SafeCare is a quality improvement model developed by the NGO PharmAccess, aimed at lower-level public and private health facilities in sub-Saharan Africa. The private sector is a major and growing source of care, but there are concerns about quality and safety, and these are insufficiently addressed by government regulation or international hospital accreditation standards. SafeCare was designed to address this gap, offering realistic setting-appropriate standards and stepwise certification, as well as access to credit for implementing improvements.
We undertook a large-scale randomised controlled trial to evaluate the impact on quality of care of the roll out of SafeCare to private for-profit and faith-based facilities in Tanzania. The trial assessed the effects on the quality of care received by patients through comparison of 237 intervention and control facilities after 1.5–2 years of implementation. To do this, we:
- measured clinical quality through standardised patient surveys
- observed infection prevention and control (IPC) behaviours
- conducted in-depth interviews with facility in-charges and implementing staff to assess the perceived benefits and costs of participating, and the factors affecting quality improvement and business performance.
- interviewed national level key informants to explore how the SafeCare model had shaped the market for healthcare and the policy environment
The results are expected to make an important contribution to the evidence base on improving private sector care, and to the literature on measuring process quality of patient care.
- Jessica J C King, Jishnu Das, Ada Kwan, Benjamin Daniels, Timothy Powell-Jackson, Christina Makungu, Catherine Goodman, How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities, Health Policy and Planning, Volume 34, Issue 8, October 2019, pages 625–634
- Wiseman V, Lagarde M, Kovacs R On behalf of Members of the Standardised Patients Working Group, et al Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities BMJ Global Health 2019;4:e001908
- Timothy Powell-Jackson, Jessica J C King, Christina Makungu, Nicole Spieker, Susannah Woodd, Peter Risha, Catherine Goodman, Infection prevention and control compliance in Tanzanian outpatient facilities: a cross-sectional study with implications for the control of COVID-19, The Lancet
- Policy brief
- Mystery shoppers for healthcare providers: risky or rewarding in measuring quality of care?
Ifakara Health Institute: Christina Makungu, Abdallah Mkopi
PharmAccess Foundation: Nicole Spieker, Peter Risha
Until end of June 2020