The SafeCare Initiative, an African network of healthcare policy-makers focusing on patient safety has been established following a landmark two-day conference on basic healthcare standards in Cape Town.

The conference held on March 9 and 10 at Cape Town’s International Convention Centre, was attended by over 100 delegates, senior representatives from health departments in at least 13 African countries and key health figures from the World Health Organisation, Holland and the U.S.

The initiative is a global quality think tank that will provide healthcare facilities in resource-restricted settings with a means to improve service delivery. It is a partnership between COHSASA, PharmAccess Foundation of the Netherlands and the Joint Commission International, the United States-based quality standards authority.

The SafeCare Initiative is a quality improvement and accreditation system that will work with district hospitals and clinics across the continent to offer basic acceptable healthcare standards. Tertiary level hospitals will not form part of the initiative in the short term.

The aim is to ensure Africans and others in resource-restricted countries have access to safe, quality healthcare. Through the SafeCare Initiative, primary healthcare providers – even those with very few resources – will be able to improve their service delivery and, in so doing, reach international standards of care for patients.

Professor Stuart Whittaker, CEO of COHSASA and first Chair of the SafeCare Initiative, said the shortage of qualified personnel and funds and the enormous burden of disease in Africa, particularly in the rural areas, stopped health workers from being effective.

“If the SafeCare Initiative is properly applied it will mean that health workers will be able to meet professional and internationally accredited standards of safety and quality and therefore be in a position to provide quality and safe care to their patients.”

He also said that cutting edge technology will be used so that information about facilities could be generated in a minute and comments and recommendations made quickly.

“The level and detail of the report will depend on who will use it and what their needs are."
This system would be able to find out precisely what is going on by isolating specific problems and where intervention was urgently needed.


The founding members of the SafeCare Initiative hold up a signed document to mark the formal launch of the conference in Cape Town (9/10 March). From left: Michiel de Wilde (CEO of PharmAccess Foundation); Paula Wilson (CEO of JCI); Prof Stuart Whittaker (CEO of COHSASA).

An assessment of the baseline situation in facilities at the start of a programme for accreditation was really “when the rubber hits the road”, said Whittaker, with the facility coming under intense scrutiny in all areas of operation – from the emergency room to its theatres and right through to what was happening in its kitchen and laundry.

Assessors went into individual departments scratching beneath the surface and asking questions that flagged whether or not basic procedures were followed.
“We want to know what’s going on in the operating theatre, because that is where things could go wrong. We look at the post-operative area, which can potentially be a high risk area.”

“This initiative is not a quick fix but rather an incremental process of improving quality towards excellence,” Whittaker said.
A process will be adopted that combines all the skills and experience of the three organisations, including a system that recognises five certified levels of achievement.

The healthcare facilities, some of them coming in at very poor baselines, will gradually improve their ability to provide safe and quality healthcare and along the way – as a means of encouragement – they will be awarded certificates that mark their progress towards achieving excellence.

Michiel de Wilde, managing director of the PharmAccess Foundation, said the SafeCare Initiative was an opportunity for countries in Africa to learn from each other and share knowledge on how to address a critical health issue.

“A very practical next step for the SafeCare Initiative is to facilitate an information exchange network between healthcare providers. We are asking all countries interested in contributing to the discussion on quality and standards to work through SafeCare to open and keep the dialogue going.”

Stuart Whittaker, the first chair of SafeCare and CEO of COHSASA, said the launch of the initiative was the combined effort and experience of the three dedicated organisations to ensure a basic level of care and safety for African people.

“Now, more than ever, it is important that we identify human error so that learning can take place. The evolution of monitoring quality in healthcare has reached the point where standards and guidelines have been developed to influence performance and to measure outcomes so that finally patients visiting hospitals and clinics know that they will receive an acceptable level of care,” said Whittaker.

Paula Wilson, CEO of JCI, said the organisation worked in 90 countries around the world and she sensed that the same mission and vision for patient care was shared broadly. “We work with partners in every country but take into account the cultural and regional norms and how these could impact on patient care.”


Dr Paul vanOstenberg, Senior Executive Director, International Accreditation and Standards for the Joint Commission International watches on as a South African traditional Imbongi (or Praise Singer) heralds the formal launch of the SafeCare Initiative.

Ghana, Nigeria, Lesotho, Botswana, Kenya all made presentations showing how basic standards and healthcare were applied in their countries.
Dr Nicholas Tweneboa, director of operations from the National Health Insurance Authority in Ghana, said expertise had been developed over the past few years within the NHIS in Ghana and he believed a partnership with SafeCare could be mutually beneficial.

“Accreditation is an essential tool that serves as a first step in promoting quality and safety and we expect and welcome continued and expanded international collaboration and partnerships.”

Dr Carmen Audera-Lopez, from the WHO’s patient safety programme, also addressed the conference saying that too often, lower levels of staff and even patients were afraid to speak up in the presence of a doctor or point out mistakes when patient safety was compromised.

“The WHO is proposing simple solutions to bring about the changes we want to see in patient safety,” she said. These included enforcing hand washing, checklists, protocols, standard procedures and finding local solutions to local problems. Most important though was that there had to be a change in patient safety culture.
“And that comes with leadership followed by communication and learning from mistakes.”

The SafeCare Initiative is now poised to be rolled out across Africa. It offers a comprehensive toolkit to make a real difference: a set of standards tried and tested instruments, innovative training methods and financing incentives and monitoring and reporting tools that can be used by assessors to help healthcare facilities provide safe and quality care to patients.