In 2017, the Regional Initiatives for Health Systems Improvement (RIHSI) LTD, on the Quality of Health Care in the region, established within the Uganda, was asked to identify strategies for improving the quality of health care in the Region. As part of this effort, the RIHSI Team registered this organization with the mission to be available, at all times, to provide excellence, innovation and superlative quality in the care of patients, the training of health professionals, and the creation and sharing of health knowledge within a culture that promotes equity, diversity and inclusiveness.
The underlying fragmentation of the health care system is not surprising given that health care providers do not have the payment support or other tools they need to communicate and work together effectively to improve patient care.While many patients often do not receive medically necessary care, others receive care that may be unnecessary, or even harmful. The RIHSI team, while working under various projects, has documented tremendous variation in hospital inpatient lengths of stay, visits to specialists, procedures and testing, and costs — not only by different geographic areas of the African countries, but also from hospital to hospital in the same town.
This variation has no apparent impact on the health of the populations being treated. Limited evidence on which treatments and procedures are most effective, limited evidence on how to inform providers about the effectiveness of different treatments, and failures to detect and reduce errors further contribute to gaps in the quality and efficiency of care. These issues are particularly relevant to lower-income Africans and to members of diverse ethnic and demographic groups who often face great disparities in health and health care.
Finally, providers will not be as successful as they can be over the long term if they have don’t have access to practical evidence, that the RIHSI team intends to bring, on which clinical practices work best in particular cases or which patients need timely interventions. Evaluations of past efforts to integrate delivery system reforms show promising results.The RIHSI team will make a lot of progress to support better quality care in the near future. Building on the robust Health Sector Quality Improvement Framework and Strategic Plan of the Ministry of Health, support from the donors, RIHSI will establish quality reporting systems for providers. There is more activity than ever around the development of quality measures, thanks to private organizations like the implementing partners for Performance Improvement, as well as public support and initiatives in the district local governments. The National QI Coordination Committee has taken important steps including assisting with the prioritization of measures for development and implementation, and especially in “endorsing” quality measures to promote the consistent use of meaningful, well-understood measures.