In recognition of strong quality improvement systems being essential for achieving priority health outcomes, in 2011 PharmAccess (PAI) developed the SafeCare standards and stepwise quality improvement methodology under a formal partnership with the Council of Health Service Accreditation of Southern Africa (COHSASA) and the Joint Commission International (JCI). The methodology benchmarks the performance of health facilities in the provision of quality care and formally recognises this through certification. After the official launch of the standards, PharmAccess started enrolling health facilities in Ghana, Kenya, Nigeria, and Tanzania into the programme. By early 2014, 164 facilities in Tanzania had been enrolled and 28 per cent of them had improved by 10 per cent within 18 months of enrolment. Patient numbers increased by 5 per cent within six months. Following these encouraging results, HDIF funded PharmAccess to take the innovation to scale, with the ambition to achieve a tipping point that would influence a systematic and sustainable change in quality improvement in the Tanzanian health sector.
In order to scale up, PharmAccess aimed to enrol 400 facilities into the programme and support them to undertake a stepwise improvement in quality of services as measured through the SafeCare methodology. In addition to supporting facilities in providing better care, technical support was offered so that facilities could access affordable loans through local banks to invest in quality improvement or to expand services. To systematise quality improvement changes throughout the private health system, PharmAccess embedded the SafeCare approach into the existing health policy and infrastructure of Tanzania.
PharmAccess worked in close collaboration with the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and also partnered with three national private sector umbrella organisations to implement project activities: the Association of Private Health Facilities in Tanzania (APHFTA), Christian Social Services Commission (CSSC), and Private Nurses and Midwives Association of Tanzania (PRINMAT). At the beginning of the project, PharmAccess provided technical support to their partners to undertake the project activities. Then, the technical assistance (TA) partners took charge of implementation at facility level and PharmAccess remained responsible for coordination, mentoring, technical support upgrades and issuing certificates of recognition.
- Seventy per cent of facilities improved by more than 20 per cent in the SafeCare score on the subsequent assessment after the entry or baseline assessment.
- In addition, some facilities found that engaging in SafeCare helps their efforts in implementing the SafeCare-generated Quality Improvement Plan and to address other MoHCDGEC health-care improvement initiatives.
- Implementing partners have included the SafeCare methodology as the approach to improve quality of services. For example, CSSC now has more than 200 sites across those enrolled into the quality programme.
- MoHCDGEC’s adoption of the basic tenets of the SafeCare model into other initiatives and frameworks has created a strong policy driver for a standard-based quality improvement approach.