By Dr. Mary Adam and Dr. Jackline Oluoch Aridi
Last month the curtains came down on the inaugural African Consortium for Quality Improvement in Frontline Healthcare Research (ACQUIRE)’s Leadership Forum in Nairobi. Themed ‘Building Quality Improvement into Africa’s Health System Agenda,’ the meeting acknowledged that several African countries face challenges with their quality standards of healthcare care.
One of the key questions that emerged from the discussions was ‘How can these countries center the patients’ experience and their preference for higher quality of care in a country’s health system?’
Referencing Kenya as a case study, the delegates observed that its healthcare system still struggled with service delivery challenges despite making tremendous strides in policy development including publishing the Kenya Model for Quality Health (KQMH) and the Quality-of-Care Certification Framework.
Existing evidence shows that female patients especially, are more likely to experience poor-quality healthcare services. The words of a woman in labor with her first child narrating her desperate experience, still ring in our minds. “…I could see how people were giving birth and the doctors were harsh, beating people seriously and you were next and you don’t even know what you were going to do.” The reality is that it could have happened to any of us or our relatives. Mistreatment of pregnant women is a reality for many women driving higher rates of maternal mortality.
Unfortunately, as available data demonstrates, while the proportion of women delivering in a health facility in Kenya has increased from 44 to 60% in recent years, concerns abound that with good reason, they will still avoid delivering in a health facility, with poor quality of care, fear of abuse and disrespect ranking as some of the main reasons influencing their decisions.
Fortunately, frameworks exist to help healthcare facilities and national governments improve their services, transparency, and accountability to their patients. The KQMH is an example that provides a starting point to objectively measure the quality of care across the entire health system. Similarly, the World Health Organization’s statement on the Prevention and Elimination of Disrespect and Abuse During Childbirth, sets standards and supports local policy development. During the ACQUIRE conference, Kenya’s Ministry of Health announced that an additional law was on the way to address the quality of patient care, which has been a lingering issue for sector players. Known as the Quality -of Care Bill, it is being prepared by the government to build on the various previous initiatives to raise the standard of healthcare provided countrywide.
However, frameworks and policy documents are insufficient. A paradigm shift needs to happen within the healthcare system. The system needs to measure what matters to patients. Patients need to have a voice. And most importantly, the system needs to listen. We must collectively embrace and institute patient-centered healthcare. In any case, there are models with quality indicators that have been developed for healthcare systems. While these patient-centered quality indicators may not be perfect, they provide an excellent starting point, especially if the patients themselves participate in the development of these measurement tools.
Scholars such as Professor Patience Afulani have created measurement scales using data from African countries including Ghana and Kenya with simple questions like, “Did the doctors, nurses, and other workers treat you with respect?” “Were you covered up during your examination in the labor room?”. The responses to these questions can be tracked to give direct feedback to healthcare workers and hold the management of the healthcare facilities accountable.
Healthcare workers should listen to patients and capture what matters to them. When management provides an enabling environment for front-line healthcare workers to learn from their data, the quality of care can be improved.
It is important to map the patient choices and preferences because most times policymakers rely on evidence, which can be quite broad-based and tends to work with generalized results. We must shift our focus to examining the essential roles played by families, communities, and patients when designing our health systems.
Let us complement the frameworks and regulations on the quality of patient care with homegrown indicators to measure the quality and incorporate the priorities and experiences of patients and caregivers.
Our patients should not encounter poor quality healthcare services. We should move beyond dreaming about patient-centered healthcare to real practice. We believe that forums such as the ACQUIRE Quality Improvement Conference should be held regularly to bring together healthcare leaders from across the continent and assess our collective progress.
This way, we will support each other as accountability partners to make quality healthcare a daily reality.
ackline Oluoch Aridi, MPA, PhD is a Health systems Researcher who serves as a Director at the University of Notre Dame, Nairobi, a founding board member at Brother Andre Hospital in Dandora and serves as Adjunct Faculty at the Institute for Healthcare Management, Strathmore University Business School
Mary B. Adam MD, MA, PhD is a co-founder of the Africa Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE), Head of Research at Kijabe Hospital and is a Clinical Associate Professor at Vanderbilt University and a member of the Vanderbilt Institute of Global Health.
