Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

Abstract

BackgroundPatient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.PurposeThis paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.MethodsA randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.FindingsClinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment.ConclusionCommunity engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.

Correlates of Patients’ Preference for Therapeutic Injections in a Major Regional Referral Hospital in Ghana: Implications for Policy and Clinical Practice

“…Multicollinearity diagnosis was conducted on all the explanatory variables prior to their inclusion in the regression model. The average variance inflation factor (VIF) was found to be 1.31, which is below the 10.0 rule of thumb necessary for exclusion from the regression model (Alhassan et al, 2016;Greene, 2002;Tabachnick & Fidell, 2001).…”

“…However, many of these studies were conducted outside Ghana, hence the motivation for this current study. For instance, some previous studies suggest that patients measure the quality of health care they receive by the number of therapeutic injections prescribed and administered (Alhassan et al, 2015;Alhassan et al, 2016;Kermode, 2004;Kotwal et al, 2004).…”

Citizen engagement in public services in low‐ and middle‐income countries: A mixed‐methods systematic review of participation, inclusion, transparency and accountability (PITA) initiatives

“…Programme costs were reported in four studies (Alhassan et al 2015;Ananthpur et al 2014;Björkman Nyqvist et al 2017;Pandey et al 2007). Only total costs were presented across these studies, and the costing methodology used in arriving at these cost values were described as "back of the envelope" and were not detailed.…”

“…Three studies reported factors influencing implementation costs. Alhassan et al (2015) suggested that factors such as champions being community members and resources being mobilised from within the F I G U R E 3 5 Final outcomes for pure public and merit goods 8 Cost data may be considered as incomplete due to loss of follow-up. MNAR or nonignorably missing censoring occurs when the mechanism that generates the censored observations is correlated with the mechanism that generates cost (Glick, Doshi, Sonnad, & Polsky, 2015).…”

Incentives for climate mitigation in the land use sector – the effects of payment for environmental services (PES) on environmental and socio-economic outcomes in low- and middle-income countries: a mixed-method systematic review

“…Five studies included in this review evaluate community-based monitoring of health services (Alhassan et al 2015Alhassan et al 2016, Björkman & Svensson 2009, Björkman et al 2017, Fiala & Premand 2017, Gullo et al 2017. Because the main intervention aims to engage citizen in monitoring health worker's performance, the service users in the intervention groups in these studies are more likely to remember the services they received over the past year because they paid attention to it (recall bias).…”