Improving Quality of Care in Primary Healthcare Facilities in Rural Nigeria using SafeCare Standards and Methodology (N. Ndili*1, N Spieker1, M. Oludipe1, U. Okoli2, E. Ezeokeke3,) 1PharmAccess Foundation 2 SURE P, 3 SOML Abuja, Nigeria
Nigerian patients have limited access to quality care due to inefficient resource allocation and limited health insurance coverage. There is limited institutionalized systems and standards that can ensure objective measurement of the level of quality of basic healthcare facilities. The Federal Ministry of Health SURE-P project engaged PharmAccess to support a quality improvement initiatives in 40 primary health facilities from October 2013 to March 2015.
The mean score for TrtA facilities at baseline was 36% and 48% at end line; compared to 36% and 35% respectively for TrtB facilities. TrtA facilities increased in overall scores (5-23%), while TrtB facilities varied between - 3% and 3%. TrtA facilities improved notably in areas in which they received facilitation support.
Key success factors noted were: community support by the Ward Development Committee; senior cadre of the Officer-in charge of the facility and positive staff responsiveness to capacity building and technical support. Five TrtA facilities that had all 3 factors present improved the most by an average of 20%, while those with one or more of these factors improved the least (an average of 7%). Challenges faced revolved around the unwillingness of facility leadership to invest in quality.
Improving quality and access to care in Nigeria will require a coordinated effort between stakeholders and institutions in health systems. SafeCare has developed quality standards and a scalable assessment methodology to facilitate transparent transactions that can help build trust between stakeholders, and lay a foundation for country-led quality monitoring systems. The system has proven successful in rural, public facilities in Nigeria and in private facilities through earlier studies.