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Recognition of Quality Improvement through certification and accreditation. Nicole Spieker. Healthcare in Africa - a vicious circle. African health care systems stuck in a vicious circle of low demand and supply Access to quality basic health care among the poor is low. Demand. Financing.

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healthcare in africa a vicious circle
Healthcare in Africa - a vicious circle
  • African health care systems stuck in a vicious circle of low demand and supply
  • Access to quality basic health care among the poor is low

Demand

Financing

Supply

Low

  • Solidarity
  • Out-of-pocket expenses
  • Access to health care
  • Ownership
  • Quality and capacity
  • Efficiency
  • Availability data
  • Risk for owners and investors

Delivery

Low

Patient

  • Catastrophic spending
  • Low utilization
slide3

Breaking the vicious circle

  • Health Insurance Fund
  • Introducing health insurance
  • Premium subsidies
  • Education and marketing
  • Upgrading and capacity building
  • Quality assurance
  • Certification and accreditation

Donors /

governments (tax)

Government

(public)

Demand

Supply

Financing

Higher

  • Solidarity
  • Out-of-pocket expenses
  • Access to health care
  • Ownership
  • Quality
  • Efficiency
  • Availability of data
  • Risk
  • Investment opportunities

Trust

Delivery

Higher

Prepayment

(contribution)

by users

Patient

  • Investment Fund for Health in Africa
  • Medical Credit Fund
  • Increased willingness to pre-pay
  • Decreased financial risk
slide4

Quality Improvement vs. accreditation programs

  • Quality Assessment
    • “Prequalification”
    • Improvement tool, dedicated to
    • making informed decisions on
    • human and material capacity
    • building of medical service
    • providers in Africa
    • Assets, skills, processes
    • Input for initiation of coordinated improvement program
    • Implementation oriented
    • Voluntary or contractual participation
    • Specialists/peer to peer
  • Accreditation methods
    • “Qualification”
    • Evaluation tool dedicated to
    • measure current performance
    • against set standards
    • Predominantly processes
    • Input for maintenance of improvement program
    • Observation oriented
    • Semi-voluntary participation
    • Professional assessors
slide5

Licensing and Accreditation programmes

Internationally Accredited

Accreditation Standards

Process, Systems & Outcomes (Quality Improvement) Standards

Clinical Care & Patient Safety (including infection control)

Leadership & Governance

Excellent

Poor

Safe & Acceptable

Good

Numbers of Standards

Quality Assurance Standards for licensing

Structure & Basic

Process Standards:

Health & Safety

Cleanliness

Medicine Procurement

Licensure

Accreditation

Quality

quality improvement and accreditation
Quality improvement and accreditation
  • Accreditation is a process in which certification of competency, authority, or credibility is presented.
  • Organizations which certify third parties against official standards are themselves formally accredited ISQua
  • This accreditation process ensures that their certification practices are acceptable: they are competent to test and certify third parties, behave ethically and employ suitable quality assurance.
  • International accreditation bodies exist:
    • Managerial accreditation such as ISO
    • Healthcare provider specific accreditation:
      • JCI (USA)
      • COHSASA (South Africa)
      • Accreditation Canada
      • JAS-ANZ (Australia and New Zealand)
      • Etc..
aspects of quality
Aspects of quality

Relational quality

how do we address the patient? (e.g.

reception, doctor-patient relationship),

how does the patient perceive quality ?

Technical quality

professional capacity (e.g. skills, education, diplomas)

Functional quality

what is helpful for the care received by the patient (e.g. hygiene)

Organizational quality

organizing work and workflow, governance structure, etc.

healthcare quality performance
Healthcare quality performance

Can be measured in different dimensions:

Assets (equipment, etc.) available?

Skills (medical & other) - deficiencies?

Processes: how are they arranged within the clinic?

Outputs and outcomes of the clinic (individual and public health?)

Can be improvedby different interventions:

Purchase of assets & supplies

Training of staff / continuous education

Implementation of (standard operating) procedures

Implementation of safe systems and processes

Technical assistance (local and long distance)

External quality control and proficiency testing

the safecare initiative

The SafeCare Initiative

The SafeCare Initiative was started in 2011 through a collaborative of:

PharmAccess International Foundation, the Netherlands

The Council for Health Service Accreditation of Southern Africa South Africa

The Joint Commission International, USA

safecare initiative mission

SafeCare Initiative Mission

Place the issue of safe health care provision on the agenda in resource-restricted settings and create a platform for like-minded organisations and people who wish to provide safe health care despite resource constraints

safecare principles 1

SafeCare principles (1)

  • Development of innovative and realistic standards for healthcare providers in resource restricted settings.
  • Development of astep-wise improvement process that canbe measured and used by governments, donors, health insurers, (social) investors and loan providers to implement performance-based financing incentives in tandem with healthcare quality improvement (MCF).
safecare principles 2

SafeCare principles (2)

  • The standards and stepwise improvement are developed to:
  • increase efficiencies of healthcare facilities in resource-poor settings
  • qualify them to negotiate participation in insurance programs (HIF or commercial),
  • attract (MCF) loans and investments
  • increase patient flows and sustainability
  • improve the reputation and transparency of these healthcare facilities
standards tailored to hc provider categories
Standards tailored to HC provider categories

1

Tertiary (teaching) hospital- providing majority of specialized medical care .

2

Referral hospital providing a broad spectrum of medical care

3

District Hospital (or faith based/private hospital) providing 24 hrs services

4

Primary health center (minimum one MD, nurse and lab technician)

Basic health center offering primary health and maternal care(min. one clinical officer)

5

6

Health shop/nurse driven clinic: advice on basic health care issues

international standards local solutions

International standards, local solutions

“Quality is not necessarily high-tech or high cost”

SafeCare allows for realistic, practical and achievable solutions in resource restricted settings

safecare phased approach
SafeCare: phased approach

Phase 2: graded recognition

SafeCarestandards + tools

Phase 1: selection

SafeCare Essentials

Phase 3: accreditation

COHSASA

vv

Local facilitation & evaluation visits

Local facilitation/external evaluation visits

% of standard compliance

Full standards

compliance

Rapid Assessment

Certificate awarded

summary of areas covered by hospital standards
Summary of areas covered by hospital standards

Phase 2: graded recognition

Use of SafeCare standards and tools in an annual cycle:

assessment baseline

upgrading plan

technical assistance

assessment follow-up

certificates

Areas covered by SafeCare Primary Health Care Service standards

the evaluative architecture
The evaluative architecture

Criteria

Standard

Performance Indicator

Criteria

Criteria

Standard

Departments / Services

Criteria

Criteria

Standard

Performance Indicator

Criteria

Criteria

Overall Facility / Service Scores

Standard

Criteria

Criteria

Standard

Performance Indicator

Criteria

Criteria

Standard

Departments / Services

Criteria

Criteria

Standard

Criteria

Performance Indicator

Criteria

Standard

Criteria

slide18

SafeCare scoring system (1)

  • There are four levels of compliance:
  • Compliant [C]*
  • Partially compliant [PC]*
  • Not compliant [NC]*
  • Not applicable [NA] selected based on category of provider

Compliant criteria are scored as 100

PC and NC scores are weighted according to their severity:

afridb s erver for data storage and analysis
AfriDB: server for data storage and analysis

Service elements

Within 3 hours after submission of data through AfriQA, a TEMP report is available on AfriDB

yearly independent assessment by cohsasa
Yearly: independent assessment by COHSASA

100

Accreditation:

Accreditation level

Intermediate pre-accreditation

Entry level pre-accreditation

Accreditation

COHSASA

85

80

75

Safe Care

Certificates

of Improvement can be awarded, based on measured improvement

Compliance to quality standards

Safe Care recognition letter of entry

The Essentials (self) assessment and QI guidance

phase 3 accreditation by cohsasa
Phase 3: Accreditation by COHSASA

Accreditation of >530 facilities; 297 facilities in South Africa

impact of quality
Impact of Quality

Access: willingness to pay, trust, availability

Appropriateness: The right care at the right time for the right patient

Quality

Transparancy: benchmarking and accountibility

Cost effectiveness: sustainablity of quality improvement

safecare contributes to trust
SafeCare contributes to Trust
  • Patients : know where to go (branding)  increased revenue for private providers
  • Healthcare providers: can get better access to loans, insurers and patients
  • Banks :can provide loans based on quality plans and can rely on external validation
  • Donors : can allocate their funds to clear opportunities and monitor results
  • Governments: can be provided with a basis for a legal framework to monitor and regulate
  • Insurers: can choose or reward better performing providers
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