Patient safety

Safe Surgery in Africa

Safety is a fundamental principle of health-care provision and a critical component of any quality management. This is particularly true in the fast expanding area of surgery. About 234 million major operations are performed worldwide every year. The change in disease patterns worldwide is increasing the need for surgical services considerably. Epidemics and infections are giving way, as leading causes of death, to ischemic heart diseases, cancers, and trauma - which need surgical interventions. Ensuring better access to surgical care and its safe delivery are crucial to its effectiveness. The available evidence suggests that as many as half of the complications and deaths arising from surgery could be avoided if certain basic standards of care were followed. Safety in surgical care should not be limited by whether resources are available or not.

Promoting and implementing safe surgery through use of the WHO Surgical Safety Checklist in African hospitals is therefore of great importance.

Recently, the WHO Regional Office for Africa, together with the WHO Patient Safety Programme, organized a workshop in Harare, Zimbabwe, to support countries in their efforts to increase adherence to safety standards in surgical care in order to reduce morbidity and mortality caused by unsafe surgery.

Surgeons, anaesthesiologists and nurse leaders from teaching facilities in ten countries (Botswana, Kenya, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) were selected as participants. Focus groups discussed what kind of errors in surgical care are commonly observed, how to adapt the WHO Surgical Safety Checklist to local situations, how to implement the Checklist at facility level, and how to develop a dissemination plan for the Checklist country-wide.

Participants, although from a variety of countries and backgrounds, identified very similar errors and potential solutions, indicating that the underlying reasons where also similar. Organizational culture, lack of effective communication, human factors as well as personal attitudes were identified as major contributing factors to unsafe surgical care.

Participants felt it was important to liaise with leadership at various levels, with professional societies and networks, as well as civil society, in order to build momentum for change. All participants agreed to function as connectors and amplifiers and to take part in an "electronic community of learning and practice" to share their experience in establishing the Checklist in their own hospital, as well as spreading safe surgery to other facilities

It is too early to report on progress and impact of the WHO Surgical Safety Checklist implementation in the above-mentioned countries. However, encouraged by the success of this first workshop, in bringing together agents of change, a second workshop following the same model is planned in French-speaking African countries later this year. Suggested country participants include Algeria, Burkina Faso, Burundi, Cameroon, Chad, Congo, Cote d’Ivoire, DR-Congo, Gabon, Guinea, Mali, Mauritius, Niger and Senegal.

Africa as a whole has already 198 facilities registered as WHO Surgical Safety Checklist implementing hospitals through the WHO Patient Safety webpage: but much remains to be done.