In our previous discussions, we have lamented the existence of communication gaps, implementation gaps, ownership gaps, accountability gaps and governance gaps in our health systems. We have also discussed the pursuit of excellence in this era of a new hope for Africa and how it can be institutionalized and sustained. In our past discussions, we have proposed solutions. Now, let’s ask and answer the question of “How” to close those many gaps and how not merely to pursue but to actually achieve excellence in Africa’s health.
All countries round the world and regions are struggling with this question and there are many examples of interventions that different countries have put in place within their respective health systems to implement health plans and achieve desired health outcomes. All these interventions have a common theme: how to do things better and how to improve performance. There are several technical names given to a variety of management approaches to performance measurement, analysis and improvement. In our previous discussion on Pursing Excellence, we discussed the potential of Quality Assurance (QA) as a management approach with potential to achieve the performance improvements that will close the many gaps listed above. I would like to return to the discussion on the potential of QA to transform the management of health systems in Africa.
I am encouraged to do this for four reasons. (i) the quality of care movement is gaining ground in Africa: at the beginning February 2013, the International Association for Quality of Health Care (IsQUA), held its first African Regional meeting in Accra, Ghana. At the end of March, 2013, the member states of the East African Community annual meeting will dedicate a plenary session to Quality Assurance of Health Care in the sub-region; the government of Japan is supporting a large quality of health care program in several West African countries and the government of the USA has also many QA programs in other African countries. (ii) As a continent with limited resources QA can make these resources achieve the most. We need it more than anyone else. Our health systems, hospitals, and primary health care stand to benefit from QA, (iii) I have personal positive experience in Uganda and other African on the successful application of the QA approach to in improving health system performance. (iv) This is a good time for us in Africa to stop moaning and to get our act together as we take full advantage of economic growth and global good will and solidarity. So what is QA and how does it work?
QA is a management approach that was popularized after the Second World War in Japan and the USA by Edwards Deming, Joseph Juran and Kaoru Ishikawa with the objective of eliminating as many errors as possible in the process of manufacturing industrial products. It has now been applied to all sectors including of course the health sector. QA focuses on strict adherence to cyclical planning-doing-checking-planning again. QA has many definitions some of them include “doing the right thing the right way the first time and always”, “achieving the most with available resources”, and “performing according to set standards”. QA focuses on the use of data, team work and self-assessment. I am of the view that if the QA approach is widely adopted, it will provide the answer to the challenge of routine uptake of research evidence into policy and has potential to transform institutional and individual mind set both in the office and at home to set and achieve targets.
QA approach has close relatives in terminology and has been modified to fit all sectors. Some of these relatives include Total Quality Management (TQM), Continuous Quality Improvement (CQI) and in our previous discussion Pape Gaye referred us to a publication “Optimizing Performance and Quality (OPQ)”. I would like to hear more from you all on your positive or negative experience with QA in the health sector in particular, or indeed at home.