Accreditation & Quality Assurance: Accelerating progress Towards Universal Health coverage in Africa - A Critical Role of the Private Sector

As many low and middle-income countries (LMICs) pursue health care reforms to achieve universal health coverage (UHC), the development of national accreditation systems has become an increasingly common quality-enhancing strategy endorsed by players, including Ministries of Health. There have been some investments in health facilities and medical diagnostics laboratories in Africa, contributing to more interface between accreditation as a continuous quality improvement strategy in accelerating the overall goal of achieving universal health coverage. Dr. Eckhard Kleinau, Director at URC, drew lessons from Jordan in establishing an accreditation council and efforts to move from pilots to scale and the requisite enabling environment for accreditation of health facilities to thrive. According to Jacqui Stewart, the CEO of COHSASA, accreditation is for both public and private health facilities. Ensuring that the entire health facility is accredited and well managed is crucial to ensure optimal working.

In ensuring health facilities’ optimal working, the process is critical and an iterative journey through accreditation. The processes within health facilities should be documented and systematized. Dr. Mohamed El Sahili, CEO of Medland Hospital, noted the importance of maintaining standards post accreditation, especially during the current COVID -19 pandemic and increased workload among health care workers.According to the World Bank, quality and safety are integral in achieving patient safety. Approaches such as performance-based financing, clinical audits, quality improvement processes, and accreditation have shown that quality can be improved in a relatively short time, even in highly constrained settings and without major additional investments in other health inputs. Jacqui Stewart, CEO-COHSASA, emphasized that public-private partnerships (PPPs) are critical and contribute to cross-fertilization across sectors. King Faisal Hospital is one of the outstanding public health facilities accredited by COHSASA. Dr. Edgar Kalimba, Deputy CEO of King Faisal Hospital, demonstrated the 15-year journey of King Faisal Hospital – a public hospital in Kigali, Rwanda, to be the only accredited health facility for the past ten years. According to Dr. Kalimba, “Health care stakeholders should work on access and quality of health services in tandem. Accreditation/quality improvement changes the mindset and approach of health services delivery by health care workers, including the governance and running of health facilities.”

An enabling environment is critical for the accreditation of health facilities. In Rwanda, the private sector played a crucial role by providing Community-Based Health Insurance, covering more than 80% of the Rwanda population. According to Dr. Nicole Spieker from Pharm Access Foundation, they have developed through a product called “ Safe Care” a way to stimulate investments in contracting health services. "Safe Care" developed a methodology to rank health facilities in terms of risks, including the investment risk for the banks. The "Safe Care" partnership has resulted in health facilities linkage to lending facilities through banks that are more amenable to investing in health services with a better understanding of risk profiles through accreditation. Similarly, insurance schemes are looking to reward better quality.