PatientPatient SafetySafety -- AfricanAfrican PerspectivesPerspectives

Dr Tom Mboya Okeyo MD MPH DSHI Head of Department of Health Standards and Regulatory Services, Kenya Paper presented at World Alliance for Patient Safety Conference, Nairobi 17 Jan 2005 Context: Patient Safety Challenge in Africa

• Extreme poverty • Failed health reforms • AIDS Crisis • Humanitarian crisis Health and Economic . Indicators – UNDP

Indicators. Kenya Tanzania Uganda Population (2001-2 millions) 31.2 35.6 24.2 GDP (2001 – US$ millions) 11.2 9.3 5.7 Life –Expectancy (1999 –years) 56 44 44.7 Infant Mortality Rate (2001) 74 (79) 104 79 (97) Under-five mortality rate (2001) 112 165 124 Maternal Mortality Rate (1998) 590 530 510

Trends of Health Indicators Negative Negative Negative National Health Expenditure: Consolidated General. Government versus Private expenditure (2001)

. CGG Private

25%

75%

Source: MOH, 2003 and National Health Accounts (WHO/NHA unit, 28-5-03) NB: CGG= consolidated general government which includes government health expenditure at all government levels as well as expenditure by the National Hospital Insurance Fund. ‘Private’ includes out-of-pocket health expenditure, and health expenditure via Private Prepaid Health Plans, firms and employer-based schemes, NGOs and non-profit institutions. Sources of Health Financing by percentage contribution. to the total national healthcare expenditure per annum in Kenya (2001)

. 53.1% 1.6%

16.4% OOP GoK/MoH NHIF PPP 3.6% FEMS NGO/NP 3.9% 21.4% Source: MOH, 2003 and National Health Accounts (WHO/NHA unit, 28-5-03) NB: OOP=out of pocket expenditure; GOK/MOH refers to tax-funded health expenditure by the Government of Kenya/Ministry of Health; NHIF=National Hospital Insurance Fund; PPP=Private Prepaid Health Plans, FEMS= firms and employer-based medical services; NGO/NP= non-government organizations and non-profit institutions. Local solutions

• Uganda – contained AIDS Spread • Kenya – Island of Peace • Brazil – health reforms worked • Bangladesh – empower women • India – demystify cost of drugs African Patient Safety . Strategy

. PoliticalPolitical Will Will

SolidaritySolidarity FinancingFinancing

HumanHuman ResourceResource

EvidenceEvidence BaseBase GenericGeneric Drugs Drugs

EmpowerEmpower WomenWomen DSRS-KQM . KQM integrates…

Evidence-based. Development/revision and dissemination of Medicine clinical and public health standards and guidelines

with

Total Quality • Application of QM principles Management • Use of Master Checklist

and

Patient Promote community involvement and participation Partnership Patients/Clients are co-producers of health outcome DSRS-KQM QM Principles – Core. Values of the Kenyan Health Sector

Principle. 1 -Customer Focus (Internal-Health Worker, External- Patient).

Principle 2 - Leadership

Principle 3 – Involvement of People

Principle 4 – Systems Approach to Management

Principle 5 – Process Approach

Principle 6 – Continual Improvement

Principle 7 – Factual Approach to Decision Making

back DSRS-KQM . Quality Standards and Master Checklist

. STRUCTURE PROCESS OUTCOME

P4 Systems Approach

1. Leadership 12. Results: 11. Process: 2. Staff; 12.1 Patients/clients 3. Policy; S&G; Work Plan (Needs monitored and used for Quality -Health Service: improvement) 4. Facility; Client-Provider-Interaction 12.2 Performance of facility 5. Supplies (Nasocomial Infection Rates, Adverse Events, ER Ratio, Mortality Experience, CS 6. Equipment; -Continuous QI rates, bed occupancy rates) 7. Transport; 12.3 PHC Programmes -Programme Mgmt (HIV/AIDS, TB, Malaria, Reproductive Health, 8. Referral RH; Malaria, EPI, Immunization, Communicable Diseases) 9. Records & HMIS HIV/AIDS/TB; IMCI; 12.4 Staff (Staff Satisfaction) 10. Financial Mgmt. Communicable diseases 12.5 Society (Society Satisfaction) back KQM – Mater Check-list Help function and background. information

. Click ? Learn standards then assess against a 1 – 5 rating Type QI activities in the Task Window against each standard KQM – Database. Report grouped per facility etc Report with figures .

Graphical Report KQM Patient Safety Assessment 2003

Hospital Health centres Dispensary Private Clinics Quality Standards •Satisfaction with Quality and Safety of health 49% 29% 29% 69% services (Results) •Client-Provider-Relations (Process) – staff attitudes 43% 23% 14% 80% •Leadership 49% 42% 36% 79% •Human Resource (Staff motivation) 59% 30% 40% 67% •Availability and use of standards & guidelines 29% 25% 50% 75%

•Infrastructure – public health standards 76% 33% 25% 55% •Supplies & drugs standards 63% 42% 53% 69% •Equipment and Diagnostic Services 53% 15% 10% 25% •Transport standards 69% 10% 10% 59%

•Referral System standards 78% 10% 10% 60% •Records & Information System standards 71% 46% 33% 76% •Financial Management 59% 22% 10% 75% Conclusion

• Extreme poverty, implementation of inappropriate health policies, the AIDS crisis and humanitarian crisis together pose a major challenge to Patient Safety in Africa • Local solutions, which are sensitive to Africa’s social, cultural, economic and political realities are key to developing an African Patient Safety Strategy. • Ensuring political commitment, access to quality generic medicines and empowerment of women are important cornerstones to a new African Patient Safety Strategy • Implementation of Quality Standards based on KQM provides effective tools to monitor and evaluate patient safety in a comprehensive manner. THANK YOU.