From Left: Dr Nicole Spieker, Mr Ton Westenenk, Professor Tobias Rinke de Wit, Mr James Barker and Professor Stuart Whittaker in the December discussions to shape up a business model for SafeCare. Following that meeting, the SafeCare Foundation is on its way to being established with all three organisations, COHSASA, PharmAccess and the Joint Commission, signing a tripartite agreement.

Three organizations from three different continents have taken the next step in their commitment and dedication to improve the safety and quality of health care provided in resource-restricted countries.

COHSASA, the PharmAccess Foundation of the Netherlands and U.S.-based Joint Commission International (JCI), have signed an agreement to begin the process of establishing the SafeCare Foundation.

SafeCare has grown out of a global initiative, launched in March 2011 in Cape Town, South Africa, to introduce a comprehensive health quality improvement programme using internationally recognised standards to improve healthcare delivery. The SafeCare programme is designed for healthcare providers in resource-poor settings to assist them in stepwise quality improvement and the delivery of safer care to their patients. As a new Foundation with its International Board and its Secretariat based in Amsterdam, SafeCare will be able to expand its knowledge and capacities even further and build on the concrete experience and skills of its founding organizations.

To date, the SafeCare programme has been initiated in over 107 clinics in six countries – Kenya, Nigeria, Tanzania, Ghana, Lesotho and South Africa.

The facilities participating in SafeCare have committed to improve the quality of their services, as part of their participation in various insurance and medical credit programmes. The first 10 of these facilities have recently obtained their “Certificates of Improvement”, which were awarded based on reaching pre-defined levels of standard compliance. Placed in the African context this establishes the principle of graded improvement which many African facilities will follow in the years to come.

The analysis of SafeCare certification data will allow stakeholders (e.g. governments, investors, insurers and donors) in developing countries to support feasible, cost-effective and structured quality improvement rollouts in facilities. The Foundation will build and maintain a database of organizations using its standards and keep track of their progress as well as the progress of the facilities that are represented.

In summary, the SafeCare Foundation will offer services of large-scale quality improvement programmes through automation of data entry, verification analysis and computerised web-based reporting. The impact of interventions by the SafeCare Foundation will be monitored through data analysis and operational research and findings will be published in peer-reviewed journals.

To achieve these objectives and to stimulate healthcare quality and patient safety, the SafeCare Foundation will arrange regular conferences to promote quality standards and healthcare quality issues.

In certain situations, the SafeCare Foundation will collaborate with other organisations to apply for funding of quality improvement trajectories in resource-restricted settings.

The SafeCare Foundation will also publish information on the tools, goals and results of the programme and make information and standards publicly available through its website.

In addition to the above, under the umbrella of the SafeCare Foundation a SafeCare Knowledge Institute will be established. This will be an operational research entity that can provide health intelligence data on healthcare quality improvement in Africa, provide benchmarks, perform gaps analyses and study the associations between quality improvement certification and medical output and outcome. These vital analyses can be used to inform donors and governments about the status of health care in specific regions or countries.


The SafeCare methodology combines the respective knowledge, expertise, skills, tools and experience of all three organizations, COHSASA, JCI and PharmAccess, to issue a graded “Certificate of Improvement” to different categories of healthcare facilities ranging from nurse-driven health clinics to district hospitals. Certificates range from level 1 to 5, which allows for demonstrating incremental achievement in compliance with the SafeCare Foundation Standards.

Healthcare facilities will be rewarded with a “Certificate of Improvement” every time they reach the next pre-defined SafeCare step. If executed completely (SafeCare Level 5), this will qualify a facility for formal accreditation through COHSASA or JCI. The uniqueness is that the SafeCare route is all about relative improvement and does not demotivate African facilities with unreachable, international, absolute quality norms. Instead, SafeCare offers a step-wise approach, confronting facilities with incremental challenges with respect to quality and patient safety and eventually rewarding and motivating these facilities with recognition through its certification system. This step-wise improvement process can thus be used by governments, donors and companies to implement performance-based financing incentives. In addition, SafeCare can be offered in combination with various capacity building interventions, like access to affordable loans through the Medical Credit Fund or inclusion in innovative insurance programmes like those supported by the Health Insurance Fund.