Providers' perceptions of disrespect and abuse during childbirth (2) Protecting patients and supporting practitioners in tandem

14 March, 2020

Neil thanks for sharing this very important paper, and for your comments too.

One of the reasons we were driven to introduce the 12-Pillar Clinical Governance programme in 2004 to Nigeria was because a situation analysis of the health system in one of the states revealed widespread abuse of patients especially as they delivered their babies. So, not only was there a 1: 13 risk of losing the mother or baby or both, the women who survived bore the emotional scars of abuse.

As you wrote, ‘------This means that health systems need to be not only patient-centred, but also healthcare-provider-centred’, we captured that sentiment in our abridged definition of 12-pillar clinical governance: ‘protecting patients and supporting practitioners in tandem’.

It was hard to start with, to effect the necessary change of a chronic bad attitude of some staff, but within a few months of education, empowerment and support for the workforce, and sanctions for those who did not change, patients were reporting a huge change and reduction in the level of abuse and its frequency.

Joseph Ana.


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT