1. Establishing a SWCA through Safecare approach; The experiences, successes and challenges Presented by Dr Eliudi Eliakimu On behalf of other Authors: Bayoum Awadhi, Edith Ngirwamungu, Peter Risha, Nicole Spienker 5 th NQIF held at Hyatt Regency Hotel, 26 th to 28 th August, 2015 1

2. CONTENT Background Objective Methodology Results Lessons learnt Conclusion Recommendation 2

3. BACKGROUND (1/4) MoHSW began efforts to establish an accreditation system since 2005. In 2009 the HSSP III indicated the need to establish the accreditation system. Meanwhile NACP and Pharmaccess were certifying facilities for HIV/AIDS Care & treatment In 2011 Pharmaccess in collaboration with APHFTA used Safecare for QI Other Stakeholders (NSSF-SHIB, KNCU Health Plan, TPDF, CSSC) joined later In December 2012, MoHSW enstered an MoU with PharmAccess to support establishment accreditation system for HFs using SafeCare standards (SWCA)  With support from CDC Foundation Pwani region was the first region to be enrolled into the program The SWCA focused on PHC Facilities – Dispensaries, Health Centres & Level-I Hospital  Regional Referral Hospitals involved BY NOW because we have not started implementation of Hospital Standards for that level 3

4. BACKGROUND (2/4) SWCA process uses a set of basic healthcare standards to evaluate service delivery in primary health care facilities.  The SafeCare standards have been accredited by the ISQua  The SafeCare initiative recognizes five levels (1 – 5)  Annual assessments are conducted in health facilities by certified assessors.  Each level of achievement a facility is provided with a Certificate of recognition 4

5. BACKGROUND (3/4) 5

6. BACKGROUND (4/4) Facilities are safe for patients and staff Clinical services meet the needs of patients Clinical support services (laboratories, radiography, etc.) are available or accessible. Technical services provide and maintain the technology and environment required for acceptable patient care Hotel services (housekeeping, laundry, food) minimise the risk of infection and provide a safe and clean environment where nutritious food is stored and served. Management develops and implements the required policies and procedures for an effective and efficient organisation. 6

7. OBJECTIVES To establish an Accreditation Systems for Health facilities in Tanzania using Stepwise Certification towards Accreditation (SWCA) using SafeCare by September 2017. 7

8. MOHSW - FRAMEWORK ON ACCREDITATION DPs PAI MoHSW NSSF-SHIB TPDF APHFTA KNCU/ LGAs /NHIF (HIF) MoHSW CSSC Supported MoHSW to establish Accreditation System Accreditation Body Capacity at:  MoHSW  RHMTs  CHMTs  Health Facilities  PMO RALG Tools BRN-Heath Star Rating Assessment DPs MoHSW 8

9. METHODOLOGY – (1/3) A Secretariat was formed to spearhead the SWCA The SafeSare standards were reviewed by the MoHSW and adapted A National Guideline was developed to guide assessors on Safecare standards. (accessible through www.tzdpg.or.tz )www.tzdpg.or.tz Training of Safecare assessors was done at MoHSW and to other organisations, RHMTs, CHMTs and health facilities PAI-MoHSW support arrangements focus on Public HFs (including FBO with agreement as CDH)  The trained assessors conducted assessments in health facilities using SafeCare standards in 5 regions of Tanzania mainland.  5 Regions covered so far - Pwani, Dodoma, Mwanza, Iringa and Njombe.  Each facility has a Quality Improvement Plan ( Timeframe 1-2 yrs) 9

10. METHODOLOGY – (2/3) Implementation of SWCA process follows a SIX-steps process A. Assessment B. Review and approval of assessment data C. SafeCare Level Allocation & Release of Certificates D. Development, review and approval of QIP E. Dissemination to facility F. Monitoring & Evaluation 10

11. METHODOLOGY – (3/3) Assessment Review and approval of assessment data SafeCare Level Allocation & Release of Certificates Development review and approval of QIP Dissemination to facility Monitoring & Evaluation (M&E) 11

12. RESULTS (1/2) 122 assessors have been trained from MoHSW, RHMTs, CHMTs 36 Public health facilities have been assessed in 5 regions (291 HFs in the other institutions mentions in the framework ).  Most facilities were certified at Level One  QI plans are now being implemented at varying degrees.  Quality improvement training has been done in 3 regions of Pwani, Dodoma and Mwanza.  Monitoring (Facilitation visit) is done by RHMT every 6 months. Two regions of Pwani and Dodoma are due for the 2 nd round of Certification assessments 12

13. RESULTS (2/2) Presentation of Safecare Certificate of Level of achievement at the facilities was a motivating factor to the facilities. 13

14. LESSONS LEARNT (1/2) Interpretation of Safecare standards has been varying at facility level Knowledge and utilisation of National guidelines and Health Laws was low  Clinical practice guidelines are missing (anaesthesia, other care protocols) QI teams capacity to implement the plans and CHMT facilitation QIPs implementation has been varied:  Regular facilitation visits by RHMT was key to follow up the facilities in the timely implementation of the QIP  Having a SafeCare focal person at the RHMT is key in facilitating the Facilities and CHMTs.  National level facilitation is key in the initial stage of implementation of QI plans. Facilities were SafeCare assessor was present the implementation of the QI plans was on course.  Public HFs – Train 1 staff and CHMTs – 1; hence in case of transfer or retirement, facilitation is affected  Registration of Government owned health facilities cause double standards. 14

15. LESSONS LEARNT (2/2) Looking at the ISQua Checklist (2006) for Development of New Accreditation Programmes: Purpose of Accreditation Role of Accreditation in National QI Strategy or Reform Plans Support of stakeholders A Team or Committee to work on establishing an Accreditation Body Governance of Accreditation Body – Funding from Government or Insurance to run the Body in initial years – Commitment of stakeholders in establishing the Body – System fo training Surveyors – Evaluation Systems and Indicators MoHSW need to plan on funding availability to ensure sustainability of the programme 15

16. CONCLUSION The establishing accreditation using the SWCA approach is doable The SWCA has potential to identify quality gaps in health system. Active QI teams at facility level are key to timely implementation of the QI plans. Commitment of CHMT/RHMT in QIPs implementation is crucial to facilitate HFs to move from one certification level to a higher level. 16

17. RECOMMENDATIONS Provision of technical support from National, Regional and Council level is crucial at the initial stages of implementing the QI plans. The QI plans need to be incorporated into the CCHP so that activities that need financing can be timely addressed. The MoHSW need to:  Establish a clear system of registration of existing Government Health Facilities  Ensure key Clinical Practice Guidelines and Protocols of care  Strengthen Coordination of SafeCare Standards implementation by all stakeholders. 17

18. ACKNOWLEDGEMENT PMO RALG The Regional and Local Government Authorities The Regional and Council Health Management Teams PharmAccess Foundation in collaboration with CoHSASA CDC Foundation APHFTA CSSC NSSF-SHIB The KNCU in its Health Plan as well as its Members The MoHSW The National Health Insurance Fund 18

19. THANK YOU FOR LISTENING 19