Ghana’s Healthcare Quality Journey
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Theme: quality management in healthcare-module 1
Lesson: Quality Improvement in the Context of a Dynamic Healthcare Sector
Facilitator: Dr. Ernest K. Asiedu
Topic: Ghana healthcare quality journey
Introduction
With our previous knowledge in global perspective of quality, the history of quality outside of Ghana, we now look at how Ghana is moving as far as quality is concern.
Health sector quality journey in Ghana
Improving the quality of healthcare is a key objective of the health sector and the ministry of health expects that the services that we provide to our clients, our patients and consumers are of high quality.
The strategy for achieving this is through the implementation of quality assurance programs in all the health facilities. Many years ago, every health institution had quality assurance department, unit or team that made sure that infection prevention and control are catered for. making sure the standards and protocols are developed and pasted on walls, various wards including emergency units etc. all these were in- the traditional quality assurance and it’s really engraved as part of what we do.
It is envisaged that quality assurance will become integral part of routine health delivery in Ghana.
The initiatives to improve the quality of care are not new to Ghana’s health system. So we can see key personalities/pioneers including Dr. Cynthia Bannerman, Dr. Tweneboah, Dr. Aaron offei, Mrs Avortri, Dr. Diana Oddom, Dr. Oheneba Danso etc. who have been doing a lot of work within the quality space over the period.
In the mid 90’s the were two concurrent pilot projects in the country at the start of formal health care quality processes. One was carried out in the upper west region supported by DANIDA. The other one was also carried out in the eastern region also supported by Liverpool school of tropical medicine (Offei, Bannerman and kyeremeh, 2004). These projects focused on process quality without ignoring structure and outcome quality. All these were also founded on Donabedian approach of looking at things as far as quality is concerned. Running all these over the period helped establish the point where we deliver the national health quality strategy in 2016 which was ultimately launched in 2017 till 2021.
Out of this, lot of initiatives have come up. Quality was mainstreamed in the mid- 2000s with the setting up of quality assurance Departments at the Institutional care Division of the Ghana health service (GHS), headquarters (HQ). Similarly, some of these have been replicated beyond the national levels.
Ghana health service has since developed the quality standards, protocols and guidelines including:
- 1. patient’s charter (2002)
- 2. code of ethics (2002)
- 3. healthcare quality assurance manual and facilitators guide (2002) for sub districts
- 4. health quality assurance manual, sub district (2004)
- 5. patient satisfaction survey tool (OPD)
- 6. patient satisfaction survey tool (IPD)
- 7. staff satisfaction survey tool
- 8. quality assurance strategic plan (2007 – 2011)
- 9. maternal death audit guidelines (2012)
- 10. client’s complaints management guidelines (2013)
- 11. peer review checklist (2013)
- 12. referral policy (2012; REPRINT (201X)
- 13. referral feedback form (2010; REPRINT 2013)
- 14. CUSTOMER Care manual and video clip (yes matron) (2008; REPRINT 2013)
- 15. Prevention of wrong site surgery checklist (2014)
- 16. Informed consent forms for minors, adults with capacity, and adults without capacity (2014)
- 17. Perinatal death audit guidelines (2016)
Development partners have experimented with various quality assurance and quality improvement initiatives, which have provided several lessons to build upon
The diagram gives a flow of some of the quality journey starting from the 1990s right down to 2000s and 2002 to 2008 with “project fives alive” coming on board and 2016 the development of the national health quality strategy (NHQS) that ultimately is what is running the quality space within the country. But by and large a few other quality initiatives have come on board with various developments partners supporting this initiative in the country.
What is Healthcare quality
Quality of care is “the ability to achieve desirable objectives using legitimate means” (Donabedian, 1980). This means we can do things illegitimately and need to be mindful of that.
Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (institute of medicine, 1990)
Again the early definitions of healthcare quality were shaped almost exclusively by health professionals and health service researchers. However, there has been increasing recognition that the preferences and views of patients, the public and other key players are highly relevant as well (legido-quidley et al., 2008)
Good quality care is health care that is effective, safe and responds to the needs and preference of patients (European commission, 2010). This focuses so much on the consumer.
Quality of care is the degree of which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with evidence-based professional knowledge (world health organization, 2018). Quality should be looked at regardless of any determining factor i.e., sex, gender, age, disability, background, ethnicity, race etc.
What is Ghana’s healthcare quality?
Healthcare quality is the degree to which health care interventions are in accordance with standards and are safe, efficient, effective, timely, equitable, accessible, client-centered, apply appropriate technology and result in positive health outcomes, provided by an empowered workforce in an enabling environment (ministry of health) – Ghana, national healthcare quality strategy (NHQS 2016)
Why focus on quality now
For the payer we want to make sure our consumers receive quality care, they are not being harmed and ultimately, they become healed.’
It’s been envisaged as far as the universal health coverage is concern that we found ourselves embedded in a larger global movement towards universal health coverage (UHC) and we cannot do anything anyhow on our own so quality is the focus.
Again, there is a need for quality to be emphasized within the sustainable development goals (SDG) which aims to ensure healthy lives and promote well-being for all. So, Ghana cannot also be excluded from that.
The target 3.8 of SDG 3 states that achieving universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all (WHO-SDG, 2015). This shows that there is some financial risk protection without which quality may be seen meaningless. That was the need for national health insurance scheme in Ghana to provide the financial risk protection.
This global agenda affirms the importance of quality in achieving UHC by 2030
The diagram above shows some work that was done and published in the lancet global health commission on high quality health service. It says that about 5.5million death happens within our health system when they encounter poor quality care. On the other hand, there is a little over 3.3million death when they do not come into contact at all. So even though we are looking at what we call the triple aim which is looking at coverage, quality and the cost but we are saying that when people don’t have access to care which means coverage is not being attended to, the deaths that result out of that is way lower than when they come in contact with when we provide them with poor quality care.
For the burden of poor quality says between the healthcare we have (now) and the care we could have (future) lies not just a gap but a chasm which is very important to focus on.
Burden of poor quality
Some statistics of poor quality include;
- 1. 5.7 to 8.4 million deaths are attributed to poor quality care each year in low-and middle-income countries (LMICs), representing up to 15% of overall deaths in these countries.
- 2. Sixty percent of deaths in LMICs from conditions requiring health care occur due to poor quality care, whereas the remaining deaths result from non-utilization of the health system.
- 3. Inadequate quality of care imposes costs of US$1.4 trillion each year in lost productivity in LMICs.
- 4. In high income countries, 1 in 10 patients is harmed while receiving hospital care, and 7 in every 100 hospitalized patients can expect to acquire a health care-associated infection.
These are the things quality comes to address.
Recap of objectives
- 1. Present the global history and evolution of quality and Ghana’s quality healthcare journey.
- 2. Define quality and quality healthcare and what it means to different stakeholders – health worker, clients, and non-clients, policy maker, etc.
- 3. Establish why the focus on quality healthcare now.
RESOURCE MATERIALS