COHSASA CEO to chair the Quality Management Conference at Africa Health 2019

For the latest in QI head on over to the Gallagher Estate in May. Details are available here:

Conference Name: Quality Management Conference
Venue: Gallagher Convention Centre, Johannesburg
Theme: Public or private healthcare – quality is everyone’s business
Download the full programme here

The Decontamination & Sterlisation (CSSD) conference will take place from the 28-30 May 2019 at the Gallagher Convention Centre, Johannesburg, South Africa.
Developed with the support of CFSA and APPSA attend to:

Debate the implementation of current standards – who is getting it right?
Identify and mitigate risks existing within CSSDs
Discover best practice from hospitals operating outside South Africa and benchmark your hospital’s CSSD practices
Hear from leading field experts including:

Marietjie du Toit, National Infection Prevention and Control Specialist Nursing, Life Healthcare Group; Chairperson, Gauteng Infection Control Society, Johannesburg, South Africas
Xana Jardine, National Chairperson, CFSA, Johannesburg, South Africa
Marilyn de Meyer, President – Gauteng Chapter, Association for Peri‐operative
Practitioners in South Africa (APPSA); Theatre Manager, Life the Glynnwood Hospital, Johannesburg, South Africa
Terry McAuley, MSc Medical Device Decontamination, Director, STEAM
Consulting, Melbourne, Australia

To view the full conference agenda please click here


COHSASA appoints new Quality Improvement Manager

Dr Londa appointed as Quality Improvement Manager

Imagine the scene: you are suturing a rebel in the war-torn Democratic Republic of Congo. The theatre table wobbles and there is no operating light. Nor is there antiseptic. Under these conditions, you might want to change the status quo.

Thus it was that Dr Leonard Londa, who has joined the senior management team at COHSASA as the Quality Improvement Manager, became intensely aware that he wanted to change and save lives by improving the safety and quality of healthcare in any situation in which he found himself.

Dr Londa arrived as a refugee from the Congo in 2010. He obtained his medical degree at Lubumbashi University in the Democratic Republic of the Congo (DRC) in December 2008 and afterwards worked at the academic teaching hospital in Lubumbashi.

Promoted to superintendent of a hospital in a rural area, the Malemba-Nkulu Territory in the Haut-Lomani Province of the DRC, Londa had to start flexing his muscles as a clinician under pressure. This area, in the South East of the country, was also slap-bang in the middle of fighting between factions: a perennial feature of the DRC political landscape.

Says Dr Londa: “The maternal and infant mortality ratios were very high. We had one ambulance but that was out of order. So pregnant woman had to get to hospital by any means possible. They rode bicycles and we swept them up from canoes on the Congo River!  Unfortunately, some arrived too late and presented with a ruptured uterus and sepsis.

“Worse, the hospital was dirty, the theatre was dirty and there was no equipment. There was a chronic shortage of staff.”

Determined to make changes

Dr Londa, who has quality improvement imprinted in his DNA, made some changes. For one, he trained many community health workers to undertake tasks to assist mothers. He gave radio talks to educate and create awareness of potential problems in pregnancy.

“I was determined to make changes for the better.  I had to change the mindset of my peers and the community. I worked with NGOs in the area and recruited villagers to be health workers.

“Communication was a big issue and we never had enough air-time for our phones! I renovated the theatre and secured equipment. I tried to make changes. However, I had to flee eventually because of the war.”

After a long and winding road, Dr Londa arrived in South Africa. In October 2010, he worked as a medical officer at the Maluti Adventist Hospital in Lesotho. Here, he was involved in a wide range of clinical work including the management of HIV/AIDS/TB patients. He also took care of trauma cases and worked in the orthopaedic and gynaecology sections. He was the Quality Improvement Officer.

Since 2013 (and until he joined COHSASA) Dr Londa worked as the South Region programme manager and the Clinical and Quality Assurance Master Trainer at JHPIEGO in Lesotho. He was the manager at an HIV/AIDS/TB clinic and a trainer of voluntary medical male circumcision providers. He also took care of surgical emergencies.

Taking COHSASA’s mission forward

He hopes to take COHSASA’s mission forward.

“I want to give input into the COHSASA mission and make sure that whatever COHSASA stands for is being applied in the field.”

He will be overseeing the activities of all the COHSASA quality advisors. He has an interest in clinical research and wants to examine what obstacles stand in the way of a successful accreditation programme.

“I want to improve the quality and safety of health to change lives and thus lead to the creation of a more productive society. Many HIV patients only work 10 days in a month. This must change.”

Dr Londa is married with two children.



COHSASA CEO chosen as global leader in health


The CEO of The Council for Health Service Accreditation of Southern Africa (COHSASA), Jacqui Stewart, has been selected as one of the 100 Most Impactful Healthcare Leaders by the World Health & Wellness Congress for 2019 scheduled for 14th February in Mumbai, India.

The World Health & Wellness Congress is a not-for-profit body that organises the annual meeting with the objectives of learning and development, networking and recognising leaders who have contributed value to the profession or their organisation and who, through a positive impact, have made a difference.

The Congress attracts leaders from the continents of Asia, the USA, Africa and the Gulf Cooperation Council (GCC), an alliance of six countries in the Arabian Peninsula: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates.


The organisers have informed Ms Stewart as follows:

“Our approach is towards thought leadership and along with thought leaders international we would like to confer on you the “100 Most Impactful Healthcare Leaders – Global Listing”

 “The award reflects your professional achievement and our belief that you are a thought leader in healthcare industry and a valuable contributor.

 “To reach to this conclusion we have approached your peers who have recommended your name. This recommendation has been vetted by the advisory board of World Health & Wellness Congress.”

 The Health and Wellness Conference takes place on 14th and 15th Feb 2019 at The Taj Lands End, Mumbai, an iconic venue overlooking the Arabian Sea.

Responding Ms Stewart said, “I am deeply honoured and very humbled. Thank you very much to you and the advisory board for this great honour.”

Says Chair of the COHSASA Board, Ms Sharon Slabbert, “The COHSASA board congratulates Jacqui on another great achievement which is testament to her dedication to quality assurance internationally, but, particularly in Africa.”

Unable to accept the award in person in Mumbai since the dates clashed with COHSASA’s Annual General Meeting and Board Meeting, Ms Stewart has asked that Mumbai resident, Mr Anisur Rehman Jagrala, accept on her behalf.



COHSASA’s latest accreditation awards

The healthcare facilities listed in the table below have recently been awarded accreditation by The Council for Health Service Accreditation of Southern Africa (COHSASA), a not-for-profit company (NPC) based in Cape Town.

COHSASA accreditation award means the healthcare organisations have entered a rigorous quality improvement programme and have been assessed against, and comply with, standards recognised by the International Society for Quality in Health Care (ISQua), the global body overseeing accreditation and quality improvement programmes in healthcare organisations in 70 countries around the world. COHSASA itself is accredited by ISQua as are its standards.

Hospitals and clinics that initially enter the programme and meet standards are awarded two-year accreditations and as the journey in excellence continues, awards of longer duration are given. A four-year accreditation award from the Council should signal to patients that a facility has sustained standards over a commendable period.


Facility Status


Award Valid Location 
MedAhead@Wilgers in Pretoria 2 Years Full Accreditation 15 February 2019 to 14th February 2021 Die Wilgers, Pretoria, Gauteng
Mediclinic Kloof 4 Years Full Accreditation 15 February 2019 to 14th February 2023 Erasmuskloof, Pretoria, Gauteng
Mediclinic Newcastle 3 Years Full Accreditation 15 February 2019 to 14th February 2022 Newcastle, KwaZulu-Natal
Mediclinic Paarl 4 Years Full Accreditation 15 February 2019 to 14th February 2023 Paarl, Western Cape
Mediclinic Vergelegen 4 Years Full Accreditation 15 February 2019 to 14th February 2023 Somerset West, Western Cape
Queen Mamohato Memorial Hospital in Lesotho 3 Years Full Accreditation 15 February 2019 to 14th February 2022 Maseru, Lesotho
Selebi Phikwe Government Hospital in Botswana 2 Years Full Accreditation 15 February 2019 to 14th February 2021 Selebi Phikwe, Botswana



COHSASA’s fifth international accreditation

The Council for Health Service Accreditation of Southern Africa NPC (COHSASA), has achieved its fifth accreditation from the International Society for Quality in Health Care (ISQua), the global authority with a mission is to improve the quality and safety of healthcare worldwide.

This fifth accreditation, valid from 2018 to 2022, means that COHSASA itself, as an organisation, has been independently assessed by the most credible authority in the world in this field and has had its existing systems and operations validated. The process does not end there as the aim is to drive continuous quality improvement throughout the organisation.

COHSASA is the only health services accreditation body in sub-Saharan Africa to be accredited by this ISQua.

COHSASA has achieved accreditation from ISQua in 2002, 2006, 2010, 2014 and now in 2018. This latest accreditation further focuses attention on this not-for-profit organisation that will be co- hosting ISQua’s 36 th International conference in Cape Town, the first time that the conference will be held on African shores.

Furthermore, the COHSASA Healthcare Facility Standards (First Edition) has also achieved ISQua accreditation for the period of 2018 to 2022.

The ISQua surveyors gave the COHSASA Healthcare Facility Standards a rating of 89% and described the result as “excellent”. This was the first survey of this suite of standards which includes: Generic Service Elements, Inpatient Care standards and Ambulatory Care standards. These standards are an amalgamation of six existing sets and they have been combined to provide consistency and reduced duplication.

Based in Cape Town, the Council was founded in 1995. In the past 23 years, it has worked with 594 healthcare institutions across 35 clients in 11 countries in Africa. Using professional standards, COHSASA identifies gaps in service provision and assists healthcare staff to meet those gaps.

The Council empowers health workers to ensure that there are systems and processes in place, underpinned by professional standards, so that patients are provided with safe, quality care.

Commenting on the latest accreditation, CEO of COHSASA, Ms Jacqui Stewart said:

“I am absolutely delighted that COHSASA has been accredited by the International Society for Quality in Health Care (ISQua) for a fifth time and has achieved accreditation for twenty consecutive years.  This accreditation is an indication of excellent team work within the organisation, high quality systems, a commitment to our mission, vision and values and most important, a commitment to our clients.

“I am pleased that our healthcare facility standards have also been accredited for four years.  We now have just two sets of standards, healthcare facility standards for inpatient care and ambulatory care.  These two flexible sets enable us to better respond to requests to accredit facilities delivering new approaches and models of health care. We are committed to maintaining high quality programmes and services for all our clients for many more years”.

Chairperson of COHSASA, Ms Sharon Slabbert said of the latest accreditation: “The Council of Health Services Accreditation of Southern Africa has for the fifth time been accredited by the ISQua following a rigorous process of evaluation. This clearly indicates that the Council is striving towards its vision of being the leading health service accreditation organisation globally. This is only possible through the total dedication and hard work of the CEO and staff. It is through absolute adherence to the principles of the highest standards of quality in the provision of healthcare that this remarkable achievement has been made possible.”

Elaine O’ Connor, ISQua Head of the International Accreditation Programme and Strategic Partnerships CC, said: “ISQua warmly thanks and congratulates all who were involved with this process and offers best wishes for the continuing success of Council for Health Service Accreditation of Southern Africa.”

The spice and colour of Kuala Lumpur

A weaving of heads, hearts and hands at ISQua’s 35th conference

Above left: Elom Hillary Otchi, Technical Director of the Africa Institute of Healthcare Quality Safety & Accreditation (AfIHQSA) helped drum the next ISQua conference into being. He is photographed with the CEO of COHSASA, Jacqui Stewart, in resplendent Xhosa traditional wear. Above right: Lerisha Mudaliar of the Cape Town Convention Bureau talks to potential delegates at the #Cape Town2019 stand in Kuala Lumpur.
Kuala Lumpur –  a sprawling 243 sq. km urban landscape – is an exciting, first world city but caught in a time warp of architecture. Modern skyscrapers border on Moorish edifices that border on British colonial buildings. The locals are polite and helpful, and they are wonderful hosts. The food is sensational, the city sprawl overwhelming.
The taxi driver who took me from the airport some 60 kms away to Kuala Lumpur (KL) was a chatterbox. He could speak six languages – Bahasa Malaysia (principal language), English, Mandarin, Hakka, Tamil and Hindi. As we approached the city centre of Kuala Lumpur there was no escaping the Petronas Twin Towers. They are quite an exceptional feature, especially when you are eating breakfast at 32 floors up the next morning…
The world-famous Petronas Twin Towers.
The conference was based at the impressive Kuala Lumpur Convention Centre – a massive edifice which straddles one of the more impressive parks in KL. The dramatic atmosphere in the park (particularly during a thunderstorm) is emphasised because the north end of the park is dominated by one of the highest buildings in the world, the Petronas Twin Towers.
Delegates were seen popping into the Suria Shopping Centre at the base of the towers – seven floors of high-end consumer luxury to cater for shopaholics. The more adventurous explored the Batu Caves, where a Hindu temple nestles in limestone.
A wide variety of conference sessions were well attended – either plenary or in smaller conference venues – to learn and share knowledge about the latest theoretical and practical developments in the field of quality improvement, patient safety and external evaluation.
ISQua, which represents 70 countries over six continents, is acknowledged as the global authority that for the past three decades has dedicated itself to promoting quality improvement in health care.  It does this through education, knowledge sharing (the conference being one of the principle vehicles for this), evaluating accreditation bodies and connecting like-minded people through its healthcare networks. It supports health systems worldwide through its extensive networks and continuous work to improve quality in healthcare.
The theme of this year’s conference in KL was “Heads, Hearts and Hands ‘Weaving the Fabric of Quality and Safety’” and true to that theme, every delegate was presented with a gift of the most intricate woven lanyard-style necklace at the Welcome Reception.
It was at this reception that delegates got their first glimpse of plans for next year’s ISQua conference. This time it will be held in Africa, in Cape Town (#CapeTown2019). To promote it, the Cape Town and Western Cape Convention Bureau hosted a stand for delegates to get a taste of what adventures lie in store. The theme for the 2019 conference is ‘Innovate, Implement, Improve: Beating the Drum for Safety, Quality and Equity’.
Many stopped at the stand to trade flyers in their conference bags and business cards for gifts (a clever promotion to create awareness and draw prospective delegates). Some won amazing gifts, like cage diving with Great Whites in False Bay.
But the highlight, from a Cape Town perspective, was the handover ceremony, when the baton for organising and hosting the conference passes from one city and country to another.
Jacqui Stewart, CEO of COHSASA, was determined that the handover would not be lame and so she whipped up enthusiasm among African delegates attending in KL to dance, beat drums and wear traditional African dress on stage. They marched on confidently – appropriately – to the official FIFA World Cup song for 2010, Shakira’s Waka Waka (This time for Africa).
Ms. Stewart also made a short speech, spelling out the reasons for a logical move of the quality improvement focus to shift to the African continent.
As Bill Gates tweeted recently: “I’ve been traveling to African countries regularly for more than two decades. I wish others could come along so they could see what I see: a young continent filled with optimism and innovation.”
There was also short documentary on Cape Town and the Western Cape which should have whet the appetite of the most blasé traveler.
The ISQua 2018 conference in Kuala Lumpur was a great success, with revolutionary content (the role of technology, the role of compassion, metrics, AI, using logical thought to establish effective process) and great speakers. Once again, ISQua pulled it off. CEO of ISQua, Peter Lachman, and his loyal team at ISQua work so hard each year and the cumulative result is that they have created one of the premier events on the global health calendar.
Cape Town looks forward to welcoming health professionals from all over the world in October 2019. (The call for abstract papers has already gone out. Registration can be made online until 18th October 2019). See
Above: A few members of the African contingent who danced on stage at the beginning of a plenary session in Kuala Lumpur to announce the next ISQua conference in Cape Town in 2019; above left – Pumza the Penguin, the ISQua Cape Town 2019 Mascot, poses with Acshton the Kangaroo, the mascot for the ACHS (The Australian Council On Healthcare Standards). Above right: in the frame for the Cape Town conference next year (from left), Jacqui Stewart, CEO of COHSASA, Mmbangiseni Magoro, Director: Systems Data Analysis and Research at the Office of Health Standards Compliance (OHSC);   Professor Morgan Chetty, Chair of the Independent Practitioners Association Foundation, Dr Siphiwe Mndaweni CEO of the OHSC and Dr Vincent Setlhare, Acting Head of Department – Family Medicine at the University of Botswana.
Youtube link

Jwaneng Mine Hospital celebrates

Superintendent, Dr Mwamba Nsebula of Jwaneng Mine Hospital, proudly holds the COHSASA Accreditation Certificate – the fifth awarded to his hospital. Pictured with him (from left) are Marilyn Keegan, COHSASA Communications Manager; Kgosi Nkaelang Lekgoa; Ms Baile Moagi Deputy Permanent Secretary for the Ministry of Health and Wellness in Botswana; Mr Cornelius Dekop, Permanent Secretary in the Ministry of Mineral Resources, Green Technology and Energy Security; Mr Albert Milton, General Manager of the Jwaneng Mine and Kgosi Legwaila.
There were scenes of celebration – dancing, singing, DJ spinning, jazz and marimba bands, choirs and praise prayers when Jwaneng Mine Hospital in Botswana achieved a score of 99 out of a possible 100 for their recent fifth COHSASA accreditation award.
This fifth award signifies that not only has the hospital reached international standards but has consistently maintained them for over a decade and a half!
Led by a masterful Director of Ceremonies, Tumie Ramsden, the Debswana Club was beautifully decorated and filled with hospital doctors, nurses and administrators in finest array; a swirl of gold and silver and shimmering evening gowns. 
Dignitaries included Mr Cornelius Dekop, the Permanent Secretary in the Ministry of Mineral Resources, Green Technology and Energy Security; Mr Albert Milton, the General Manager of Jwaneng Mine and Ms Baile Moagi, the Deputy Permanent Secretary in the Ministry of Health and Wellness. 
But the centre of gravity turned around the hospital personnel who had worked so hard to ensure that Jwaneng met international standards yet again. This hospital that serves a catchment population of 80 000 – well beyond the miners and their families – is setting an excellent example of how quality and safe healthcare can be delivered to patients on a sustainable basis.
The evening started off with some brisk marimba playing by the pupils from the Acadia Primary School and what a wonderful performance they gave! It set the tone for the rest of the evening; joy and celebration. 
A wonderful dinner was served interspersed with speeches, dancing, music performances and an energetic DJ.
All departments that achieved over 80 (and that meant all the departments in the hospital) received certificates and the “big” one – the accreditation certificate – was handed over to Dr Mwamba Nsebula, Superintendent of Jwaneng Hospital – by Ms Baile Moagi. 
Highlights of the evening… 
The Katrin Kleijnhans Quality Trophy is awarded to an individual, a unit, a department or a discipline in a healthcare facility that made the most impressive or substantial contribution to quality improvement during the COHSASA accreditation process. 
The recipient is not selected by COHSASA but is chosen by the appropriate authority at the healthcare facility. 
At Jwaneng, the award was jointly shared by Victoria Phenyo Botlhole, the Quality Assurance Coordinator of Jwaneng Hospital and the Occupational Therapy Department of the hospital, represented by Dr Keletso Maribe (pictured here together holding the trophy). 
After its initial presentation, it is hoped that the trophy will become an annual internal floating trophy, given to a deserving recipient at the facility. It is also envisaged that the name on the trophy will become synonymous with the values, efforts and rewards involved in continuing quality improvement and serve to encourage and acknowledge all such efforts in the future. 
Welcoming guests, the General Manager of Jwaneng Mine, Mr Albert Milton said, “This re-accreditation bears testimony to Jwaneng Mine’s strong commitment to providing safe healthcare practices of a reputable quality. This resonates well with our value system ‘Putting Safety First’ and caring for our people.” 
Welcoming guests, the General Manager of Jwaneng Mine, Mr Albert Milton said, “This re-accreditation bears testimony to Jwaneng Mine’s strong commitment to providing safe healthcare practices of a reputable quality. This resonates well with our value system ‘Putting Safety First’ and caring for our people.” 
Mr Milton said the hospital’s continuing success with accreditation had led to the mine management’s decision to continue allocating resources to the hospital where in 2017 the total allocated budget was 80 million pula (R 104 296 000,00).
“This goes towards providing better health service for over 30 000 Jwaneng inhabitants, plus all patients from the surrounding villages and all motorists on the whole stretch of the Trans-Kalahari highway,” he said.
“Ladies and gentlemen, we are proud of our association with COHSASA, which has been instrumental in our quality improvement endeavours. To this end, Jwaneng Mine Hospital has embarked on a hospital expansion project which will reposition us as a healthcare facility comparable to any facility of its size, anywhere in the world,” he said.
Members of the Jwaneng Mine Hospital Choir file in for a medley of wonderful harmony.
In his keynote address, the permanent secretary of Ministry of Mineral Resources, Green Technology and Energy Security, Mr Cornelius Dekop said that accreditation was a worthwhile long-term investment to secure a future of quality health care for the citizens of Botswana.
“Jwaneng Mine Hospital is a true representative of Debswana’s philosophy, that its entrepreneurial success should be underpinned by social and economic responsibility. I am informed that this philosophy has at its core, the belief in turning diamond dreams into lasting reality, and aims at creating, building and maintaining sustainable partnerships with members of the community.  That way, communities can benefit from the legacy of diamonds in a real, lasting and significant way.
“On behalf of the Ministry of Mineral Resources, Green Technology and Energy Security, I call on everyone to do their best to keep up this great tradition.
“Ultimately, this tradition is an investment, a platform to promote dialogue on fundamental initiatives towards the success of our health sector nationally. 
“We are proud to celebrate Jwaneng Mine Hospital’s fifth re-accreditation by COHSASA.  We look forward to many more fruitful years of cooperation and exchange.”
Mr Albert Milton, General Manager of Jwaneng Mine, congratulates the hospital on its magnificent achievement.
Jacqui Stewart, CEO of COHSASA said that “This accreditation ceremony is indeed an auspicious occasion, with Jwaneng having achieved five consecutive accreditation awards. These have been achieved through the dedication and hard work of you and your team and you can all be justifiably proud. The users of your services always know that the hospital will be functioning well and the standards of care will be high. Congratulations!”
Jwaneng Mine Hospital has been in the COHSASA accreditation programme since 2002 (from 2002 to 2004; from 2007-2009, from 2009-2012, from 2014 to 2017 and from 2017 until 2020). 
In 2006 the hospital scored 86.71 on average, was given a focus survey and asked to re-submit for a final evaluation for accreditation. 
This was because some aspects of the infection prevention and control programme needed further development and implementation and some legal requirements had to be met. These outstanding criteria were indeed met and the hospital was accredited from 2007 to 2009.
Mr Cornelius Dekop, Permanent Secretary in the Botswana Ministry of Mineral Resources, Green Technology and Energy Security, discusses accreditation as a long-term investment.
By the time Jwaneng was surveyed again in 2009, eight service elements scored a full 100 and the overall score of the hospital was 97! This time Jwaneng was accredited for three years. In 2014 – eight service elements again scored 100 and the overall score of the hospital was 96. At their survey last year, most of the service elements at Jwaneng scored in the high 90s and 11 service elements scored 100. 
The most recent overall score for the hospital was 99 out of a possible 100. 
COHSASA is now in its 23nd year of operation. It has worked with more than 600 facilities across Africa and it is the only ISQua-accredited healthcare evaluation body on the continent. 
Members of the marimba band from Acacia Primary School get into their stride.

IHK meets international standards a second time around

Entrance to the International Hospital Kampala in Uganda

by Marilyn Keegan and Nancy Akullo

The International Hospital Kampala (IHK), a 100-bed private hospital in Uganda and part of the International Medical Group, has noticed a significant drop in hospital-acquired infections (HAI) and more successful monitoring of continuous quality improvement and adverse events since its second accreditation with COHSASA.

This is according to hospital staff who have been working with the accreditation programme since 2014 and with the Council’s Patient Safety Information System (PatSIS) since May 2015.They have been collecting data to back up their claims. 

IHK is the only COHSASA-accredited hospital in Uganda. The hospital has now been accredited for a second time for three years after achieving a score of 97 out of 100 at its external survey.

The Council for Health Service Accreditation of Southern Africa (COHSASA) is the only internationally accredited quality improvement and accreditation body for healthcare facilities based in Africa. In the past 23 years over 550 facilities throughout the continent have entered the COHSASA programme to improve the quality and safety of the healthcare services provided to patients. 

IHK first entered the COHSASA programme in April 2014 and received its first full accreditation award in August 2015 with a score of 86 out of 100. The hospital re-entered into the programme soon afterwards and in November 2017, the COHSASA Board accredited IHK for three years when a score of 97 was achieved.

Dr Ian Clarke, Chairman of the International Medical Group, the umbrella organisation under which IHK falls, says:  “COHSASA accreditation has been a very worthwhile exercise for International Hospital Kampala since it is one of the few specific medical accreditations and benchmarks that can be carried out by a hospital in Africa. Previously we had ISO certification which was non-specific. We are happy to have full COHSASA certification for the second-time around.”

Commenting on the Accreditation process, Ms Jackie Nabukeera, Head of Quality Assurance for IHK says:

“The International Hospital Kampala (IHK) enrolled in the COHSASA programme in 2014.  This decision was taken because COHSASA standards were specific to a healthcare setting. We wanted to know how different departments in a hospital were supposed to be operating to implement the relevant internationally-accepted standards.

“As a hospital, we had specific quality problems which included, but were not limited to: documentation, measuring hospital acquired infections, risk identification and mitigation and measuring quality improvement. It was important for us to respond to these issues so that continuity of care and appropriate interventions for the patients could be made. 

“In addition, the web-based CoQIS quality information programme generated data that could be collected and analysed to inform different quality improvement projects.

“However, as with any new programme, there were challenges: poor staff buy-in and lack of adequate knowledge to drive the hospital’s QI programme to mention but a few. This meant we had to make concerted efforts to communicate the importance of the quality improvement programme at staff meetings and training staff to equip them with the knowledge they needed to steer the QI programme. We also needed to collar the support from the executive and senior management team. 

“Being consistent in spreading the message and providing training has proved to be fruitful and has resulted in our second COHSASA accreditation.”

The ICU Unit at IHK Hospital in Uganda


“The Quality improvement and accreditation programme has positively impacted patient care in our unit in various areas. Many measures in relation to infection control have been implemented since 2017. They include hand washing and the use of checklists for both placement and monitoring of indwelling devices. Audits have been done to ensure compliance with these new measures. 

“Infection control has been a great success because we have been pushing hand washing, where techniques have been mastered and practiced by staff and the patients’ attendants. Through hand washing audits we have been able to monitor compliance among the staff. This has reduced cross infection in our patients and there is a massive reduction in the rates of nosocomial infection. 

“Similarly, the use of central venous catheter checklists and protocols and monitoring of all other invasive lines have aided greatly in the prevention and reduction of infections.

“Notably, medical errors are too often a cause of death. Monitoring and reporting of critical events using COHSASA’s Patient Safety Information System – PatSIS – and morbidity and mortality audits have greatly improved our knowledge of critical care and made us better practitioners than before.”

Staff Members of IHK Accident Emergency Department (from left to right): Ms Angwena Charlotte, Dr. Precious Ndomerire, Ms. Immaculate Ndagire, Ms. Dorah Nakamwa, Ms. Peace Kwiocwiny and Ms. Damalie Nalugwa.

Ms. EVA NAMBUGU, Ward Manager Obstetrics & Gynaecology

“COHSASA standard assessment manuals specify what needs to be in place and how it should be done. From a multidisciplinary point of view, the standards have helped our department to receive prompt and efficient services from other essential service areas and departments of the hospital.

“When it comes to assessments, the standards have helped the department to do self-assessments to identify gaps and find possible ways of closing them; for example: protocols, guidelines, tools and checklists have been developed to correct the gaps and reduce mistakes. Risk assessment registers have helped to quantify risks and incidences and inform us to what extent protocols are being followed.

“The programme has also improved our ability to obtain meaningful data collection and analysis which has set a basis for continuous improvement.

“We have been able to monitor performance competence by using the checklists we have put in place. Due to the care tools, guidelines and protocols we have developed we are able to assess the quality of care we render to our clients. When incidents occur, we investigate the root cause and then work to mitigate them.”

Maternity Unit Staff (front row from left): Ms Victoria Nambaziira, Ms Juliet Nagulani, Ms Tedy Nabasajji, Ms Florence Nambakire, Ms Resty Nansubuga, Ms Sophia Namaganda and Mrs Kyeyune Eva Nambugu. (Back row from left): Ms Annet Nakaddu, Ms Ray Clara Rijoo, Ms Betty Sharon Awubire and Medical Officer, Dr Ivan Kabuye.

Ms. PEACE NATIMBA, Unit Manager, Medical-Surgical Ward

“The COHSASA Patient Safety Information System – PatSIS – has created transparency in the medical-surgical ward and challenges in the unit are being sorted out with ease. For example, because of reporting these near-misses and incidences, the administration has helped fix our nurse-call system and currently they are purchasing new equipment for the unit. 

“More so, near-misses and adverse incidences are being managed head-on since the unit members feel free to report them in the system.  These have all aided the provision of quality care to our patients as well as increased their satisfaction with our service.”

Issued March 2018

For more information contact Marilyn Keegan –