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