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Were They Pushed or Did They Jump?

IZINDABA Beleaguered public hospitals and clinics, due for a quality assurance 'make-over' and continual monitoring in advance of the much-vaunted National Health Insurance (NHI), may emerge little better in spite of strenuous government efforts. The pivotal Office of Standards Compliance (OSC), tasked with drafting and monitoring minimum health care standards nationwide , has parted ways with the local leaders in the field and could be headed for dysfunction, some experts believe. After intermittent OSC consultation with, and several last-minute appeals for help from the local NGO with the strongest track record, the two bodies have reached a stand-off, neither talking to the other after disagreement on several issues. Several consultants to the OSC also believe that its failure to fully incorporate the best local advice and keep its top local advisor on board has led to poorly developed measurement standards, a dangerously accelerated process and deeply flawed pilot studies. The OSC denies this, claiming to have obtained 'enormous buy-in' from provincial teams and other stakeholders and to be on track with 'reliable, flexible and validated' measurement tools. The 15-year-old, not-for-profit NGO – the Council for Health Service Accreditation of Southern Africa (COHSASA) – has already independently assessed, monitored and accredited 55 public and 25 private sector local hospitals, based on essential performance indicators. It has more sets of standards accredited by the International Society for Quality in Health Care (ISQua) than any other health care accrediting body in the world and advises the World Health Organization (WHO) on patient safety and quality issues. Its quality assurance methods and protocols are the gold standard in Botswana, Swaziland and Lesotho and the City of Cape Town (clinics and community health centres), and are also in use to varying degrees at private and public hospitals in Namibia, Nigeria, Zambia, Tanzania and Rwanda. A full quarter (28) of all hospices in South Africa are fully accredited by COHSASA with 97 headed towards full accreditation, hugely elevating their credibility and opening international funding doors, the Hospice and Palliative Care Association of South Africa told Izindaba. In spite of this, the OSC is now using a British-based company, the Care Quality Commission, to audit the tools and processes it has developed, citing important similarities with the proposed local NHI funding model. South Africa's impending NHI system rests on hospitals and clinics in the private and public sector being gradually and incrementally accredited according to a set …