Improving healthcare quality in sub-Saharan Africa through Collaborative Learning

By Joy Nwizu and Ebun Sotubo of Solina Health


A healthcare system’s ability to provide quality services and improve health outcomes is dependent on the efficient functioning of its components. According to the Institute of Medicine1, improving quality is about making healthcare safe, effective, patient-centered, timely, efficient and equitable. However, many sub-Saharan African countries struggle to provide quality services to their citizens. Well-known challenges include; inadequate healthcare financing, lack of national and sub-national strategic plans for health sector development, inefficient resource allocation, poor supply chain infrastructure, and a shortage of skilled healthcare personnel.


Solina Health, the West African regional broker for the Center for Health Market Innovations (CHMI) hosted a collaborative learning exchange in Lagos, Nigeria with the theme: “Quality Improvement in Healthcare.” Seven private-sector health organizations were selected from the larger CHMI Learning Exchange to share common challenges relating to the quality of health service delivery and access to care in their respective settings. The programs, all profiled on CHMI, included:

How can health care organizations improve quality?

The collaborative meeting featured brainstorming sessions on quality improvement and discussions on how to build a culture of improvement in health programs and facilities across Africa. Participants highlighted the role of community engagement, patient-centeredness, system-wide quality improvement initiatives, financing, performance measurement and reporting, capacity building and mentorship, amongst others in improving the quality of healthcare delivery.

The seven organizations in the learning collaborative discussed their experiences and lessons learned in Quality Improvement (QI) activities, including:

  • Involving relevant stakeholders in all quality improvement efforts
  • Incorporating quality improvement initiatives into every health facility/organization, and not in isolation;
  • The use of non-financial incentives for health workers for sustainable QI initiatives
  • Constant process measurement to promptly identify and strengthen failing processes in healthcare amongst others.


Participating health programs also visited Paelon Memorial Clinic to learn about their QI system. Paelon is the first facility in West Africa to attain the highest level (level 5) on the Safecare quality improvement program. Safecare is a consortium that supports basic healthcare providers to deliver safe and quality-secured care to their patients according to internationally recognized standards. Dr. Nnenna Mbonu, the quality improvement lead and Dr. Uloma, the Administrative officer at Paelon Memorial Clinic attributed the clinic’s success in implementing quality improvement to:

  • Management buy-in and unrelenting support to driving quality activities
  • Involvement of staff when developing quality improvement activities
  • Mandatory training of all new hires on the processes and policies guiding the clinic
  • Regular update of their process manuals and policy documents
  • Periodic refresher technical training for all staff and
  • Proper documentation at all points of care.


At the conclusion of the 2-day collaborative learning event, participants documented their ideas and developed quality improvement plans. Solina and CHMI will hold a final meeting in Kenya in May/June 2017 to share experiences from the kick-off collaborative and the learning exchange between partners.


1Institute of Medicine (2001). Shaping the Future for Health. Crossing the Chasm: A New Health System for the 21st Century, Washington DC: National Academy Press

  1. James Oizamesi Adanini
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    This is mind blowing. For a technical assistant in an immunization project striving for 100%coverage. I have gained an insight to things I can do. Thanks

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  5. Amechi Ezeogba
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    This collaborative learning is a great initiative. When people from different backgrounds brainstorm and share knowledge on a platform like this, it speeds up effective learning. Health care provision should not just be about the number of people that access the services but also the quality of services being accessed. This is very important and has a lot to do with patient-centeredness, and should be at the very core of health care programmes.
    The six factors to which Paelon Memorial Clinic attributed their success would involve a clear understanding of the quality improvement vision backed by an unwavering commitment of all staff, from top to bottom, in actualising this. However, beyond these is the cost implication especially when considering the inadequate financing of our overburdened large government health facilities and the attendant difficulties in putting these factors in place. Unfortunately, these are where the many poor Nigerians access care.
    Therefore, while I applaud this wonderful idea and plans to develop workable quality improvement strategies, we should also consider doing it in the most efficient way, especially in the face of limited resources available.

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