Business and Finance
Patient Safety Improvement in Africa
The Promota was privileged to have a brief interview with Mr. James Mwesigwa, a founder member and Vice-President of PASIMPIA [Patient Safety Improvement In Africa]. James is actively at the forefront of improving Patient Safety Improvement in Africa and Uganda is fortunate to be the first country to benefit from this pilot initiative.
Can you tell our readers about you and your education background?
Iam a founder member and Vice-President of PASIMPIA . I hold an MSc & Diploma (Quality and Safety in Health care) of Imperial College London. Also I hold an MSc (Health Services Management) and a BSc (Hons) Health Studies of London South Bank University. Prior to migrating in the United Kingdom, I had qualified as Clinical & Dental Public Health Officer at the Dental School, Mulago Hospital in Uganda. I have worked in Africa and United Kingdom for both NGOs and private sectors. In the last fifteen years I have worked as a project manager in healthcare quality improvement programmes. Currently, I am working closely with WHO-African Partnership for Patient Safety and European ICT-Patient Safety Companies to extend their services to the African region.
What does PASIMPIA stand for?
PASIMPIA stands for Patient Safety Improvement in Africa. PASIMPIA provides appropriate knowledge and practical skills that are relevant to the developing country’s healthcare systems needs, with a focus in Sub-Saharan African region. Visit our website at [http://www.pasimpia.org].
PASIMPIA can engage Uganda government hospitals in patient safety and quality improvement programmes, and offer affordable, sustainable and innovative patient safety solutions through practical teaching. The patient safety solutions to be offered to selected African countries are those based on fundamentals of evidence-based practice, competent leadership, teamwork, management and communication, but founded on bedrock innovative thinking
What extent of harm to patients from healthcare systems is known in Uganda?
Currently, the Uganda National Health Service is served by data-poor hospitals. As they are known, these hospitals are those that do not routinely collect information about characteristics of the patient and/or of the process of care and/or where the data sources are not accessible and/or reliable. That implies, millions of patients receiving healthcare from Uganda government hospitals may be at risk of suffering from patient safety incidents: unintended or unexpected events that may lead to prolonged ill-health, injury, extended hospital stay, disability, disease or suffering and death caused by unsafe vaccinations, injections and blood transfusion, counterfeit and substandard drugs, unreliable equipment and practices, inadequate infection control, and overall poor health services, facilities and environments. There is no research evidence or data at present on above stated incidents or risks and for that matter the extent of harm to patients from healthcare systems in Uganda is largely unknown.
What do you think is the cause of these medical errors and how can we ensure safety of patient?
The poor state of infrastructure and equipment, unreliable supply and quality of drugs, short comings in waste management and infection control and severe under- financing of essential operating costs make the probability of error and harm much greater than in industrialised countries. For example many injections used for treatment in developing countries such as Uganda are in fact unnecessary, as oral drug treatment would equally or be more effective. The danger comes from reuse of syringes without sterilizations, with syringes often just being rinsed in water between injections. Although lack of knowledge and poor standards play a part, danger is hugely compounded by the basic lack of resources and the need to reuse any item of equipment if at all possible.
Do you think, ICT can help in reducing the rate of errors in healthcare and how?
ICT has been shown to contribute not only to reducing the rate of errors in healthcare by providing more accurate and transparent information. ICT tools can enhance patient safety in three ways:
- Can help prevent medical errors and adverse events,
- Can initiate rapid responses to any event
- Can enable the tracking of events, if they occur, and provide feedback on them to learn from such events
However, patient safety should go further than merely reducing medical errors and ICT solutions that support healthcare professionals in their work can contribute greatly to improving more generally the quality of care.
Do you think there is a need to establish a specialised academy for training healthcare professionals in appropriate patient safety solutions which are vital for a sustainable safe National Health Service development in Uganda?
Oh yes, the academy would offer healthcare professionals knowledge and skills: to measure the magnitude and type of different adverse events that lead to patient harm, offer leadership and governance competency training in order to groom better leaders with improved patient safety skills that can mobilise their staff and engage them into increased awareness of patient safety, protect the patients through the introduction of ICT patient safety solution so that the Uganda hospitals pursue sustainable health care systems that are conscious to their protection of their patients.
I understand you were recently in Uganda, what did you find out as regards to patients?
Several factors that would increase the risk of Healthcare Associated Infections were evident throughout the government hospitals I visited.
For example poor hygiene and waste disposal, inadequate infrastructure and equipment, understaffing, overcrowding, lack of basic infection control knowledge and implementation, unsafe procedures and a lack of guidelines and policies.
While national surveillance systems exist in many high-income countries, they are non-existent in the vast majority of low-income countries such as Uganda. To be precise numbers of Healthcare Associated Infections remain unknown because of the difficulty in gathering reliable data country wide.
Uganda government has carried out a number of upgrades of the medical school curriculums but the upgrades have not addressed the healthcare needs of offering training tailored to quality and patient safety requirements. How do you plan PASIMPIA to address this?
The academy would establish specialised training for healthcare professionals in appropriate patient safety solutions which are vital for development of a sustainable safe national health service in Uganda. The academy would offer an opportunity to introduce creativeness and innovativeness to medical students and healthcare professionals in their practice that will empower them to always find appropriate solutions to patient safety problems, provide training for better clinical waste management to all Uganda government hospitals, undertake research and carry out studies on the best healthcare quality improvement programme and patient safety solutions and translating evidence into safer care.
What are 3 issues you would change in the health system if you are given the opportunity?
At present it is extremely difficult to imagine or propose an effective and a functional solution without a clear knowledge and understanding of the cause and impact of this on the government, individual and the healthcare organisations. To work out patient solutions:
First, we need to understand the root cause of adverse medical events in order to avoid them or to deal with them.
Secondly, we also need to understand the methods that can be used to calculate their impacts and costs, in order to take the most targeted and specific of approaches to handling them.
Thirdly, we need to understand the role that ICT and patient safety training can play in improving patient safety culture among health care practitioners.