Assessment of SafeCare healthcare quality improvement program for sustainable scaling in Ghana

Abstract

The Christian Health Association of Ghana (CHAG) with technical assistance from a Non-Governmental Organisation, PharmAccess is implementing a quality improvement programme in selected health facilities using the SafeCare international standards and methodology. The programme is planned to be transferred to the network of CHAG health facilities to run sustainably after an initial two years. The current study examines challenges and opportunities in the implementation of the programme and based on lessons learnt, explore factors that will promote or constrain a sustainable transitioning to CHAG network. The study used a cross-sectional qualitative design (multiple case studies) and interviewed 93 individuals from 27 health facilities, 9 assessors, 12 heads of Church Health Directorates (CHD), 3 officers from CHAG and 2 from PharmAccess. A thematic analytical approach was used in analysing and reporting the findings. Findings indicate that poor programme awareness among health facility leadership and staff as well as among CHD leadership adversely affected buy-in and commitment at the early stages of implementation, although this changed for the better later. Challenges included lack of motivated staff, inadequate finance, poor access to relevant information and the internet and lack of appropriate administrative and governance structures for implementation. Notwithstanding these challenges, SafeCare became popular and is seen as impactful by all stakeholders and therefore recommended to be continued with CHAG. CHAG can take advantage of the willingness to adopt SafeCare, the positive attitude among stakeholders and the complementary findings of this study to develop a sound, inclusive and sustainable transition strategy for scaling.