Patients everywhere should be able to trust the quality of healthcare available in their communities. SafeCare creates trust through transparency, by setting standards and providing a stepwise approach for healthcare facilities that inspires and motivates all stakeholders in the ecosystem to improve quality.
A standards-based approach that fits the challenging context
Every year, 5 million people die in low- and middle-income countries because of poor quality of healthcare – more deaths than from malaria, HIV, and tuberculosis combined. Many of these causes are preventable or treatable, as long as adequate quality care is provided by skilled practitioners.
This may seem simple, but it is not. Health facilities – especially primary healthcare centers (PHC), the cornerstone of the sub-Saharan Africa healthcare system – face many daunting challenges. As the first point of entry for healthcare services from antenatal checkups to minor emergency surgical procedures, they are the go-to place for a growing population. At the lower end of the quality spectrum, women who just gave birth might be found sharing a bed, which is not only unsafe but is also exacerbating hospital-acquired infections. Combine this with a lack of handwashing stations and shortage of medication, and the lack of adequate quality care is clear.
This lack of quality is the result of a lack of investment in health, which leads to a lack of basic infrastructure, a lack of working equipment, medicine stock-outs and demotivated staff. In Nigeria, a significant portion of the healthcare workforce is leaving the country as a result of the poor social and economic conditions, increasing the workload for those who are left behind and undermining morale and lowering the quality of care even more.
Poor quality of care is a structural barrier to achieving universal health coverage (UHC). When patients do not trust the quality of the care they receive, they are less likely to seek care, leading to low and ineffective use of care. Without quality care, UHC remains an empty promise.
SafeCare aims to address this vicious cycle by providing an accessible standards-based stepwise approach to quality improvement that is relevant and applicable in resource-restricted settings. SafeCare connects thousands of healthcare facilities and stakeholders, public and private, in low- and middle-income countries (LMICs) to improve the quality of care and outcomes for millions of patients.
Healthcare facilities can only improve what they are aware of and measure, so the first step of the process is assessing and benchmarking. Through this step, SafeCare provides data insights that help facility staff make decisions.
The benefit of quality data extends far beyond the facilities themselves. Data insights enable stakeholders across the healthcare ecosystem to allocate funds to the most critical improvements. Transparency is also imperative for investors, including for our own healthcare fund, the Medical Credit Fund. And data can help governments develop policies and regulatory frameworks that support country-wide quality improvement.
The ultimate goal is to improve patient health outcomes. Behavioral research SafeCare carried out in 2022 shows that the number one motivator for health staff is to personally experience quality improvement through their patients’ improved safety and wellbeing.
Building a culture of quality and drive engagement
A culture of quality means that quality is top of mind and integrated in the daily practice of healthcare providers and that staff members are motivated to take part in a journey to better care. Equally, in order to implement a culture of quality nationwide, every stakeholder of the ecosystem must take part in quality improvement.
SafeCare uses technology – the Quality Platform – to connect facilities in the region and inspire and change behavior of staff. Through gamification, badges, and benchmarking the platform is designed to enhance the motivation of all staff members, and it’s already changing the way its 4,500 users approach quality. Facilities can carry out self-assessments through the platform too, helping providers in remote rural and fragile areas improve quality.
For other health stakeholders like investees and governments, the Quality Platform provides the opportunity to act upon the most urgent needs. With the real-time monitoring dashboards, they can follow the progress facilities are making.
The Quality Platform enables SafeCare to optimize and increase users’ focus on quality through low-cost, remote, and digital support. In 2023, we will further drive innovations through the platform, with a focus on tele-medicine, remote care models and modular training (e.g., epidemic preparedness). Our ambition is to become the go-to place for peer-to-peer learning, gaining insights, and accessing contracting opportunities.
Improving the aspects of healthcare that matter most
SafeCare addresses all medical and non-medical aspects of care. While structural improvements like installing handwashing stations are relatively easy, care process improvements like having a triage protocol in place or actively reporting medication errors are likely to save more lives. This is why SafeCare is increasing its focus on criteria that are expected to have the biggest impact on health outcomes.
Data shows significant progress in 2022. For example, the number of SafeCare facilities that have a pre-operative checklist in place increased from 49% in 2021 to 66% in 2022. According to the WHO, operational checklists can reduce mortality and complications in the surgical environment by over 30%. Similarly, guidelines compliance at facilities improved from 41% to 83% over the year – a crucial step towards creating a safe, highly reliable environment.
Scaling through institutionalization via sustainable global partnerships
In order to impact the 5 million people who die due to poor-quality healthcare every year, we need to continue to scale and localize our approach. We do this by collaborating with public and private partners.
Our ongoing cooperation with the Christian Health Association of Ghana (CHAG) represents the potential SafeCare has to transform quality. As a licensed party servicing the health needs of at least one-third of the population, CHAG has helped many facilities across Ghana to improve their quality. In 2022, SafeCare was also formally recognized at a national level by Health Facility Regulatory Agency (HeFRA) for assessing quality improvement of health facilities and recognized as a Continuing Professional Development (CPD) activity by medical professional bodies.
In Zanzibar, the government implemented the SafeCare methodology across the archipelago to assess and improve the quality of all its facilities. Through SafeCare, Zanzibar’s public entities have access to quality improvement tools for institutionalizing quality care.
In 2022, SafeCare equally supported an increasing number of states and counties in Nigeria and Kenya, as well as private partners like Namibia Health Risk Solutions (NHRS). We also extended the impact of SafeCare through partners that have a broad reach and are highly valued in the market. We initiated a new global (license) partnership with CRS International (Africa), and we continued to build on our partnership with Aga Khan Health Services (Asia).
By the end of 2022, we had 32 partners reaching almost 15,000 providers using SafeCare’s stepwise approach. Cumulatively, 10,000 quality assessments have taken place since SafeCare started.
Through the expansion of SafeCare in 2022, we saw a transition towards more financial sustainability, with 10 paying public and private partners. A growing portfolio of self-paying partners ensures the longevity of our approach, with SafeCare remaining non-profit.
“The government vowed to offer free healthcare and outstanding services following the 1964 Revolution in Zanzibar. As time goes on, Zanzibar's population is rapidly increasing, yet its economy is not growing fast enough. We have made big infrastructural investments to increase access to care, but our budget is insufficient to cover everything"
Nassor Ahmed Mazrui, Zanzibar Minister of Health
Growing presence in Asia
Thanks to the support of MSD for Mothers, we grew our partnership with Manyata – a quality improvement and certification initiative provided by the National Federation of Obstetric and Gynecological Societies of India (FOGSI). India’s quality of care among private providers is inconsistent and there is no consensus on standards and monitoring. Inconsistent care leaves patients and pregnant women at high risk of complications and death.
We worked with FOGSI to co-create a digital quality assessment tool that transformed the way quality monitoring is done. So far, 138 facilities have received technical assistance to improve quality. With the digital tool, Manyata can scale to at least 1,000 facilities by 2024.
In addition to the Manyata program, we are working on expanding SafeCare in India with partners such as Access Health International and PSI. Growing and strengthening our presence in Asia, we now have a team of two SafeCare colleagues in India.
The business of quality: do health quality investments pay off?
It is possible to improve quality of care, including through SafeCare. But with concerns about initial costs healthcare facilities often lack the incentive to adopt quality improvement methods.
Research PharmAccess conducted shows that under most conditions, better quality care is correlated to more and better businesses. The study demonstrates significant links between higher SafeCare scores and increased patient visits and staff numbers in facilities in Africa. To further stimulate investments in health, SafeCare links facilities to Medical Credit Fund (MCF) for loans and provides support to MCF’s clients to materialize quality investments.
(+) Read the full article (preprint under peer-review).
The circulation of poor quality or fake drugs is a serious public health challenge in sub-Saharan Africa. In Ghana, PharmAccess set up Med4All: a digital platform that aims to make quality medicines widely accessible at an affordable price.
In 2022, Med4All struggled as a result of the depreciation of the cedi and the country’s economic crisis. In October, inflation surged to 40.5%, resulting in daily price increases for medicines and difficulties with suppliers demanding cash on delivery or refusing to deliver orders. The average delivery time of medicines increased from 14 to 30 days.
To address the issues, Med4All started working with suppliers that did not require cash on delivery and started new negotiations for price reduction in exchange for a temporary, fixed payment cycle. While the cedi seems to be stabilizing in 2023, businesses and customers continue to face challenges.
In 2022, we also continued our work with CHAG on improving medicine quality and pricing. Through this collaboration, more than half a million patients have already accessed quality-controlled medicines, and healthcare providers benefit from prices that are on average 20% lower than the market price and are compliant with the regulator’s quality requirements.