THINKING ALOUD: Do we need international healthcare accreditation?

What you need to know:

International accreditation is not cheap.  It comes at a huge cost, which is usually quietly passed on to patients

Providing healthcare, especially quality healthcare of an adequate and acceptable standard, is a complex and challenging process. Healthcare services can be provided either by the public sector or private sector, or by a combination of both.

Fundamentally, healthcare and hospital accreditation is about improving how care is delivered to patients and the quality of the care they receive. Accreditation has been defined as “A self-assessment and external peer assessment process used by healthcare organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”.

Accreditation is one important component in patient safety. However, there is limited and contested evidence supporting the effectiveness of accreditation programmes. We need accreditation mainly to improve patient safety, improve the pathways that provide comprehensive care and also to put a stop to some doctors acting as demigods who are beyond reproach. Accreditation is thus important and needed in all our health facilities, public and private alike. 

In Tanzania, international accreditation has mainly been sought by the private health subsector, but this type of accreditation is not cheap.  It comes at a huge cost, which is quietly passed on to patients. This makes such hospitals extremely expensive, with a vast majority of Tanzanians being unable to afford treatment at these facilities.

Debate is raging about the effectiveness of international accreditation. It seems there is a hidden motive to get international accreditation, which is to use it as a marketing strategy. Thus some hospitals go for international healthcare accreditation as a de facto form of advertising and marketing. The moment they receive certification, big posters and banners are placed along corridors and other strategic places to attract the attention of clients. In a way, this is contrary to medical ethics.

International accreditation has become big business involving millions of dollars and involves people who fraudulently and deceitfully masquerade as inspectors of these international agencies. This accreditation is nothing but a big time profit-making venture, and in the process makes healthcare provision very expensive in poor countries like Tanzania.

International agencies that are involved in the business of accreditation profess that accreditation should ideally be independent of governmental control, but they do not give any explanation as to why this should be the case. I think that accreditation can be independent, but it can also be under governmental supervision.

Another important issue is that accreditation groups should assess hospitals “holistically”, and not just some isolated facets of activities or services such as laboratories, pharmacy services, infection control, financial health or information technology.

Many a time, outreach or satellite clinics of main hospitals are very conveniently excluded because the quality at these clinics is sometimes pathetic and there is no monetary incentive. This should not be the case.

The best accreditation schemes should also assess academic and intellectual activity such as teaching and research and also look into adherence of research ethics.

I know of countries that do not allow these international agencies and instead have their own local agencies that provide such services. For example, Accreditation Canada’s Qmentum accreditation programme provides a comprehensive range of services under one governing structure. Canada does not allow agencies from the US or anywhere else to do their healthcare facility accreditation.

Similarly, Tanzania should have its own local accreditation agency, preferably under the Ministry of Health (MoH). The accreditation procedure can be better streamlined, considering the prevailing local conditions. Let interested health personnel get appropriate training before such an agency is established. This is a challenge for the MoH. Global agencies like WHO should be able to lend support for such an initiative.

However, healthcare can never be truly “free”. Someone somewhere will always have to pay, and the payer will always want the best value for money. “Affordability” of healthcare can be an insurmountable hurdle for some human beings.

No one healthcare system has a monopoly of excellence and no one provider country or scheme can claim to be the total arbiter of quality. The same is true of healthcare accreditation schemes.

As we move towards universal access of healthcare, we should be mindful of quality of care that will be given to our citizens. Quality should be for all and there should be no compromise.

Also, the provision of healthcare should not be prohibitively expensive and a preserve of the wealthy. This should not be the direction of the current government.

The MoH is without doubt doing a good job, but it is failing in monitoring and regulating the private health subsector. Perhaps someone within the ministry has a vested interest.

Zulfiqarali Premji is a retired Muhimbili University of Health and Allied Sciences (Muhas) professor currently living in Canada