This study funded by the National Institute for Health and Care Research (a HIFA supporting organisation), finds multiple failures in empowering healthcare workers to deliver effective care, a scenario that will be familiar to many: limited space; limited water, sanitation and hygiene amenities and practices, inadequate human and material resources; inadequate provision for basic needs including nutrition; heavy workloads for healthcare workers; poor communication and reduced engagement with patients and caregivers; understaffing; long queues and lack of compliance with procedures for triage, treatment, stabilization and monitoring due to a lack of expertise; lack of context-specific sepsis management guidelines...
Citation, abstract and a comment from me.
CITATION: Facilitating high quality acute care in resource-constrained environments: Perspectives of patients recovering from sepsis, their caregivers and healthcare workers in Uganda and Malawi
Felix Limbani ,Olive Kabajaasi ,Margaret Basemera,Kate Gooding,Nathan Kenya-Mugisha,Mercy Mkandawire,Davis Rusoke,Shevin T. Jacob ,Anne Ruhweza Katahoire ,Jamie Rylance ,on behalf of the African Research Collaboration on Sepsis, Patient Experience Study Group
Published: August 15, 2022. https://doi.org/10.1371/journal.pgph.0000272
ABSTRACT
Sepsis is a major global health problem, especially in sub-Saharan Africa. Improving patient care requires that healthcare providers understand patients’ priorities and provide quality care within the confines of the context they work. We report the perspectives of patients, caregivers and healthcare workers regarding care quality for patients admitted for sepsis to public hospitals in Uganda and Malawi. This qualitative descriptive study in two hospitals included face-to face semi-structured interviews with purposively selected patients recovering from sepsis, their caregivers and healthcare workers. In both Malawi and Uganda, sepsis care often occurred in resource-constrained environments which undermined healthcare workers’ capacity to deliver safe, consistent and accessible care. Constraints included limited space, strained; water, sanitation and hygiene (WASH) amenities and practices, inadequate human and material resources and inadequate provision for basic needs including nutrition. Heavy workloads for healthcare workers strained relationships, led to poor communication and reduced engagement with patients and caregivers. These consequences were exacerbated by understaffing which affected handover and continuity of care. All groups (healthcare workers, patients and caregivers) reported delays in care due to long queues and lack of compliance with procedures for triage, treatment, stabilization and monitoring due to a lack of expertise, supervision and context-specific sepsis management guidelines. Quality sepsis care relies on effective severity-based triaging, rapid treatment of emergencies and individualised testing to confirm diagnosis and monitoring. Hospitals in resource-constrained systems contend with limitations in key resources, including for space, staff, expertise, equipment and medicines, in turn contributing to gaps in areas such as WASH and effective care delivery, as well as communication and other relational aspects of care. These limitations are the predominant challenges to achieving high quality care.
COMMENT (NPW): We have exchanged hundreds of messages about improving quality of health services, and yet there has been little comment on how to improve quality in low-resource settings such as described above. There are at least two aspects to consider. Firstly, how to identify, prioritise and address the basic needs for health workers to deliver care; and second, how to embed quality approaches that might improve outcomes despite the inadequate working conditions. I look forward to hear from HIFA members about these issues. hifa@hifaforums.org
Best wishes, Neil
Coordinator, WHO-HIFA project on Learning for Quality Health Services
https://www.hifa.org/projects/learning-quality-health-services
Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
Global Healthcare Information Network: Working in official relations with WHO
