An integrated approach required to improve health quality and outcomes in Africa

The global commitment to reach the Sustainable Development Goals by 2030 include providing high-quality promotive, preventive, curative, rehabilitative, and palliative health services to all communities.

However, a recent joint global report by the World Health Organisation, the Organisation for Economic Co-operation and Development, and the World Bank Group, found that quality of care, particularly in low- and middle-income countries, is suboptimal and that, in several African countries, accurate diagnoses are made in some cases, as little as a third of the time, and clinical guidelines for common conditions are adhered to less than 45% of the time.

With an average of just one doctor to every 10 000 people in Africa, the lack of human resources contributes significantly to the challenges in delivering quality care to patients.

Jacqui Stewart, CEO of The Council for Health Service Accreditation of Southern Africa NPC (COHSASA) believes that issues of quality should take centre stage on health policy reform agendas and that aid funders could play an important role in assisting governments to drive cohesive quality programs. She adds that good resources, such as the WHO Toolkit on implementing a policy strategy, already exist but are not always implemented effectively.

Stewart adds that COHSASA, the only internationally accredited quality improvement and accreditation body for healthcare facilities in sub-Saharan Africa, sets quality standards which cut across the entire facility and empowers healthcare facility personnel to bring about improvements and meet standards through their own efforts.

“Accreditation is a marathon, not a sprint.  Good quality and safety standards must be holistic and integrated across all levels and departments of a healthcare facility in order to result in better patient care,” she says.

Dr Lydia Okutoyi, Obstetric Gynecologist at Kenyatta National Hospital in Nairobi and speaker at this year’s Africa Health Conference, believes that child and maternal health are a good indicator of the quality of care within a country’s health system.  She says that, while there has been some progress on the continent, there is still an unnecessary high burden of maternal mortality from preventable conditions, such as obstructed labour, sepsis, and abortion-related conditions.

Dr Okutoyi adds that improving quality and outcomes must be  a holistic effort that includes empowering women to know when to seek care. Respectful care is another key factor in providing quality and safe care.

Respectful care means not only care that is technically correct but must also enable the mother to feel safe through, for instance, applying good hygiene standards,” says Dr Okutoyi.

Both experts believe that communities can and do play a significant role in improving the quality and safety of care.  In obstetric care, this could mean educating birth attendants or doulas on the danger signs during pregnancy, the importance of ante-natal care for the mother, or the establishment of ‘waiting homes’ close to a health facility for women who live in remote areas.

Stewart believes that by including quality and standards education at undergraduate level for all healthcare professionals, these principles would be inculcated into the health system and in turn would assist in bringing about system-wide positive change.

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