Making healthcare safer for patients

Maternal and newborn care are the focus of World Patient Safety Day this year

Making healthcare safer for patients

The number of patients injured, disabled or infected while accessing unsafe healthcare has become an issue of great concern globally. Over 134 million adverse events occur in hospitals in low and middle-income countries due to unsafe care, resulting in 2.6 million deaths each year. Every second, someone in the world suffers avoidable harm due to unsafe care or is exposed to the risk of being harmed while receiving care. As a result, there is a danger that unsafe healthcare will undermine global efforts in setting up universal health coverage.

To highlight this problem and raise awareness for taking corrective actions, the World Health Organisation (WHO) has been observing World Patient Safety Day since 2019 in September every year. The overall objectives of World Patient Safety Day are to enhance global understanding of patient safety, increase public engagement in health care safety, and promote global action to prevent and reduce avoidable harm in health care.

It is also important to recognise the impact of patient safety in reducing costs related to patient harm and improving efficiency in health care systems as globally, the cost associated with medication errors has been estimated at $42 billion annually.

A theme is announced by the WHO every year to highlight the priority area critical to patient safety. The theme for World Patient Safety Day 2021 is safe maternal and newborn care, keeping in view the significant burden of risks and harm women and newborns are exposed to when receiving unsafe care during childbirth.

As per WHO notified data, approximately 810 women die every day from preventable pregnancy-related causes and complications during childbirth. In addition to that, around 6,700 newborns die every day, accounting for 47 per cent of all under-five deaths. Alarmingly, the maternal mortality ratio remains high in Pakistan, ranging between 350 and 500 per 100,000 live births, while the neonatal mortality ratio is over 50 per 1,000 live births. Reliable data on health has, however, been an issue in planning and developing healthcare strategies for both government and private sectors. The main factors that prevent women from receiving or seeking quality care during pregnancy and childbirth include poverty, physical access, lack of information, inadequate and poor quality services, cultural beliefs and practices and births assisted by unskilled health personnel.

The government has recently developed and launched National Guidelines for Infection Prevention and Control and established the Centre for Occupational and Patient Safety (COPS) at the National Institute of Health (NIH). The Centre provides strategic direction for health professionals to drive transformational changes in the neglected domain of safety. Many hospitals across the country are now conducting regular health awareness and education on hand hygiene both for patients and health workers. These guidelines are equally applicable to the healthcare establishments providing maternal and child care. Patient safety depends on actions and deliberations shared stakeholders, including health system leaders and health professionals, healthcare organisations, ministry and departments of health, health regularity authorities, political leaders, patients, families and communities.

The latest UNICEF report on child mortality highlights early death risks faced by newborns in developing countries. Unfortunately, Pakistan stands amongst the countries with the highest newborn mortality rates. Newborns face a one in 22 chance of dying in the first month of their birth. Infant mortality rate (74 deaths/1,000 live births) means one in every 14 infants in Pakistan die before reaching one year of age. Pakistan has the highest infant mortality rate and stillbirths 40.7/1,000.

Healthcare delivery and management in Pakistan have primarily been devolved to the provincial governments, except in the case of federally administered territories. However, the federal government is responsible for planning and formulating national health policies and international coordination. Each provincial government has established a healthcare system with the objective of protecting the health of its citizens by providing preventive and curative services.

It is, however, essential for the decision makers to realise that women and newborns need quality and respectful maternity care (RMC) services even when disaster strikes. The term RMC encompasses quality interpersonal interaction, embraces the fundamental rights of mothers, newborns and their families and recognises that all childbearing women need and deserve respectful care and protection of their rights to choose the services.

As a regulatory body working towards providing quality and safe healthcare services, the Punjab Healthcare Commission (PHC) is striving to institutionalise quality improvement systems and establish mechanisms at healthcare establishments (HCEs) that reduce the risk of preventable harm to patients. The Commission has prescribed standards regarding healthcare service delivery at various types of HCEs in the Punjab. The Commission is the first organisation to develop minimum acceptable standards of healthcare delivery that also specify indicators to assess their compliance. The standards prescribed by the PHC also provide measures for safety in all functional areas in hospitals and healthcare establishments.

In addition to the standards of care to the obstetric patients and their newborns at large hospital settings, the Commission has developed standards for providing basic maternal and childcare meant for nursing homes, midwifery clinics and family welfare clinics etc. The standards will ensure that services are well led and delivered by qualified professionals within the scope approved by their respective councils. These standards incorporate enforcing good hand hygiene practices and using safe delivery kits and other measures to prevent healthcare-associated infections. The standards also focus on providing counselling, information and safe birth spacing services for the clients.

Above all, it is important to note that the health and hygiene-related behaviour of people in Pakistan is not encouraging due to unawareness of these matters and the unavailability of such amenities. The UNICEF reports that an estimated 70 per cent of households still drink bacterially contaminated water, and 25 million people still practice open defecation. Lack of access to clean drinking water and proper sanitation facilities negatively impacts the health and safety of the public and patients at large, including the mother and children.

The spread of Covid-19 in the country demands strict safety measures to be taken by the public. We need to establish a culture of adopting health safety measures at household and community levels to address the threat of Covid-19 and protect us against epidemics.

The writer is a freelance journalist

Making healthcare safer for patients