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How to ensure the best quality of healthcare for African patients

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The African population deserves high standards in healthcare, according to Africa Health 2021 speaker Jacqui Stewart, COHSASA CEO.

In her presentation on the first day of Africa Health 2021, Jacqui Stewart, CEO of The Council for Health Service Accreditation of Southern Africa NPC (COHSASA), said that ensuring the consistency of standards of regulation and accreditation will guide healthcare in treating patients better.

“The standards we have in Africa should be the same as everywhere. They set up the bar that says that's what our population deserves,” she told her audience. 

Stewart said during her session, The role of standards, regulation and accreditation in quality and safety, that standards contribute to quality and performance improvement in health organisations and the wider health system. 

“That is really important because a patient does not start and finish in one healthcare organisation - they go across the system and the standards should reflect the transition of care and the journey of the patient,” she explained.

Standards furthermore should be realistic, measurable, behavioural and achievable.

“Standards must be patient focused and encompass all aspects of an organisation. Standards should be comprehensive and reflect all dimensions of quality - efficiency, effectiveness, responsiveness,” she said.

To ensure these standards, Stewart said that there are four processes in which a third party can evaluate an organisation or an individual: Licensing, Regulation, Certification and Accreditation.

Licensing is when a government authority grants permission to a healthcare organisation through an onsite inspection to operate. This happens “often in the private sector - maybe with double standards - because we license in the private sector not the public one, but I think it is critical to have a minimum national standard,” she said. 

Licensing often sets out the minimum requirements in terms of physical infrastructure, equipment and sometimes staffing.

She explained regulations as the use of laws or rules to impose constraints on organisations and individuals to ensure the safety of the health system. Pharmaceutical companies are included in this.

“Institutional regulation is often done as an inspection and is seen to be punitive, which can generate a culture of compliance rather than a culture of quality,” she said.

The other two ways to evaluate a healthcare provider are through certification and accreditation. 

Certification is when an authorised body, whether a government or a non-government body, evaluates and recognises that an individual, such as a physician, or an organisation meets predetermined requirements. A certification example is the ISO which is related to technical conformance. 

Accreditation on the other hand is a voluntary process sought by a healthcare provider, often defined as public recognition of the achievement of the standards by a healthcare organisation through independent external peer evaluation. It provides an objective method to verify the status of healthcare provided. 

Stewart believes that the perception of these evaluative processes ought to change, so that rather than an “inspection” they are viewed as serving to ensure patient wellbeing as part of the culture of the healthcare system. 

The COHSASA chief executive also explained that ensuring standards begins with licensing as a minimum requirement for health operators – all hospitals must be licensed to practise.

Regulation is the next step, to enforce conformed behaviour, as regulators require predetermined behavioural requirements that are designed to protect the health and safety of patients. Certification and accreditation follow. 

“I believe that licensing, regulation, certification and accreditation all have their role, and they are all roles because what we need to do is to set a trajectory towards excellence,” she concluded.

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