quality in practice; towards sustainable quality of … 13 verslag conferentie_def_lr.pdf ·...

SafeCare Conference ReportQUALITY IN PRACTICE;

TOWARDS SUSTAINABLE QUALITY OF CARE IN AFRICA

26-27 September, 2013 White Sands, Mombasa, Kenya

2

CONFERENCE REPORT QUALITY IN PRACTICE

SafeCare acts as the custodian of

internationally recognized, unique

sets of standards that are realistic

for resource-restricted settings. As

such, SafeCare encourages people

to think and talk about quality of

health care. Creating standards that

help patients compare the quality

of the services at different facilities

and make informed decisions

about health care encourages

utilization and willingness to (pre)

pay. Governments have the task

of laying the foundations for this

by establishing policies and the

legislative environment to regulate

and enforce quality of care. Also,

in order to ensure sustainability,

insurance companies, banks,

investors and donors need to

connect quality improvements with

financial incentives. How to achieve

transparency and sustainability of

quality on a national scale was at

the heart of the discussions held at

the second SafeCare conference.

International experts from academia,

African ministries of health, national

and private insurance companies,

non-governmental organizations,

healthcare facility networks as well as

regulators and innovators gathered in

Mombasa to share ideas, successes

and lessons learned on sustainable

quality improvement. They presented

their visions on the transparency of

quality in individual presentations

and participated in several panel

discussions. Thanks to their valuable

input, we look back on an enlightening

and inspiring conference and look

forward to working together towards

sustainable quality of care in Africa.

This conference report provides an

overview of the main themes covered

during the two-day SafeCare conference.

• Opening session: “In order to create

willingness to pre-pay, the care

provided should be reliable, effective

and of the highest possible quality”

• Regulatory approach to quality;

Introduction

licensing and accreditation: “The

success of the system depends on an

effective, multi-stakeholder approach”

• Introducing the PharmAccess

Pharmacy Improvement Program:

“Pharmacies propose a challenge but

also an opportunity. If we ignore them,

we ignore the health needs of a very

One of the main lessons we at SafeCare have learned in the

first few years of operations, is that transparency of the

quality of healthcare truly is key when it comes to building

trust in the healthcare system.

large group of patients”

• Voices from the private sector:

“Quality of health care is a way of

marketing yourself”

• Learning & Analysis and Closing

comments: “Quality is really at the

core of any healthcare system”

Quality in Practice; Towards Sustainable Quality of Care in Africa

3


“In order to create willingness to pre-pay, the care

provided should be reliable, effective and of the highest

possible quality”

Nicole Spieker, managing director of

SafeCare, opened the second SafeCare

conference, welcoming the 65 partici-

pants from over ten different countries

to Mombasa. The first SafeCare

conference, held in Cape Town in 2011,

focused on meeting the challenges

faced by emerging countries in the

provision of quality primary health

care. This conference represented

the next step, inviting key players to

discuss ‘Quality in Practice; Towards

Sustainable Quality of Care in Africa.’

Onno Schellekens, managing director

of the PharmAccess Group, held

a presentation on the need for

benchmarking of healthcare providers

in order to attract more financial

investments, thereby increasing the

overall amount of money available for

healthcare provision. Professor Fred

H.K Segor, Principal Secretary of

the Kenyan Ministry of Health, was

invited to deliver the key note lecture

but was unable to attend due to the

terrorist attack in Nairobi a few days

before the conference. Thankfully,

Dr. Kandie of the Kenyan Ministry of

Health read his speech on his behalf,

adding that “at times like these the

importance of good quality care is

more evident than ever. When people

need care in times of emergency,

they need to be able to rely on the

infrastructure, doctors, nurses and

medication to cater to their needs.”

Active role

The Principal Secretary stressed the

importance of quality: “The Ministry

realizes that linking quality of care to

healthcare financing is fundamental

for realizing the ambitions objectives

of the National Health Policy as well

as the Vision 2030. To grow as a

country, we need a healthy Kenyan

population, and to achieve this, all

Kenyans need to have universal access

to quality health care,” he emphasized.

Participants such as Senior Advisor to

the Ministry of Health Nigeria Kelechi

Ohiri acknowledged that governments

should take a more active role by setting

up programs that actually change the

health situation of the people.

Opening session

Dr. Kandie of the Kenyan Ministry of Health

Onno Schellekens, managing director of the PharmAccess Group

4


Onno Schellekens believes that it will

be some time before such scenarios

become reality. “We have learned

that in the end, Africa is facing an

enforcement problem. A lack of

enforcement causes costs and risks

to go through the roof. This creates a

huge waste in the economy, in a whole

range of sectors, not just health.”

A second problem Schellekens identifies

is that health “is not about spending

money, it’s about attracting money.

It is about crowding funding into the

system and about spending it more

effectively.” Schellekens explains that

in OECD countries an average of 15

percent of GDP is spent on health; in

Africa, this averages only a few percent.

Without sufficient money in the system,

it’s no surprise that governments are

struggling to meet the health needs of

their populations. He concluded by stres-

sing that “the good thing about health

care is that if you do it right, people

will start to invest in their own future.”

On the subject of crowding resources

into the system, Nicole Spieker

explained that “we need to know where

investments need to go. We need to

know how much money is needed, and

for what. Quality health care increases

transparency and efficiency, which

contributes to sustainability.”

Spieker stresses that making quality

transparent will increase trust and

the willingness to pay among patients,

doctors, insurance companies, banks,

governments and international

investors. In his speech, Professor

Segor also advocated that “in order

to create willingness to pre-pay and

the benefits that come with it, the

care provided should be reliable,

effective and of the highest possible

quality.” Only then can the stigma

that surrounds health insurance be

reduced.

Kelechi Ohiri, Special Assistant to the Nigerian Minister of State for Health

5


During the second half of the morning

session, experts presented their

vision on how government regulation

can influence quality improvement in

healthcare.

Paul van Ostenberg, vice-president of

the Joint Commission International

(JCI), spoke on the role of licensing

and accreditation. He stressed that

countries should build their own strong

national systems for monitoring and

improving healthcare: “organizations

such as JCI can add an international

context, but they cannot replace or

compete with these systems.”

At the core of regulation lies licensing,

whereby governments enforce the

minimum level of services to protect

the safety of patients, health workforce

Regulatory approach to quality; licensing and accreditation

“The success of the system depends on an effective, multi-

stakeholder approach”

and public health. To stimulate

continuous quality improvement beyond

this level, governments or non-

government agencies can introduce

accreditation. This usually voluntary

process grants recognition to health-

care institutions which meet certain

standards, requiring continuous

improvement in structures, processes

and outcomes. Paul van Ostenberg

explains that “SafeCare adds a third

dimension to the regulatory frame-

work: certification. Certification

evaluates and recognizes an organi-

zation’s adherence with pre-determined

requirements or criteria. SafeCare

offers a context-specific approach for

healthcare institutions to continuously

develop the level of their services.”

Close collaboration

To achieve a higher standard of care,

it is important that there is universal

participation of health facilities, a

uniform approach, effective monitoring

systems, and positive incentives for

participation. Close collaboration Paul van Ostenberg, vice-president of the Joint Commission International

‘SafeCare offers a context-specific approach for healthcare institutions to continuously develop the level of their services.’

6


between regulators, NGOs and accre-

ditation institutions helps to strengthen

this system. Where the government

sets the national agenda, enforces the

minimum requirement and sanctions

underperformance, the private and

NGO sector add value by stimulating

healthcare institutions to meet optimal

standards, through innovative and

sector focused approaches.

Nathaniel Otoo, acting deputy chief

executive at the National Health

Insurance Scheme (NHIS) in Ghana

explains how “the involvement of the

private sector in Ghana has been a

catalyst for the government’s strategy

to regulate the health system.” The

development and refinement of

comprehensive accreditation standards

for both the public and private health

sector came to full scale in 2009 and

became the essential tool for quality

assurance. In 2011, the Health Institu-

tions and Facilities Act was passed,

covering both the public and private

sector. It describes accreditation as

a voluntary process, whereby the

government regulates independent

accreditation bodies to carry out

accreditation. Additionally, the govern-

ment’s role is to guarantee the

general provisions of the healthcare

system, data reporting systems, and

to provide guidelines and appeal

procedures regarding accreditation.

This framework is currently being

implemented. Nathanial Otoo points

out that “the success of the system

depends on an effective, multi-stake-

holder approach. In addition, results

should be made known to the public,

which will positively influence the

quality of care by expressing their

opinion and choosing preferred health

facilities.”

In his presentation, Dr. Abdulraheem

Oba Sulyman, Special Adviser to the

Governor of Kwara State on Health

Insurance affirmed the importance

of working together, quoting Ban

Ki-Moon, Secretary-General of the

United Nations: “The ground-breaking

community health insurance scheme

of the Kwara State Government is

another hopeful example. This unique

initiative offers comprehensive

healthcare to all community people,

year round, at a modest cost. It is

accomplished through cooperation

among government, traditional rulers,

the private sector and donors. This is

Dr. Abdulraheem Oba Sulyman, Special Adviser to the Governor of Kwara State on Health Insurance

7


exactly the kind of innovative partner-

ship that we should replicate – here

in Nigeria and beyond.” Dr. Sulyman

emphasized that quality assurance is

key when it comes to scaling up health

insurance. Other key success factors

he mentioned included community

buy-in and participation, recruitment

and capacity development of health-

care personnel and continued involve-

ment of funders.

Attracting funds

According to Kelechi Ohiri, the Special

Assistant to the Nigerian Minister

of State for Health, the government

needs to take up a more active role

by setting up programs that actually

change the health situation of the

people. “Changing health outcomes

and saving lives is what we are

trying to address.” He emphasized

that quality improvement is not only

about regulation: “The government

cannot simply put legislation in place

and expect everything to be okay. In

a federal system with autonomous

states, we need to show concrete,

positive results to convince politicians

that quality improvement actually

does change health outcomes and

save lives. Accreditation can, as part

of the government’s developmental

approach, help to attract funds into the

health sector. This should generate a

market for quality improvement, whereby

the government plays a leading role.”

Dr. Lucy Musyoka, deputy director

of medical services at the Ministry

of Health Kenya, explains the

systematic, holistic approach to

integrated quality improvement of

the Kenyan Quality Model for Health

(KQMH) in Kenya. It has chosen to

coordinate and legitimize quality

improvement programs, approaches

and methodologies among diverse

stakeholders. Its role is to set a

framework for program evaluation,

in particular the impact evaluation

of diverse approaches to quality

improvement: “the government should

develop regulation for public-private

partnerships that increases access

to quality healthcare for Kenyans.”

This idea was shared by Simeon Ole

Kirgotty, CEO of Kenya’s National

Hospital Insurance Fund (NHIF),

who gave a presentation on quality

assurance and stated: “Through

collaboration we can achieve an

effective quality strategy that,

combined with expansion in health

access, will achieve improvements in

health outcomes.”

Simeon Ole Kirgotty, CEO of Kenya’s NHIF

During the round table discussion,

the presenters shared the opinion

that collecting data, showing results

and exchanging information are key

to success. This involves not only

the governments, but also private

partners, NGOs and donors.

8


The second day of the SafeCare

conference started with the intro-

duction of the newly developed

Pharmacy Improvement Program.

Millicent Olulo Orera, Senior Quality

Manager of SafeCare in Kenya,

addressed the need from which the

program originated, the scope of the

program and the challenges that lie

ahead. Millicent Olulo Orera explained

that “pharmacies propose a challenge

but also an opportunity. If we ignore

them, we ignore the health needs of

a very large group of patients.”

In Africa, about 50 percent of the

people turn to their local pharmacy

or drug seller for advice when ill.

Yet, many of the drug sellers are

unregistered and unqualified and

services can be of poor quality.

Medicines are not always available,

too expensive or of unreliable quality.

At the same time, pharmacies lack

access to finance to improve the

situation.

Introducing the PharmAccess Pharmacy Improvement Program

“Pharmacies propose a challenge but also an opportunity.

If we ignore them, we ignore the health needs of a very

large group of patients.”

In order to address this situation,

PharmAccess partnered with the Pfizer

Global Health Fellows (GHF) program

to develop the Pharmacy Improvement

Program. The GHF program is Pfizer’s

signature international corporate

volunteer program. It places highly

skilled colleagues in three to six month

specialized fellowships with leading

international health organizations.

GHF fellows assisted PharmAccess in

developing the pharmacy program.

The Pharmacy Improvement Program

aims to improve access to quality

medicines through enhancing quality

and finance in private pharmacies.

It builds upon the existing Medical

Credit Fund and SafeCare programs,

extending them to include pharmacies

as well as clinics. In her presentation,

Millicent Olulo Orera explained

how the program would go about

increasing the quality of services and

the bankability of these small private

pharmacies. Bonifacia Agyei, Emmanuel Aiyenigba and Ziyanda Vundle

9


Work in progress

This program was real food for thought

for the health experts present at

the conference and evoked a lively

discussion on topics such as how

to address the pharmacy retailers

without addressing the wholesalers,

how to ensure the quality of care

beyond stocks and how to identify

counterfeit drugs in the program.

“The program is definitely work in

progress,” Orera explained. “We want

to start with the loan program and in

time see how we can work with retailers

and wholesalers to control the supply

of medicines and prevent counterfeit

and substandard drugs from entering

the pharmacies as much as possible.”

Another frequently heard question

during the session was why the program

excludes unregistered pharmacies,

which represent the majority. Orera

acknowledged that this will be a

challenge since there are many un-

registered pharmacies and these are

often the first point of contact for

customers. “The program will only

include pharmacies that have appropriate

registration and qualifications. If this

eventually encourages pharmacies to

register their premises so that we can

be sure they operate within the regulatory

framework, that’s a plus. We’ll be working

closely with the regulators to manage

this and will not lock out pharmacies in

the remote and rural areas.”

Millicent Olulo Orera, Senior Quality Manager of SafeCare in Kenya

1 0


realize that this provider really cares

about quality. Things that are imme-

diately visible to patients like white

coats, gloves, direction signs, posters

and protocols; these examples really

scream quality,” says Dr. Sowden.

In addition to these visible examples,

Dr. Sowden explained that quality is

also in the way you communicate to

patients and he believes this aspect

could be emphasized more in the

methodology. “We now recognize that

people are nervous or even scared. For

that reason, we ask them some non-

medical questions first, about their

On the second day of the conference,

different actors from the private

sector shared their story. The session

focused on quality as an opportunity

for branding and self-regulation. During

a lively discussion led by Monica

Oguttu, Managing director of K-MET,

Dr. Alice Bett, director of Siloam

hospital and Dr. Nicholas Sowden,

director of Penda Health presented

their experiences on what transparency

of quality means for private providers

and for their patients. Both their

facilities are located in Kenya and work

according to the SafeCare methodology.

In addition, Dr. Samwell Ogillo, director

of Association of Private Health

Facilities in Tanzania (APHFTA)

explained the importance of clear

guidelines for the private sector to be

able to self-regulate.

“Quality of health care is a way of

marketing yourself,” Dr. Alice Bett

‘Perceived quality of care in the eye of the patient is just as important’

Voices from the private sector

“Quality of health care is a way of marketing yourself”

explained. “With quality in place you

don’t need to do any other marketing.

Quality health care is about meeting

the needs of the customer. It’s all

about communication and the manner

in which patients are handled. Their

needs must be addressed as they

arise and they should be informed

in a manner that they understand.

Furthermore, the client expects a

clean environment. If customers are

satisfied with the services received,

they will go out into the community

and tell this to others, leading in our

case to an increase in patients.”

Alice Bett explained that Siloam

Hospital was able to improve and

expand their services through loans

received from the Medical Credit

Fund and their partner the Kisumu

Medical Educational Trust (K-MET).

“Now, the next phase for us is to make

sure that we sustain quality. We have

implemented procedures on how to

use the different waste dispensers

and when to use the soap dispensers;

previously we had nothing like that.”

Siloam hopes to obtain SafeCare level

three of SafeCare within the next few

months.

Branding quality

Dr. Nicholas Sowden, director of Penda

Health, was on the same page as Alice

Bett. He shared that Penda Health

clients have also reacted positively to

the improved quality. As a result, Penda

has seen an increase in patients and

has made a profit for the first time.

Dr. Sowden thinks that more can be

done to really brand quality within

the SafeCare methodology; to make

it even more visible to the patients.

“First of all, by focusing on quality

improvement issues that make people

Dr. Samwell Ogillo, director of Association of Private Health Facilities in Tanzania

1 1


day and the weather. We make sure

that they are at ease and that the

patients understand what is happening.

The number of patients has gone up

dramatically as a result of better

patient communication.” Dr. Edward

Nketiah-Amponsah, a senior Economics

lecturer at the University of Ghana,

also stressed the need to focus on

how patients experience the care

received. “It is not just about improving

the quality of the clinic in terms of

equipment or renovations. Perceived

quality of care in the eye of the

patient is just as important, treating

people with dignity and respect.”

Lastly, Dr. Sowden believes that SafeCare

should develop actual branding

materials for healthcare providers,

hardcopy as well as online to “show

patients that this provider is taking

quality seriously.” These materials

could range from signs on the exterior

of the clinic to materials designed to

communicate the different quality

steps in the SafeCare process to

patients. This way, the patients learn

that the level of quality is something

that is improving, a work in progress.

“Explaining to patients what level

you have and what this means does

not only mean that they better

understand the methodology, it also

allows them to compare the different

providers in their area.”

Open data

Dr. Ogillo, director of APHFTA, acknow-

ledged the importance of open data

to inform clients. However, to do this

effectively he thinks we should take

it one step higher. In his presentation

he stressed the importance of clear

information from governments for the

private sector. Dr. Ogillo: “The private

sector should have very clear guidelines

and regulations in place for self-

regulation. Not having this clarity leads

to corruption, meaning we will be

fighting among ourselves.”

Referring to the presentations that

preceded his, Dr. Ogillo emphasized

that the ambition is there. “Private

facilities want to adhere and are

willing to work hard for it. By having

clear guidelines in place the facilities

actually know what it is they need to

adhere to. In case of a dispute, you

can explain exactly which guidelines or

regulations they are in violation of.” In

conclusion, according to Dr. Ogillo clear

guidelines are a condition for creating

transparency for patients, for and

between providers and for governments. Joyce Wanderi, Head of Social Marketing at PSI Kenya

and Maxwell Antwi, SafeCare country manager in Ghana

1 2


It is safe to say that the SafeCare

conference reached its goal of promoting

discussions between the participants

on the importance of transparency of

quality health care. The public and

private sector speakers from over ten

countries shared constructive

experiences and new insights on how

to work towards sustainable quality

care in Africa.

Nicole Spieker tied all the different

sessions together in her closing

remarks. “Quality is really at the core

of any healthcare system. It is what

doctors should do: give the right

treatment to the right patient at the

right time.” She explained how quality

creates trust with patients in the

healthcare system and in turn creates

willingness to (pre-)pay for healthcare.

“In addition, during these past two

days we have learned that transparency

of quality of care can be an income

generator for private providers,”

Spieker said. As the NHIF shared with

the participants at the conference,

the NHIF links quality levels to the

financial support they provide to

Closing comments“Quality is really at the core of

any healthcare system”

clinics, thereby creating an incentive

for healthcare providers to continue to

improve the quality of their services.

Penda Health noticed an increase in

patient visits because the patients

could actually see and experience

the improved quality. Spieker:

“These examples are an important

Nicole Spieker, managing director of SafeCare

development in understanding the

factors that make quality of care self-

sustaining and self-financing.”

Lessons learned

After these opening remarks,

Spieker briefly summarized the most

important lessons per session.

1. The first session of the conference

focused on the role of the government

as a regulator of quality of care.

Spieker: “The politics of aligning

healthcare stakeholders and partner

organizations and setting a quality

framework is incredibly challenging.

There is a real need for data to

1 3


improve the framework. Not just for

reporting, but for open data.” She

believes there should be a general

platform that can be used by stake-

holders and even patients to learn

more about the level of quality of

individual facilities.

This requires that each country should

have a set framework with defined

roles and responsibilities for gazetting,

licensing, certification and accreditation.

However, many countries are still

struggling with this process. Spieker:

“In Nathaniel Otoo’s presentation, we

learned that Ghana has made a

significant step by institutionalizing

these roles into an independent

organization mandated by all partners

through the HFRA.” More in general,

Spieker concluded that the exchange

of information and best practices during

the conference was extremely valuable

and should be promoted further.

2. Another session during the

conference focused on financing

mechanisms through health insurance

companies and banks. Spieker: “We

had already identified the important

role quality plays as an income

generator for providers. In relation

to that, we learned that quality can

function as risk reduction strategy for

insurance companies and banks.”

In the two different presentations by

the NHIF, both Dr. George Midiwo and

Simeon Ole Kirgotty explained NHIF’s

plans to ask providers to pay for

certification, which is an important

step towards a viable accreditation

framework. In addition, Medical Credit

Fund managing director Monique

Dolfing-Vogelenzang’s presentation

further made clear that doctors are

reliable lenders. The Medical Credit

Fund, operating in four countries and

with over 500 clinics, has a loan

repayment performance of over 95

percent. The success of this program

has also led to the expansion of loan

provision. Where the program was

initially geared towards clinics, it has

now expanded to include pharmacies,

an important link in the healthcare

chain. “We are very excited to be able

to roll out this new activity, as it also

demonstrates that trust levels among

investors have risen,” Dolfing-Vogelen-

zang said. Spieker: “It pays to invest

in quality healthcare and there is a lot

of willingness to link quality to payment

for performance. The providers now

need to make sure it’s in place.”

3. The third session gave a voice to

the private sector. Spieker: “We held

a lively discussion about the private

sector. The presentations by Dr. Alice

Bett and Dr. Nicholas Sowden showed

us that going through a quality

evaluation process can be a positive

thing. It’s not just an audit where

people come and tell you all the things

that you’re doing wrong. It’s perceived

as a very positive process.” Going

through a quality evaluation process

has been found to lead to an increase

in patient visits. In that sense, quality

functions as an income generator.

Also, as Dr. Sowden explained, it is

Dr. George Midiwo, Director of Accreditation of the NHIF

14


useful for the owners, the doctors and

the staff to learn how to best organize

processes and to recognize what the

benefits are of taking such steps. This

knowledge motivates them.

Spieker: “Yet, what the representatives

also clearly emphasized is that the

perspective of the patient is very

important. Patients need to be more

informed about quality and quality

improvement.” Again, sharing online

data with the public on the achievements

of certain facilities would help. In

addition, Dr. Sowden suggested SafeCare

develop materials to allow clinics to

brand their quality level. He expressed

the desire to be able to better commu-

nicate to his patients what a certain

quality level and quality improvement

is about, using signs, posters and

other materials.

Also, many speakers stressed the need

for information from the governments.

Dr. Ogillo explained that guidelines

and regulations should be available so

clinics know and understand what they

need to adhere to. Spieker: “This would

help create transparency. Especially

since private providers have already

indicated that they are willing to

comply with these guidelines.”

4. The last session on learning and

policy implications created a heated

debate. Oxford Professor Mike English

presented data that there is little

evidence that accreditation has a

positive effect on medical outcomes.

In response, Spieker emphasized

that there is still a lack of data for

resource-restricted countries where

the need for quality improvement and

transparency is much higher than in

highly regulated western countries.

Spieker: “At the end of the day it’s

about showing what we are doing and

the impact it has. It is my impression

that we are having impact; we just

haven’t asked the right questions

yet. We need to get a much better

understanding of the outcome.” In

her presentation, Dr. Modupeola

Oludipe, Senior Quality Manager of

SafeCare in Nigeria reflected on the

need to recognize that being able to

benchmark facilities, thereby giving

patients a choice, is just as important

a driver for quality improvement as

measuring absolute levels of care.

Also, Spieker believes we should broaden

the scope of what we measure. For

instance, clinics that achieve certification

are entitled to financial benefits,

creating a transparent external valida-

tion that helps transactions within the

health sector. This is something that

should be measured as an impact

indicator in addition to the improved

medical outcome.

In short, many challenges lie ahead in

setting up a quality framework. Spieker:

“In order for quality to be sustainable,

the process should be owned by the

stakeholders of the countries themselves.

By sharing valuable data and experiences,

these stakeholders can make sure

that transparency of care and the

patients are at the heart of what they

do.” Spieker believes the exchange of

ideas at conferences like this one help

identify and bridge these challenges

and she therefore concludes that the

outcome of the conference is highly

successful. Spieker: “A big thank

you to all the participants for their

valuable contributions, thoughts,

ideas and continuous support!”

Dr. Modupeola Oludipe, Senior Quality Manager of SafeCare in Nigeria

1 5


International

• PharmAccess

• COHSASA

• International Finance

Corporation

• Joint Commission International

Nigeria

• Hygeia

• Kwara State

• Ministry of Health

• Shell

• Society of Family Health

Ghana

• Medical Credit Fund

• National Health Insurance

Authority

• Stewardship Management

Consult Ltd

• University of Ghana

Kenya

• AAR

• Institute of Healthcare

Policy & Research

• KMET

• Ministry of Health

• MorrisMoses Foundation

• MSI

• PSI

• NHIF

• Penda Health

• Siloam Hospital

• University Research Co

Tanzania

• APHFTA

• MEMS

• Ministry of Health and Social

Welfare, Tanzania

• Ministry of Home Affairs

• Ministry of Home Affairs,

Tanzania Police Force

• NHIF

• NSSF

Attendees SafeCare Conference

1 6


1 7


SafeCare

Trinity Building C

Pietersbergweg 17

1105 BM Amsterdam

Phone: +31 (0) 20 566 7643

Fax: +31 (0) 20 566 9440

[email protected]

www.safe-care.org

@PharmAccessOrg

Partners

quality in practice; towards sustainable quality of … 13 verslag conferentie_def_lr.pdf ·...

Documents