should be seen as a tangible entry point into developing a high quality health system, which ultimately improves population health. The infrastructure required to deliver safe care needs to be factored in to action planning. Looking at health systems, one component that has continued to be a challenge in the African region is the human resources for health. Gross understaffing will continue to undermine the efforts on patient safety actions. The debate and concrete actions to improve patient/health worker ratio should be kept on the radar if the African region is to realise the safety actions agreed upon. Developed countries that have continued to be the destinations of the majority of the health workers should devise an agreed upon formula to assist the source countries to retain an adequate number of health workers.
Fourth, patients and communities themselves need to be involved across Africa. Civil societies which have tremendously improved service delivery in the African region should be mobilized to participate in patient safety. Individual patients must also be made aware of their rights and obligations as far as patient safety is concerned. We must build on the energy and drive of patient and community-based organizations across Africa to create an environment where patients and communities are seen as partners in co-developing safe health systems. The power dynamics are difficult to navigate but great work is already occurring – we need to build on this to overcome these dynamics.
Finally, partnerships need to be taken seriously. A WHO report on health systems strengthening presented at the World Health Assembly in 2011, highlights the importance of institutional twinning and is very much welcome. Such partnerships can be catalysts for change bringing safety teams together across continents. The power of human interaction should never be under-estimated. Teams can and have achieved huge improvements in the most challenging environments. There is an urgent need to examine how best to nurture the formation of patient safety teams through the use of partnerships.
While African health systems have much to learn about safety, these same systems can also provide the world some clear insights into how to develop and nurture safe systems. The potential for knowledge and skills to flow from Africa to the world cannot be ignored.
Patient safety is a new field across the world. In Africa, it is even newer. A clear vision of safe, effective health care that is grounded in realism, with clearly defined actions can translate the regional momentum of Yaoundé into local action for the African patient that will save lives. We need to act now. We need to act with global solidarity for patient safety with vision and realism as our guides.
Dr Sam Zaramba is a senior global health expert. He served as the Director-General of Health Services in Uganda. He was also Chair of the Executive Board of the World Health Organization. He is currently a member of the African Partnerships for Patient Safety Strategy Group. Dr Zaramba has a specific focus on strengthening African health systems through integrated action.