Research has been an important cornerstone of COHSASA’s activities since its establishment in 1995.



Internal research has been carried out to evaluate the effectiveness of COHSASA’s operations and some of these peer-reviewed papers have been published in journals. See:

COHSASA has entered into a collaborative agreement with the Economics Department of Stellenbosch University, Insight Actuaries and Consultants and Imperial College London to develop research projects.

To facilitate research activities, a computerised information system was developed to support analytical research and reporting activities culminating in the present COHSASA Quality Information System (CoQIS).

CoQIS is used routinely to report on the progress of facilities that enter COHSASA’s quality improvement and accreditation  programmes and for data mining and research.  It is also used to monitor the progress of facilities as they strive to comply with priority areas set out in quality improvement plans. This information system works in both well-resourced and poorly-resourced facilities.

Research plays an important role in designing, refining and implementing improvements to COHSASA’s programmes so that the company continues to provide value to the variety of clients that contract with it.

In addition to its research on accreditation, COHSASA conducts research into patient safety. It has developed a web-based patient safety reporting and monitoring programme, PatSIS. Research has been conducted in the Free State Province of South Africa.

COHSASA has participated in a number of national and international research programmes including:

2015          Part of a collaborative group with the Economics Department of Stellenbosch University, Insight Actuaries and Imperial College London to develop various research projects. Papers are forthcoming.

2009          Part of the “Making Existing Technologies Safer” research group for the World Alliance for Patient Safety and Imperial College Technology for Patient Safety.

2007-         World Health Organisation (WHO) collaborative research project to administer a prospective incident monitoring, reporting and response system to determine the frequency and nature of adverse events associated with HIV patients and measure responses to beneficial interventions in a hospital in the Western Cape.

2006          Making Medical Injections Safety Public Hospital Assessment Project to examine injection safety in 159 public sector hospitals with the John Snow Research and Training Group of the United States, the National Department of Health and the South African Medical Research Council.

2006          WHO-sponsored research to determine the incidence of adverse events in two Western Cape hospitals using a retrospective review of medical records methodology.

2005          Research project to develop a comprehensive care accreditation tool for antiretroviral therapy (ART) sites[1]. This tool measures ART site readiness to meet the targets for ARV provision set by the National Government[2], as well as the international requirements set by the World Health Organisation according to its “3 by 5” initiative[3].

2004/5       Research sponsored by the German Society for Technical Co-operation – Die Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH to develop an evaluative framework of organisational standards and indicators for measuring the performance of health facilities in a district that manages HIV patients according to national and international norms and standards. Known as the HIV and AIDS District Evaluation Tool (HIV-DET), the research brief was to design and deliver a quality improvement programme specific to a district HIV disease management programme (DMP) across a representative group of facilities to assist health providers to improve the quality of HIV-related services. Report on the HIV-DET available at

2003          Impact of Accreditation on the Quality of Hospital care: KwaZulu–Natal Province, South Africa, Quality Assurance Project, USA.

2002          The impact of the HIV/AIDS epidemic on hospital services in South Africa: Responses, coping strategies and behaviour of management and health professionals. A report for the World Health Organisation in collaboration with the Nelson R Mandela School of Medicine at the University of Natal and the KwaZulu-Natal Department of Health.

2001          Research for World Health Organisation and International Hospital Federation Collaborative Project Hospitals within Healthcare Systems: Their Capacity to Meet the Needs of Populations, Africa Region.

2001 –        World Health Organisation research report Assessing the Cost and Effectiveness of Hospital Accreditation in Two Developing Countries: A Preliminary Investigation.

1998-2000     South African Accreditation Impact Research jointly conducted by the Medical Research Council and the University Research Corporation of the United States.


Live links to the following academic papers are at:

  1. South African Medical Journal March 1994; 84:130-2. The South African Pilot Hospital Accreditation Programme. Part I. The Process. WHITTAKER S, BRUWER A, TALJAARD JJ ET AL.
  1. South African Medical Journal April 1994; 84: 193-194. The South African Pilot Hospital Accreditation Programme. Part ll. The Development of Standards. WHITTAKER S, BRUWER A, TALJAARD JJ ET AL.
  1. International Journal for Quality in Health Care, Vol. 6, No. 3, pp. 291-293,1994.The Eleventh International Conference on Quality in Health Care, 24-28 May 1994: One Delegate’s Perspective.
  1. Whittaker S. Quality Assurance and accreditation of South Africa’s health care facilities. Transactions of the College of Medicine of South Africa, December 1996.
  1. Whittaker S, Muller M. Improving the quality of care in South African Health Care facilities. In: Hospital and Nursing Year Book. Sunnyside, Pretoria: Pharmaceutical Printers and Publishers, 1997: pp. 44-50.
  1. International Journal for Quality in Health Care 1998; Volume 10, Number 3: pp. 263-267

Introducing quality assurance to health service delivery – some approaches from


  1. International Journal for Quality in Health Care 2000; Volume 12, Number 3: pp. 247-250

Status of a health care quality review programme in South Africa STUART WHITTAKER, RONALD W. GREEN-THOMPSON, IVAN MCCUSKER AND BUSI NYEMBEZI.

  1. Whittaker S. Facilitating Accreditation: The South African Experience. QA Brief 9, (1) Spring 2001; 21-4.
  1. Salmon J, Heavens J, Lombard C et al., The Impact of Accreditation on the Quality of

Hospital Care: KwaZulu-Natal Province Republic of South Africa: Published for the U.S.

Agency for International Development (USAID) by the Quality Assurance Project (QAP),

University Research Co., LLC. 2003. Available at:

  1. Whittaker S, Muller, M., Keegan, M. Quality Assurance Project. The Impact of Accreditation on the Quality of Hospital Care, KwaZulu–Natal Province, Republic of South Africa.(Commentary) Operations Research Results, 2003.
  1. Whittaker, S., Mulumba, R., Lombard, C., Rogers-Bloch, Q., Keegan, M. Evaluation of Injection Safety and Health Care Waste Management in South Africa: 2006 Baseline Report, August 2008 edition. Pretoria, South Africa: MMIS for the Office of the Global AIDS Coordinator, and the Department of Health and Human Services/Centers for Disease Control and Prevention.
  1. Pattinson R, Whittaker, S. Validation of Perinatal Care indicators. 2008. International Stillbirth Conference.  (Abstract) Page 86-87).
  1. Int J Qual Health Care (2009) 21(1): 27-28 first published online October 2, 2008 doi:10.1093/intqhc/mzn045 Promoting research into healthcare accreditation/external evaluation: advancing an ISQua initiative ROSA SUÑOL, WENDY NICKLIN, CHARLES BRUNEAU, AND STUART WHITTAKER.
  1. Bock, Ariella; Lombard, Carl; Swanevelder, Sonja; Mulumba, Rose, Evaluation of Injection Safety and Health Care Waste Management in South Africa: 2009 Final Report, March edition. MMIS for the Office of the Global AIDS Coordinator, and the Department of Health and Human Services/Centers for Disease Control and Prevention.
  1. Newton RC, Mytton OT, Aggarwal R, Whittaker, S et al Making Existing technology Safer in Healthcare. Qual. Saf. Health Care BMJ 2010; 19 (Suppl 2):i15-24.
  1. Whittaker S, Shaw C, Spieker N, Linegar A. Quality Standards for Healthcare Establishments in South Africa. In Padarath A, English R editors. South African Health Review 2011. Durban: Health Systems Trust; 2011.
  1. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital BMJ 2012; 344 doi: (Published 13 March 2012) R M Wilson, P Michel, S Olsen, R W Gibberd, C Vincent, R El-Assady, O Rasslan, S Qsous, W M Macharia, A Sahel, S Whittaker, M Abdo-Ali, M Letaief, N A Ahmed, A Abdellatif, I Larizgoitia, for the WHO Patient Safety EMRO/AFRO Working group.
  1. South African Medical Journal March 2012, Vol.102, No 3 Academic hospital accreditation strengthens postgraduate training programmes: Case study from Universitas Academic Hospital A LINEGAR, S WHITTAKER, G VAN ZYL.
  1. Int J Qual Health Care 2012; Volume 24, Number 6: pp. 568-577 Comparison of health service accreditation programs in low- and middle-income countries with those in higher income countries: a cross-sectional study – JEFFREY BRAITHWAITE, CHARLES D. SHAW, MAX MOLDOVAN, DAVID GREENFIELD, REECE HINCHCLIFF, VIRGINIA MUMFORD, MARIE BRUNN KRISTENSEN, JOHANNA WESTBROOK, WENDY NICKLIN, TRIONA FORTUNE AND STUART WHITTAKER.
  1. Int J Qual Health Care first published online February 13, 2013 doi:10.1093/intqhc/mzt01

Profiling health-care accreditation organizations: an international survey



[1] “Comprehensive HIV and AIDS treatment for South Africa, Facility Accreditation Form” National Department of Health, 9 January 2004

[2] “Operational plan for Comprehensive HIV and AIDS care, management and treatment for South Africa”, National Department of Health, 19 November 2003.

[3] “Treat 3 million by 2005”, World Health Organisation, 2004