Patient safety in African Health Services: Issues and Solutions - Speaking notes for the Minister of Health Republic of South Africa

Issued by: Department of Health

2 September 2008

The World Health Organisation has called on African countries to prioritise "patient safety", a concept that refers to processes or structures which, when applied, reduce the possibility of adverse events resulting from exposure to the health-care system across a range of diseases and procedures.

The report discussed today at the fifty-eighth session of the WHO Regional Committee for Africa taking place in Yaounde in Cameroon, lists 10 actions which could significantly improve patient safety in the African Region including development of a national policy for patient safety and minimizing healthcare-associated infections.

The WHO estimates that in hospitals in developed countries, 5% to 10% of patients acquire one or more infections in health facilities, the risk being two to 20 times higher in developing countries, with patients undergoing surgery being the most affected.

"This is indeed an important issue given that patients come to us when they are sick and need our help. They entrust us to do no harm. It is true that poorly trained health professionals, with inadequate equipment and supplies, and faced with heavy workloads will make mistakes. Without a strong health system we will not be able to adequately address the issue of patient safety," says, Minister Dr Manto Tshabalala-Msimang, during her response to the Report.

The Minister elaborated that suboptimal infrastructure had long been recognized as a very real threat to patient safety, with many of the health care facilities relatively old and have reached the end of their viable lifespan. A specifically designed hospital revitalization programme and clinic-building programme were introduced to modernise, rationalization and transform health care infrastructure, health technology and organizational management and development.

Outlining South Africa's efforts to improve patient safety, the Minister, stated the following:-

• Patients' Rights Charter launched in 1999 encourages civil society to participate in the development of health policies and in decision-making on matters affecting their health, including their safety. This charter is available in all official languages and training of health care workers in its implementation is conducted on a continuous basis.
• Countrywide, major progress has been made with establishing hospital boards and clinic committees to increase the partnership between patients, family members, health professionals and policy-makers. The role that these structures play in improving patient safety will be strengthened going forward.
• The Department of Health has a relatively young but rapidly developing infection prevention and control programme. A national Infection Prevention & Control Policy as well as a National Infection Prevention and Control Policy for Tuberculosis are in place. Practice guidelines for infection prevention and control are being developed.
• To date, the provision of guidance on the concepts and safe practices and procedures for patient safety have focussed infection prevention and control (including hand washing), waste management, appropriate use of personal protective equipments, blood safety and injection safety.
• Vaccines for Hepatitis B and influenza and post exposure prophylaxis for meningococcal meningitis, HIV, and syphilis are available to health care workers.
• Personal protective equipment (masks, gloves, gowns, visors, boots) is widely available in the health care system. However, the main challenge remains their optimal utilization. Major strides have also already been made to ensure the availability of appropriate and safe containerization and segregation equipment for contaminated wastes in public health facilities. For the more rural facilities the major challenge remains access to treatment sites and terminal disposal sites, as these are concentrated around the cities.
• Our Medicines Control Council has been in existence for many years and was set up to specifically ensure regulatory measures, quality and safety of medicines. Essential drug lists and treatment guidelines have been developed for hospitals and primary health care facilities. The challenge remains ensuring adherence to these guidelines.
• As well we have blood transfusion services that ensure the safety of blood and blood products - which we carefully monitor.
• Most recently we developed core standards to benchmark good practices as well as weaknesses in our health facilities. To date we have assessed 28 public hospitals and 4 community health centres. We are using these assessments, which cover 7 domains which range from patient perceptions to clinical governance, to develop health facility improvement plans for each of the facilities. This is an internal process which we are using to strengthen our ability to provide good quality care in the public health sector. We will be happy to share our initial experiences with member states.
• While we seem to have already implemented most of the actions suggested in the Report we are committed to reviewing our interventions and strengthening them.