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ANALYSIS: Laurent Degos, René Amalberti, Jean Bacou, Jean Carlet, and Charles Bruneau Breaking the mould in patient safety BMJ 2009; 338: b2585 [Full text]

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Patient safety and health care in developing countries

Neil M Pakenham-Walsh   (16 July 2009)

Patient safety and health care in developing countries 16 July 2009
Neil M Pakenham-Walsh, Coordinator, HIFA2015, Global Healthcare Information Network Charlbury OX7 3SE Send response to journal: Re: Patient safety and health care in developing countries	The Analysis by Degos and colleagues in this week's BMJ makes a good case that 'to achieve real improvements in patient safety, we need to look at the whole of patient' care, not just specific procedures'. It provides a useful, expanded definition of patient safety: 'Safety may be defined as increasing the patient's chance of receiving appropriate care that is in line with evidence based medicine'. Although it is international in its scope, the article does not address issues in the Global South, where the majority of the world's population lives. Such people, particularly the majority poor and disadvantaged, have a particularly high risk of receiving unsafe care as a result of weak health systems. In particular, healthcare providers can only provide appropriate care if they are empowered through provision of skills, equipment, information, structural support, medicines, incentives, and communication facilities (acronym: 'seismic'). In resource-poor settings in developing countries, most healthcare providers are unsupported in some or all of these areas. In such settings, we cannot address patient safety without addressing the basic needs of healthcare providers. With regard to 'looking at the whole of patient care, not just specific procedures', there does appear to be a positive shift in thinking along these lines, at least in WHO. Back in 2007, WHO announced 'nine solutions' for patient safety: 1. look-alike, sound-alike medication names; 2. patient identification; 3. communication during patient hand-overs; 4. performance of correct procedure at correct body site; 5. control of concentrated electrolyte solutions; 6. assuring medication accuracy at transitions in care; 7. avoiding catheter and tubing misconnections; 8. single use of injection devices; and 9. improved hand hygiene to prevent health care-associated infection. This provoked a discussion on the email forum HIFA2015 (Healthcare Information For All by 2015 - www.hifa2015.org), where we noted that there is one critical patient safety solution that was NOT on this list, a solution which is at least as important as any of the others, and especially relevant to developing countries: namely, to ensure that all providers have the healthcare information they need to deliver safe, effective care. The majority poor in developing countries are daily exposed to unsafe health care delivered by unsupported health workers without access to adequate information and knowledge. I was therefore very encouraged to see WHO's latest call for research proposals, which has identified the following six priority areas: - Counterfeit and substandard drugs. - Maternal and newborn care. - Safe injection practices. - Improving competencies, training and skills. - Communication and coordination across care pathways. - Latent organizational failures. To me, this seems to illustrate that WHO is embracing a much wider and more fundamental agenda than the original 'nine solutions' announced in 2007. It also seems there has been a welcome evolution in thinking on what are the priorities in patient safety in low-resource settings (which are not necessarily the same as the priorities in high-tech settings, where most patient safety research has taken place to date). Best wishes, Neil Pakenham-Walsh HIFA2015 profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network. He started his career as a hospital doctor in the UK, and has clinical experience in rural Ecuador and Peru. For the last 18 years he has been committed to improving the availability of healthcare information for health workers in developing countries. He has worked with the World Health Organization, the Wellcome Trust, and INASP (International Network for the Availability of Scientific Publications). neil.pakenham-walsh AT ghi-net.org Competing interests: I am coordinator of the global initiative Healthcare Information For All by 2015