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SafeCare Progress Report 2011-2012


2 SafeCare


Preface

Introducing SafeCare

In 2010 the PharmAccess Foundation of the Netherlands, the Joint Commission International (JCI) of the U.S.A and the Council for Health Service Accreditation of Southern Africa (COHSASA) held talks in Amsterdam to discuss the possibilities of applying universal quality standards to clinics in developing countries. The discussion focused on creating standards that would provide a solid, secure and realistic framework to ensure that patients receive safe and optimal care despite resource constraints. The SafeCare Initiative (‘SafeCare’) is the brainchild of these founder organizations and is built on their worldwide experience. Officially launched in 2011 in Cape Town, South Africa, SafeCare now acts as the custodian of these internationally recognized standards covering the wide range of basic healthcare for defined categories of health care providers. It offers a step-by-step improvement path and a recognition system that promotes quality improvement and benchmarking of healthcare facilities. SafeCare is in the process of being registered as an independent not-for-profit foundation that will own the SafeCare brand and intellectual property, and have the standards, surveyor training and quality improvement systems ISQua approved. Since its inception, SafeCare has rapidly developed and now also serves clients besides the Health Insurance Fund and Medical Credit Fund, for which it was originally developed. As of July 2012 SafeCare serves approximately 200 clinics and hospitals in quality improvement programs in Nigeria, Kenya, Tanzania, Ghana and Namibia. Contracts are being established with the Kenyan, Tanzanian and Nigerian governments to apply the SafeCare standards and external evaluation methods for their national insurance schemes and public healthcare facilities, and also for multinationals such as Shell and Heineken. Supported by the UK Department for International Development (DFID) and the Bill & Melinda Gates Foundation, SafeCare is partnering with PSI, Marie Stopes International, International Finance Corporation (IFC), Grameen Foundation and Society for Family Health (SFH) Nigeria to assess quality improvements in Ghana, Nigeria and Kenya over a period of 5 years. A program with USAID and the police and armed forces in Tanzania (PEPFAR) is currently being negotiated. These quality improvement programs comprise nearly 1,900 clinics and support an estimated 2,626,400 patient visits per month. With a flying start of the initiative since its inception, we look forward to expanding and strengthening our activities across the African continent! Nicole Spieker Program Director Quality October 2012 SafeCare 3


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Our Mission, Vision and Objectives The mission of SafeCare is to get 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.

Objectives 1 Improving quality of care of primary and secondary health care facilities in resource-restricted settings through an external evaluation system based on standards and step-by-step quality improvement plans.

The vision of SafeCare is to become the leading international expert forum (think tank) for safe healthcare provision in resource restricted settings supported by pertinent operational research.

2 Rating and benchmarking of healthcare facilities, franchise networks and resource-restricted countries. 3 Establish a foundation for performance-based payout and funding systems for healthcare improvement. 4 Work in a legal framework that is accepted by local and national authorities and may be extended to a national certification and/or accreditation system for both public and private healthcare providers.

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Background There is a shortage of institutions and standards that can ensure objective measurement and rating of the level of quality of basic healthcare facilities in Africa. As a result, quality levels of providers are not transparent, benchmarking is not possible and patients face uncertainty with regard to the quality of health care they seek. Building institutions and creating standards that help patients to make informed decisions about health care will address these issues. In addition, such systemic changes could stimulate providers to improve the quality of care through targeted interventions, motivate performance-based financing mechanisms by (inter)national donors and investors, and enable local and national healthcare authorities to monitor and regulate healthcare providers. The above reasons prompted the three founding organizations PharmAccess, JCI and COHSASA to establish the SafeCare Initiative (SafeCare). SafeCare acts as the custodian of internationally recognized, unique standards that are realistic for resource-restricted settings while not compromising on quality levels. SafeCare standards focus on “bottom of the pyramid” public and private healthcare facilities such as dispensaries and health centres, that make up the main healthcare distribution channel

for low-income settings and that struggle with patient safety and quality demands. The methodology dissects the improvement process of healthcare providers in surveyable, measurable steps. Thus, an improvement path is created that offers positive incentives for healthcare providers to enhance quality and ultimately qualify for full accreditation. Whereas the latter objective might remain out of reach for most providers for some time to come, a pathway to work towards that objective will boost client, investor and regulator confidence in the motivation and capacity of healthcare providers to steadily enhance their performance. All quality improvement efforts are supported by innovative data collection and reporting tools, allowing for real-time facility assessment and online monitoring. In addition, the data collected on clinical performance allows for prioritization of financial allocation which enables a more efficient use of available resources.

The SafeCare approach offers: Tailor-made standards for resource-restricted settings. Step-by-step recognition of quality improvement as a basis for performance-based financing. SafeCare measures and recognizes relative (incremental) improvement, rather than applying a pass-or-fail system. Opportunities for quality benchmarking and data-driven resource allocation. Focused local capacity building for quality assurance. SafeCare works with Technical Assistance partners to build local capacity to guide and facilitate quality improvement. Data driven processes feeding into an international knowledge network, liaising with WHO and other international organisations. Advocacy and networking. SafeCare is also meant to put “healthcare quality and safety” on the international agenda, particularly where it relates to resource-restricted settings. 6 SafeCare


Yearly Independent Assessment

0

Poor

1

2

3

4

To achieve a sustainable approach, SafeCare works with Technical Assistance partners such as clinic associations, NGO’s, franchisors and health maintenance organizations (HMOs) to build local capacity to guide and facilitate quality improvement in the participating facilities. To achieve this, local personnel is trained and certified as surveyor or facilitator in Ghana, Nigeria, Kenya and Tanzania. These certified employees form the foundation of local SafeCare ‘hubs’. This allows the full circle of improvement, facilitation and external evaluation to be operational on the ground in each of the SafeCare countries.

5

Accredition

SafeCare V

SafeCare IV

SafeCare III

SafeCare II

SafeCare I

Entry Level

Certificate definition

6

Excellent

6. Excellent quality systems in place: healthcare provider has a proven track record of continuous quality improvement, is in substantial compliance with the SafeCare standards, and meets the decision rules for accreditation by independent organization COHSASA. 5. Demonstrates long-term commitment to continuous quality improvement, ready for accreditation program and self sufficiency of continuous quality improvement. Very limited technical assistance required. 4. Strong quality systems in place, but high-risk areas still in need of attention. Limited technical assistance required. 3. Medium quality strength, acceptable but vulnerable to changing environment. Focus on self evaluation of quality improvement processes using quality indicators, guidelines and standard operating procedures. 2. Modest quality strength, requiring medium technical assistance. Healthcare quality is still likely to fluctuate. Focus on the securing of quality systems, and processes especially in high risk areas. 1. Very modest quality, with continued need for periodic technical support. Focus on implementation of processes and quality systems and the availability of financial means to ensure availability of proper infrastructure and assets. 0. Poor quality however the organization has shown leader­ship commitment and a strong desire to provide safe health care and recognizes that significant improvements are needed to reach levels of consistent, efficient, safe quality care for each patient. It has fluctuating quality healthcare provision due to the unavailability of services at times.

SafeCare is being set up as an independent not-for-profit foundation that will own the SafeCare brand and intellectual property. SafeCare’s aim is to evolve into an inter­ national network that extends beyond the three founding partners and encompasses NGO’s, government representatives and independent medical associations. The goal of this network is to put ‘healthcare quality and safety’ on the international agenda, in particular with regard to resource-restricted settings. SafeCare secretariat is based in Amsterdam.

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Achievements SafeCare is currently contracted by the Health Insurance Fund (HIF) and the Medical Credit Fund (MCF) and operational in Ghana, Kenya, Namibia, Nigeria and Tanzania. The focus in 2011 and 2012 has been on the development of local capacity to perform SafeCare certification visits. In 2012 and onwards, this will continue to be a priority. This strategy reduces costs, builds local capacity and ownership and is likely to make the program sustainable in the long run.

The PharmAccess offices in Kenya, Tanzania and Ghana have recruited SafeCare surveyors who have gone through a rigorous training process to get certified. As is the case with the SafeCare standards, this surveyor training process is fully compliant with ISQUa regulations. Currently, there are 19 SafeCare surveyors employed by PharmAccess in Nigeria, Kenya and Tanzania, who are in different stages of their training program. In addition, quality officers employed by the local TA partners are trained to qualify as facilitators. They guide and mentor the quality improvement process with the facilities. Currently, 236 facilities are in different SafeCare phases of selection or improvement; an additional 219 are expected to enroll by the end of 2012. The distribution of the healthcare facilities per country and per program is listed on page 14 and 15 and covers all assessment visits, including those that may not have been selected for the HIF program. In addition to the above, one of the focal points of SafeCare is the development of quality standards for different categories of primary and secondary health care and innovative software tools. Central to this are the SafeCare standards designed for the bottom of the pyramid healthcare providers,

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which offer practical solutions for the challenges of clinical management in a resource-restricted environment. In addition to the standards, the SafeCare Essentials is a rapid risk and patient safety tool, used for mapping facilities and program selection. All data are collected using tablets, and the data are automatically uploaded to a dedicated central server, with an automated report generated within 3 hours after submitting the data. Another innovative data management system has been the development of a quality improvement (QI) monitoring tool. This software tool is linked to the SafeCare certification report, and translates deficiencies into a comprehensive quality improvement strategy. When used in the MCF, the required budget for upgrading is coupled with to the business planning tool of the MCF. The QI tool allows for monitoring of the upgrading process, mapping of ‘low hanging fruit’ and the rewarding of targets met.


Interview with Dr.

Samwel Ogillo

“SafeCare has put APHFTA in a position to self-regulate the quality within private facilities and the sector as a whole.” “Before SafeCare the government gave us minimum standards to follow. This was simply a list of what should be present in a facility, but there was no way of actually measuring the level of achievement. The difference now is that you can actually measure, qualify and quantify progress by implementing the standards of SafeCare. We can actually talk about deliverables that can point out on where we were, where we are now and where we want to go. They have become guiding principles. Before it was like a ship going out to the ocean without a compass, but now we have a direction to take towards our destination. The program has therefore put APHFTA in a position to self-regulate the quality within private facilities and the sector as a whole. “For many facilities it was an eye opener as well. They were saying that they were offering the best quality in town, but if you would sit with them and explain what quality actually means, they realized they were far from offering good quality. After being in the program now for two years we have witnessed a huge change in the way the facilities operate. This can be seen right from entering a facility, the way the patient registers, the way the regiments are in seeing a doctor and the way the claims are effectively being controlled. “The result is that we see both the number of patients and the income of the facilities increase

because of the quality improvements we have advised. We have also noticed the appreciation of patients and the community in how the services have been improved, how they are approached and how they are treated now. “However, there is only so much you can do in improving the quality without requiring further financial resources. If we would come in with just the quality program and without offering soft loans, the facilities would say “we understand what you want and we like your program but we simply don’t have the money to implement it” and therefore you won’t have the same outcome. The combination of the two is crucial, where they have the possibility of getting financial assistance through the Medical Credit Fund to achieve the outcome they want in terms of quality.

Dr. Samwel Ogillo is CEO of the Association of Private Healthcare Facilities in Tanzania (APHFTA). APHFTA is a technical assistance partner of SafeCare and the Medical Credit Fund.

“Since it has now been documented in the Tanzania Quality Improvement Framework (TQIF) of the Ministry of Health and Social Welfare, we can discuss with the Ministry on how to improve the quality of care in health sector in a constructive manner. We can actually set an aim that, for example, all facilities should have at least SafeCare level three in the country. That is a good discussion to have, to actually set goals and formulate deliverables. This gives us something to reference to when we talk about improving the quality of healthcare services in the country.” SafeCare 9


Our Standards Although comfortable buildings with good staff and adequate equipment is an important goal, excellent care can be provided with limited resources, through proper training, personnel support and functional administrative structures. Many healthcare organizations in sub-Saharan Africa start from a resource restricted base and that they may feel that the gap between their actual situation and the standards is too great to bridge. The standards are designed to help bridge this gap between today and a better tomorrow, bringing improved quality of care and patient safety in a stepwise approach. While the ultimate goal is full standards compliance (accreditation), it is important to recognize an organization’s achievements along the way. To guide the facilities on this journey SafeCare uses 13 service elements that together represent the different aspects of healthcare delivery. The 13 elements range from how management is organized to how the cleaning staff operates. Below each of the service elements is briefly described.

1 Management and Leadership Management and leadership work collaboratively to develop the plans and policies needed to fulfil the mission of the facility and to co-ordinate and integrate the health service’s activities. This helps to ensure that adequate human resources, space, equipment and other resources are available to meet patients’ needs at all times.

2 Human Resource Management A health facility needs an appropriate number of suitably qualified people to fulfil its mission and meet patient needs. Recruiting, evaluating and appointing personnel are best accomplished through a co-ordinated, efficient and uniform process. Staff is provided with opportunities to learn and advance personally and professionally.

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3 Patient and family rights and access to care Health facilities work to establish trust and open communication with patients and to understand and protect each patient’s cultural, psychosocial and spiritual values. Patient care outcomes are improved when patients, and, as appropriate, their families are involved in care decisions and processes in a way that matches cultural expectations.

4 Management of Information Aggregated data from patient visits and treatment provided help the health facility understand its current performance and identify opportunities for improvement. By participating in external performance databases, a health facility can compare its performance to that of other similar health facilities, locally or nationally. Service managers and leaders use this data to improve the quality of the services offered.

5 Risk Management Health facilities work to provide a safe, functional and supportive facility for patients, families, personnel, volunteers and visitors. To reach this goal, facilities, equipment and medication must be effectively managed. Management must strive to identify, evaluate, reduce and control hazards and risks; prevent accidents and injuries and maintain a safe environment.


6 Primary healthcare services

10 Diagnostic imaging service

Certain activities are basic to patient care, including planning and delivering care to each patient, monitoring the patient to understand the results of the care, modifying care when necessary and completing the follow-up. Care may be preventive, palliative, curative or rehabilitative and may include the use of medications, supportive therapies, or a combination of these approaches. Guidelines are available for the assessment and treatment of patients for each program.

The organization ensures that the diagnostic imaging service meets the needs of its patient population, the clinical services offered, and the healthcare providers. When a diagnostic imaging service is provided, there are radiation safety programs in place, and individuals with adequate training, skills, and experience are available to undertake diagnostic imaging procedures and interpret the results.

7 Inpatient Care

A pharmacy with qualified pharmacists dispenses medication, or medical and nursing personnel may issue certain medications within the service. The patient, physician, nurse and other care providers work together to monitor patients on medications. The purposes of monitoring are to evaluate the response to medication, to adjust the dosage or type of medication, when needed, and to evaluate the patient for adverse effects.

Providing the most appropriate care in a setting that supports and responds to each patient’s unique needs requires a high level of planning and coordination. A plan for each patient is based on an assessment of needs. That care may be preventive, palliative, curative or rehabilitative and may include the use of anaesthesia, surgery, medication, supportive therapies, or a combination of these approaches. Delivery of the services is coordinated, integrated and monitored.

8 Operating theatre and anaesthetic services Services in the operating theatre and anaesthetic services carry high risk. It is essential that there is collaboration between the personnel in the theatre, the infection control and health and safety personnel and those responsible for supplying and maintaining equipment. Anaesthesia, sedation and surgical interventions require complete and comprehensive patient assessment, integrated care planning, continued patient monitoring and criteriadetermined transfer for continuing care, rehabilitation and eventual discharge.

9 Laboratory Services Laboratory investigations and rapid reporting systems are essential for patient assessment and the implementation of treatment plans. Laboratory services must be available at those times required by the organisation, including emergency and after-hour services.

11 Medication Management

12 Facility Management Services Buildings, grounds, plant and machinery are provided and maintained, and do not pose hazards to the occupants. Utility systems (electrical, water, oxygen, ventilation, vacuum and other utility systems) are maintained, to minimise the risks of operating failures.

13 Support Services The managers/supervisors of the services such as laundry, housekeeping and catering or support services work with other organisational leaders and managers to improve the quality of service delivery throughout the organization, and to ensure that services comply with criteria relating to management, leadership, human resource development, infection control, environmental safety and quality improvement.

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“As part of the quality program we renovated the whole clinic, which was necessary, because there was no proper entry, no good space to register patients, the pharmacy and the lab where a mess and the doctors rooms were very poor. Now we have good partitioning and all the rooms are tiled, there is running water in every room and electricity is safe.� Dr. Hassan Ahmad, owner of Bonde Dispensary, Tanzania


“For providers SafeCare works as a guide to measure achievement overtime and to be able to set priorities and stride to a longterm journey with an incentive to keep moving forward.” Millicent Olulo, Senior Quality Manager of SafeCare in Kenya

“We have seen improvements in infrastructure, the building, in machinery and most important in the staff. In 2007 we had 16 staff members, today we have 64 people working here.” Dr. Jacob Kayode Agbede, owner of Ogo Oluma Hospital, Nigeria


Clinics and Results 86

Data until 31 Augustus 2012

80

Ghana

Kenya

29%

60%

Top 3 service elements

Service elements with most room for improvement

Risk Management

In-patient care

Risk Management

Primary Health Care

Human Resource Management

Primary Health Care

Management of Information

In-patient care

Management of Information

Diagnostic imaging

Support Services

36%

55%

Top 3 service elements

Service elements with most room for improvement

Diagnostic imaging

Average overall assessment score SafeCare Standards

27

Highest overall assessment score SafeCare Standards

Nigeria

236 Total number of clinics in program

Average overall assessment score SafeCare Standards

43

Highest overall assessment score SafeCare Standards

Tanzania

48%

90%

38%

Average overall assessment score SafeCare Standards

60%

Highest overall assessment score SafeCare Standards

Top 3 service elements

Service elements with most room for improvement

Top 3 service elements

Service elements with most room for improvement

Laboratory

Risk Management

In-patient care

Risk Management

Medication Management

Operating Theatre & Anaesthetics

Primary Health Care

Support Services

Diagnostic imaging

Support Services

Diagnostic imaging

Human Resource Management

Average overall assessment score SafeCare Standards

Highest overall assessment score SafeCare Standards


Clinic level

Level

327 Number of assessments

164

163

14

SafeCare Essentials

SafeCare Standards

Number of certificates rewarded

Clinic Type

44 %

72 %

236

Number of clinics currently in the program

=

Private

Urban

16 %

20 %

Public/Government

Peri-urban

11 %

36 %

NGO/Based

Patients & Care

Rural

Clincs

V 0 IV 1 III 2 II 3 I 4 Entry level 4

Type of facility university teaching hospital

3

referral centre

2

district hospital

46

primary health centre

58

basic health centre

114

health shop

2852

13

25499 Family planning

Medical staff

39699 Immunizations

1495

6515

Other medical staff

Total number of staff

2168

38819 Malaria

525189 Number of patient visits per month

Supporting staff

25093 HIV

Improvement Areas Top 3 service elements

Service elements with most room for improvement

14 ­- 90 % Range of assessment score SafeCare Standards

Diagnostic imaging

In-patient care

Primary Health Care

Risk Management

Support Services

Human Resource Management

Capacity building

29

Number of trainings given

=

Clinical care

10

Lab 4

103

Number of facilitators trained

Pharmacy 4 Quality management

8

Admin 3

4

Number of surveyors trained

Technical assistance partners MDF Ghana KMET Kenya PSI Kenya APHFTA Tanzania Hygeia Nigeria

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Interview with Meggy

Agola

“Continuous training and technical support from the SafeCare program has given me the skills to train healthcare providers and assess facilities.” “Coming from a poor background, I always dreamed of a healthcare related career. As a qualified nurse, I volunteered in a teaching hospital for one year to improve my nursing skills and to learn new concepts. When I got a got a job at KMET doing reproductive health interventions, I immediately noticed that patient safety was at risk due to the quality of services. The Ministry of Health only conducted punitive supervision instead of supporting and stimulating quality improvements. When I became a part of the SafeCare program, I was able to help improve the quality of service step-by-step and at a low cost. “Continuous training and technical support from the SafeCare program has given me the skills to train healthcare providers and assess facilities. Through networking with like-minded partners I have strengthened my links with the Ministry of Health. In the SafeCare program I provide technical support to healthcare facilities taking part in the quality improvement process of the Medical Credit Fund program. This support includes selecting clinics, entry assessment, developing upgrading plans, monitoring implementation 16 SafeCare

progress and intermediate quality assessments. With continuous technical assistance from the Amsterdam office, I can now offer program improvement objectives. A practical example of my role is the Cherangany Nursing Home facility. This facility scored an average of 40% during the entry-assessment, a quality improvement plan was then developed to address the identified gaps with a focus on critical areas. The facility implementation was monitored quarterly. During the follow-up, technical support was given to various individual departments through training on infection prevention, waste management, fire protection, development of and access to departmental guidelines according to standard requirements. In May 2012, I conducted an internal mock survey to determine the implementation rate of the Safe Care standards. This motivated the facility since they could identify their gaps and when the external assessors visited the facility its average score improved from 40% to 70%.”

Meggy Agola is Senior Quality Assurance Officer of Kisumu Medical & Education Trust, the technical assistance partner of the Medical Credit Fund and SafeCare in Kenya.


Our Ambition For 2012 and onwards the focus will be on the strengthening and expansion of SafeCare as a service provider to the MCF and HIF programs, further capacity building of local assessors and facilitators and further promotional and support activities. Another 220 facilities are expected to enter the program directly through our partner organizations. In addition to the existing MCF and HIF programs, the SafeCare country expansion is scheduled as follows: Kenya

In Kenya the SafeCare work is expected to increase tenfold in the next 2 years. Besides HIF and MCF programs, SafeCare is a partner in the APHIAplus program, which aims to strengthen Kenyan health systems and includes the implementation and expansion of the Kenyan SafeCare certification body. The initial target facilities are those which are member of social franchising networks such as Tunza (PSI) and Goldstar (FHI360) but also facility associations such as K-MET. SafeCare is also a partner of the AHME program, which has been granted in July 2012, that aims to expand external certification methodology to the social franchises of PSI, MSI and FSH in Kenya, Nigeria and Ghana. For national programs, SafeCare has entered into a collaboration agreement with the NHIF as a Technical Assistance partner for the implementation of SafeCare standards into the NHIF accreditation system to be introduced into 280 healthcare facilities across the country starting in 2012. SafeCare is providing the Ministry of Health technical assistance on their quality improvement methodology.

Tanzania

Besides the HIF and MCF networks in Tanzania, over 172 clinics of the armed forces (TPDF/ TPPI) are in a quality improvement program that has been supervised by PharmAccess

over the past 5 years under a PEPFAR/USAID agreement. The SafeCare methodology is has been introduced into these clinics this year with a phase 1 program starting in March 2012. A proposal is being developed to introduce SafeCare methodology to the health insurance scheme of the National Social Security Fund (NSSF) in Tanzania. The Ministry of Health has adopted the methodology.

Nigeria

In addition to the implementation of the HIF and MCF programs as mentioned in the overview, SafeCare is cooperating with the Ministry of Health of Lagos State to provide technical assistance to adopt SafeCare methodology into a national institutionalized quality improvement and recognition methodology. SafeCare works with Shell to certify their healthcare facilities. On top of that the AHME program will be implemented.

Ghana

In Ghana SafeCare works with the MCF clinics to guide and evaluate clinics in quality improvement. In addition, 64 facilities are using the SafeCare essentials tool to guide and measure improvement of progress in a WOTRO research program together with the NHIA and a local PhD student.

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Financial overview Starting capital for the SafeCare program was obtained from MSF (‘medefinanciering’) of the Dutch government and from the Health Insurance Fund (a grant from the Ministry of Foreign Affairs of the Netherlands). This allowed SafeCare to develop the standards, field test the methodology, apply for ISQua accreditation and introduce the software, data collection and reporting methodology. During its initial development phase, innovations have been financially supported by the Health Insurance Fund (HIF). In addition, the direct quality improvement and evaluation activities of facilities that are participating in the HIF and Medical Credit Fund programs provide direct and paid demand for SafeCare. This is currently leading to significant leverage by attracting new contracts and funds as listed in table

below. Especially funding from USAID and Bill & Melinda Gates Foundation and DFID (the AHME program) has significantly increased the financial self-sufficiency of SafeCare. Although additional funding is still required, we expect the program to be self-reliant within the next 3 to 5 years with funding coming from both public and private stakeholders.

Program Contracting SafeCare Program

Time Frame

SafeCare Funding

APHIAplus Program Kenya: USAID funded consortium aims to strengthen Kenyan health systems and includes the expansion of the Kenyan SafeCare certification body

3 years

1,300,000 USD

AHME Program: funded by Gates Foundation and DFID under HANSHEP introduces SafeCare external certification methodology to the social franchises of PSI, MSI and FSH in Kenya, Nigeria and Ghana

5 years

4,200,000 USD

TPDF/TPPI, Tanzania: over 172 clinics of the armed forces (TPDF/TPPI) are in a quality improvement program that has been supervised by PharmAccess under a PEPFAR/USAID agreement over the past 5 years. The SafeCare methodology is introduced into these clinics this year with a phase 1 program started in March 2012

tbd

tbd

NHIF, Kenya: SafeCare is entering into a collaboration agreement with the NHIF as a Technical Assistance partner for the implementation of SafeCare standards into the NHIF accreditation system to be introduced in 280 healthcare facilities across the country starting in 2012

3 years

780,000 USD

MHOS, Nigeria: SafeCare is entering into collaboration with the MOHS to provide technical assistance to adopt SafeCare methodology into a national institutionalized quality improvement and recognition methodology

tbd

tbd

Royal Shell, Nigeria: SafeCare certifies SHELL healthcare facilities in Beyalsa State, Nigeria

tbd

120,000 USD


Management and Partner organizations SafeCare partners PharmAccess: Based in Amsterdam, the Netherlands, PharmAccess has experience in over 30 countries in Africa in upgrading and quality improvement of basic healthcare providers such as (nurse driven) facilities, health centers and district hospitals. PharmAccess’ expertise particularly concentrates on early quality improvement activities, including providing local assistance to providers with refurbishments, purchasing of bio-medical assets and building skills through interactive workshops. The quality improvement process is monitored through a rigorous data collection and analysis system. In addition, PharmAccess improves the financial situation of health providers by (where possible) connecting to existing or new healthcare insurance programs to secure income on the demand side and by business training on the supply side to improve access to affordable financing, including loans and investments. COHSASA: Based in Cape Town, South Africa, this organization is accredited by the International Society for Quality in Health Care (ISQua) as a competent healthcare evaluation body, and its standards are recognized as meeting the principles set out by ISQua. COHSASA has been working in the field of quality improvement and accreditation for over 15 years. During this time, COHSASA has worked in over 530 (different types of) facilities – from tertiary hospitals to basic clinics – in the public and private sectors in South Africa, the SADEC

20 SafeCare

region and other parts of Africa. Countries in which programs are operational include the RSA, Swaziland, Lesotho, Namibia, Botswana, Zambia, Rwanda and Nigeria. JCI: Based in Illinois, U.S.A, JCI is the international arm of The Joint Commission, the United States health care accreditation body. JCI has been working with health care organizations, ministries of health and global organizations in over 80 countries since 1994, and has accredited over 400 public and private health care organizations. Its focus is on improving the safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organizations implement practical and sustainable solutions. In June 2011, JCI received a four-year accreditation by ISQua that provides assurances that the standards, training and processes used by JCI to survey the performance of health care organizations meet the highest international benchmarks for accreditation entities.


SafeCare Management   The Quality Team, Amsterdam (PharmAccess) Nicole Spieker Program Director Quality Tobias Rinke de Wit Research & Business Development Hanneke Peeters Senior Quality Manager Christine Deurman Senior Quality Manager John Dekker Laboratory and Procurement Officer Aletta Kliphuis Quality Manager Annedien Plantenga Quality Manager   The Quality Team, Africa (PharmAccess) Peter Risha Program Director SafeCare Tanzania Edith Ngirwamungu Quality Manager Tanzania Johnson Yokoyana Quality Manager Tanzania Dupsie Oludipe Senior Quality Manager Nigeria Emmanuel Aiyenigba Quality Manager Nigeria Ibironke Dada Quality Manager Nigeria Tolulope Akinpelu Quality Manager Nigeria    Milicent Olulo Senior Quality Manager Kenya Jacinta Mburu Quality Manager Kenya Margaret Mwakiridia Quality Manager Kenya Mary Njoki Quality Manager Kenya John Nziu Quality Manager Kenya   The Quality Team, Cape Town (COHSASA) Prof. Stuart Whittaker CEO Jacqui Stewart Deputy CEO; Chief Operations Manager Ziyanda Vundle Quality and Facilitation Manager Jalaloedien Abrahams Informatics Manager Lyn Rayment Standards Development Coordinator Grace Labadorios GP Accreditation Standards Coordinator Marilyn Keegan Communications Manager Helena Tredoux Human Resources and Quality Assurance Manager Giel van Schalkwyk Chief Surveyor Paddy Clark Personal Assistant to Director Business Development Chris Bloem Surveyor Riël le Roux Surveyor   The Quality Team, Chicago (Joint Commission International) Paula Wilson President and CEO Paul vanOstenberg Vice President International Accreditation, Standards and Measurement Cecily Pew Director Board and Committee Activities

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Group of organizations SafeCare was co-founded by PharmAccess and is part of a group of organizations pursuing the same objective. PharmAccess is a Dutch not-for-profit organization dedicated to improve health care in Africa through innovative approaches. We believe that supporting and involving the private sector in the delivery of health care is crucial in countries where governments are not capable to provide public health nationwide. Donor money can be effectively used to increase trust in the health system, lower the investment risk and transaction costs and mobilize private sector investments. PharmAccess contributes to the development of health systems by stimulating both the demand and supply side, measuring and improving quality and increasing the amount of money in the system, leveraged by donor contributions. The organization has set an example as a different way of development cooperation making use of public-private partnerships. This approach has attracted a lot of international attention, including a G20 prize for our innovative financing model presented by President Obama in 2010. PharmAccess and its related foundations mobilize public and private resources for the benefit of doctors and patients through insurance (Health Insurance Fund), loans to doctors (Medical Credit Fund), clinical standards (SafeCare), private investments (Investment Fund for Health in Africa) and operational research (Amsterdam Institute for Global Health and Development). Together, this group of organizations serves the purpose of making good health care accessible to everyone in Africa, leading to healthier populations and social and economic development. Our partners, donors, investors and clients include Dutch and African (local) governments, local health maintenance organizations and insurance companies such as Hygea, AAR and MicroEnsure, international (donor) organizations such as World Bank/IFC, United States Agency for International Development (USAID), International Labour Organisation (ILO), Clinton Foundation, DFID, Marie Stopes International and PSI, international public and private investors, multinationals such as Heineken, Shell, Zain, Air France KLM and health accreditation organizations such as Council for Health Services Accreditation for Southern Africa (COHSASA) and Joint Commission International (JCI).

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Trinity Building C Pietersbergweg 17 1105 BM Amsterdam Phone: +31 (0) 20 566 7643 Fax: +31 (0) 20 566 9440 info@safe-care.org www.safe-care.org


SafeCare Progress Report 2011-2012