Safe Surgery Saves Lives in Africa

In June 2008, the World Health Organization’s (WHO) World Alliance for Patient Safety launched the Safe Surgery Saves Lives Programme. It is designed to reduce the number of surgical deaths and inadvertent errors during surgery, around the world. To date, 3,925 hospitals in 122 countries have registered as participating hospitals and 25 of those countries have mobilised resources at a national level for implementation.1 In the United Kingdom, The National Patient Safety Agency mandated that all English hospitals should implement the checklist by February 2010. They report that 100% of Trusts have successfully implemented the programme in more than one Operating Theatre and that they are now being encouraged to add a presurgical list briefing as well as a post surgical list debriefing.2 In 2007 and 2008, the global pilot study for the checklist involved eight different cities around the world. The pilot study demonstrated that, by using the checklist, an astonishing reduction in the number of surgical deaths and complications can be achieved.3 Study limitations raised some doubts as to whether the 36% reduction in deaths and major complications, dropped from 11% to 7%, could be demonstrated elsewhere. In November 2010, some of these fears were laid to rest by a study conducted in The Netherlands which showed that with the use of the checklist, surgical complications were reduced by more than one third and deaths reduced by almost half, from 1.5% to 0.8%. Checklist adherence was measured and tight correlations were found between the use of the checklist and achieving these results.4 WHO report that the studies indicate that the checklist works because it is more than a tick sheet: effective adoption generally requires local systems changes and commitment to teamwork for safety.5

Patient safety in Africa

One of the countries which took part in the initial global pilot project, Tanzania, has signed up as a country committed to implementing the Safe Surgery Saves Lives Checklist. It is the only country in Africa to have made this commitment. In addition, there are a number of individual hospitals that have made their commitment and show on a global map as using the checklist regularly or as making a commitment to participate.6 Data in many of the developing nations of the continent is difficult to assess, as national statistics on the safety of surgery are not collected. In a report by the regional director for the WHO AFRO region,7 the issues and challenges for patient safety were set out, including a recognition that most of the 46 countries in the Who Region lack national policies on safe healthcare practices. Inappropriate funding and unavailability of critical support systems including strategies, guidelines, tools and patient safety standards remain major concerns in the Region. Also mentioned are the inadequate human resources for health, weak healthcare delivery systems with sub-optimal infrastructure, poor management capacity and underequipped health facilities which have brought about a situation where the likelihood of adverse events is high. Healthcare systems that are not fully functional will inevitably result in error and patient harm. Availability of minimum supplies and basic treatment tools, lack of adequate working conditions in hospitals, overcrowding and limited microbiological information directly impact on the provision of safe patient care.8