In May 2019, the World Health Assembly (WHA) endorsed the establishment of World Patient Day (Resolution WHA 72.6) in recognition of patient safety as a global health priority to be marked annually on 17 September. The objectives of World Patient Safety Day (WPSD) are to increase public awareness and engagement, enhance global understanding, and spur global solidarity and action to promote patient safety (WHO 2019). The celebration of World Patient Safety Day (WPSD) provides an opportunity to appreciate all stakeholders in health particularly health workers. It also provides an opportunity for reflection on past events with a view to improving safety for all in the future. The theme for the 2020 WPSD: Health worker safety: priority for patient safety is particularly relevant against the background of the on-going COVID-19 pandemic.
Solutions to healthcare safety in the Nigerian health system at this challenging time of COVID-19 pandemic require a two pronged approach – management of the immediate concerns related to prevention of COVID-19 and the management of underlying quality deficits. The management of quality deficits such as national policy on quality and safety of healthcare, funding for health, human resource for health, unsafe surgical care, challenges with invasive procedures, health-care waste management, safe motherhood, medicines management, health awareness, partnerships for healthcare and development of patient charter and the lack of local data for local solutions are discussed by the author in a separate paper as is human factors implications of the COVID-19 in surgical services. In this paper, the focus is on management of immediate safety concerns – prevention of COVID-19: working together for safety – safety for health workers, safety for patients and safety for the general public (#Safety4All).
COVID-19 Pandemic: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cause of the COVID-19 pandemic (WHO 2019) has spread across the globe at an alarming rate, as of 17th September, 2020 (WPSD, 2020), global figures were 31million infections and 962,543 deaths (JHU/CSSE, 2020), for Nigeria the figures were 56,735 recorded infections with 1,093 deaths. As at 11/3/2021, the first year anniversary of the COVID-19 pandemic (11/3/202), the figures had risen astronomically to 119.2 million infections and 2,642,570 deaths (global), and 159,993 infections with 2,001 deaths in Nigeria (JHU/CSSE, 2021). To ensure that the current Nigerian national statistics are improved upon, the recognition of health workers as the major source of the resilience in the Nigerian health service must be recognised and their safety made a priority.
Global Health Systems: most health systems are weak with staggering unmet needs in healthcare safety: 1:300 patients die as a result of their treatment (not their illness), for in-patients, there is a 1:10 chance of experiencing a patient safety incident, out of this,
- 1% suffer severe harm or die
- 6% suffer moderate harm
- 24% suffer low harm
- only 69% experience no harm
50% of these occur around operations, which translates to over one million preventable surgical deaths annually (WHO, 2000) but 50% of these cases are preventable (Leape 1994, WHO 2000).
The fear of surgery is therefore a rational fear as unsafe surgical care remains a serious challenge affecting all countries with major complication rates ranging from 3%–16% and death rates ranging from 0.2% to 10% annually; the result is at least 7 million disabling complications and one million deaths each year (WHO, 2000). In response to these distressing surgical statistics, the World Health Organization (WHO) launched a global patient safety initiative; ‘Safe Surgery Saves Lives’ (WHO 2008). The Safe Surgery Saves Lives programme involved trial of a checklist by surgical teams which demonstrated a 36% reduction in post-operative complications (Haynes et al, 2009). Consequently, the WHO made the checklist an essential requirement for hospital surgical teams in all locations but the compulsory use of this simple surgical safety tool remains lacking in majority of Nigerian hospitals (PSA survey, 2018).
Unmet needs for safety from healthcare associated infections (HCAI) is similarly huge in most African healthcare systems (WHO Africa, 2008), the recognition of the challenges of HCAI in Africa at the Fifty-eighth session of the World Health Organization (WHO) Africa regional office conference:Patient Safety in African Health Services: Issues and Solut ions, Yaounde, Republic of Cameroon, 1–5 September 2008, predated the current COVID pandemic by more than ten years, had the loud warnings on the need for strategic reserves for personal protective equipment (PPEs) and the calls for action to minimize healthcare-associated infection through the implementation of simple measures such as improved hygiene conditions been heeded, the African health system in general and the Nigerian health system in particular would have been better placed to withstand the challenges of the COVID-19 pandemic when it arrived. The promotion of hand hygiene as the most effective infection control measure to be promoted as the entry point for subsequently enforcing other essential preventive measures because of its high impact factor on morbidity and mortality was emphasised and national governments were encouraged and supported with WHO resources – tools and guidelines on management. National authorities were further encouraged to adapt these to their national contexts and subsequently implement, unfortunately, the realities in most health systems in Africa show failure of implementation of these basic hygiene policies before the outbreak of the COVID-19 pandemic. The state of public hospitals in Nigeria in 2014 and 2015 were captured by two case reports below:
Water – essential for infection control: Case report 1
Five inconvenient Truths that the Ebola Outbreak has revealed: ….
Full article in the April edition of the Health Standard Journal…….