How could healthcare be anything other than quality?

Around 5 million people die each year in low and middle-income countries due to poor quality of health care. Poor care not only jeopardises the health of individuals; it erodes the trust of people and can be a barrier to people seeking clinical care.  Evidence also shows that the poorest people in society also receive the worst care. The Lancet Commission on High Quality Health Systems defines a high-quality health system as one which consistently delivers care that improves or maintains health, is valued and trusted by all people, and which responds to the changing needs of a population.   

The Government of Somaliland is committed to building a culture of quality improvement in healthcare and held an initial conference with support from KGHP back in 2019.  Now, with funding from the UK’s Department of Health and Social Care, KGHP is working in partnership with WHO, Borama Regional Hospital, Awdal Regional Health Management, the Ministry of Health Development Department of Community Health Services and Amoud University to take this work forward. The overall goal of our collaboration is to generate evidence and strengthen capacity to improve the quality of health care in Somaliland.  We are also implementing a pilot project in the Awdal region, which can serve as a basis for scaling up to a national quality improvement strategy.  

Situational Analysis of Quality Improvement (QI) - Building momentum for a national level strategy   

As a starting point, we worked with the Ministry of Health Development (MoHD) to contract a consultant to draft a situational analysis on the state of quality of care in Somaliland. With guidance from the WHO Quality Team, we have conducted a desk review, focus group discussions, and key informant interviews with health stakeholders in Somaliland, including respondents from NGOs, the Ministry of Health, health facilities, and health regulatory bodies.  The situational analysis was presented at a National Stakeholder Meeting on March 8-9, and key findings were validated. Stakeholders agreed there are more areas to explore in the situational analysis, therefore efforts to add to this document will be ongoing, led by the MoHD with technical advice from the WHO. We are hoping that this analysis and workshop are the start of a national conversation and commitment to quality of care.  The next step is to develop a national quality framework to be rolled out to all health facilities in Somaliland.  

Improving QI Knowledge and Practice in Boroma Regional Hospital and Health Centres 

Borama Regional Hospital and seven nearby health centres are the target facilities for a pilot project to support healthcare leaders there using a Training of Trainer approach. These facilities were identified by the MoHD for this intervention on the basis of high levels of poverty and vulnerable groups. A combination of rural and urban locations have been identified to maximise the applicability of findings to other areas and ensure our intervention reaches the selected Health Centres that serve rural, and therefore the most underserved populations. Health Centres selected are those which conduct outreach to their local communities.

Expert volunteers from the Quality Improvement Team at the South London and Maudsley (SLaM) NHS Foundation Trust have delivered a series of interactive online courses to leaders at Borama Hospital, Health Centres, the Ministry of Health Development and from Amoud University medical faculty. The courses have focused on both quality improvement methodologies and how to be an effective facilitator and coach, so that these trainings can be cascaded to others. In practice, Quality Improvement is a bottom-up approach led by health workers and service users, and uses data and information to drive decision-making. The improvement short courses delivered by SLaM colleagues contained theoretical background as well as practical activities, allowing participants to put into practice their learning.

Facility Assessments and Training in Key Priority Areas 

WHO has also supported two Quality Improvement experts to conduct facility assessments in Borama Regional Hospital and at seven referral health centres in the region. These assessments highlighted four key opportunities for improvement: Infection Prevention and Control, Medication Management Systems, Patient Identification and consent systems, and Emergency Management Systems.  

The partnership has chosen to focus the QI approach on Infection Prevention and Control (IPC). We worked with WHO and a local IPC expert consultant to develop a set of trainings for hospital managers, clinical staff, cleaners and waste management workers.  

Each facility has been guided in how to set up an IPC committee with Terms of Reference outlining their role in keeping up IPC standards in the facility.  We have also purchased essential equipment for the hospital and health centres to manage infection prevention and control, such as colour-coded mops, buckets, waste bins, and sterilising equipment.   We will conduct monitoring visits over the next few months to understand how the IPC committees are functioning and to check how the equipment is being used. 

Find out more about our work in Somaliland here.