Towards improving risk management in healthcare organisations in Africa: A review

This paper undertook a survey of existing literature in risk management and proposed a framework towards implementing an efficient risk management system in Africa’s healthcare organisations. The study recognises the relevance of risk management in healthcare organisations and asserts that there is no risk management system that can be said to be completely absolute. The main objective is to ensure that the healthcare institutions’ identified risks are managed within acceptable levels. It is suggested that healthcare  organisations should have a proactive risk management programme as opposed to a reactive one. This study identified Enterprise Risk Management (ERM) as involving the expansion of the role of risk management across the healthcare organisation by adopting a moreholistic approach. Finally, the study proposed an ERM model to be implemented for effective risk management of healthcare institutions in Africa. We noted that by establishing an effective risk management system, healthcare organisations would be well positioned to successfully promote quality of healthcare and enhance performance, while managing the turbulent times of change. Keywords: Risk management, Healthcare risk, Healthcare organisation

Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study

Objective: To assess hand hygiene compliance in selected primary hospitals in Ghana. Design: A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures: The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results: The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion: Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients

Healthcare governance, ownership structure and performance of hospitals in Ghana

It is argued that healthcare governance should play an important role in the overall functioning and effective performance of hospitals. However, the literature is devoid of how healthcare governance influences the performance of hospitals in Africa and other developing countries. This study examines the effects of hospital boards and ownership structure on the performance of hospitals in Ghana. The study specifically examines the characteristics of hospital boards, ascertains whether the presence of a hospital board and ownership structure affect hospital performance, evaluates the effects of hospital board characteristics and ownership structure on hospital performance, and also investigates the interaction effects of hospital board characteristics and ownership on performance. Based on a sample of 132 hospitals, the study produces a number of results. First, the study indicates that 69% of the hospitals have a board in place. The results also show that all the mission hospitals have a board in place. Half of the public hospitals and 80% of the private hospitals also have a board. The hospitals with a board exhibit varying board characteristics. Using regression models, the results show that hospitals with a board demonstrate lower occupancy, higher discharge and deliver better quality healthcare. In terms of the effect of board characteristics on performance, smaller boards are associated with better health service quality and lower occupancy. Hospitals with greater proportion of outside board members assist management to be cost efficient and improve on their operations leading to higher discharge. The results also show that hospitals with greater representation of medical staff on the board perform better in terms of occupancy but are less cost efficient. Hospitals with CEO duality perform better in terms of efficiency. However, hospitals with separate positions for the CEO and chair perform better in terms of discharge and service quality. Additionally, the evidence suggests that boards with higher female representation deliver better quality of healthcare, resulting in higher discharge rate. Also, frequency of board meetings is associated with lower occupancy, higher discharge and improved health service quality. The results also show that mission-based and private hospitals perform better than public hospitals. Further, the results of the interaction effects suggest that mission-based and private hospitals with effective board governance exhibit better performance than public hospitals. This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for effective and efficient governance and management of hospitals.<br/

Medical Waste Management Practices in a Southern African Hospital

This study examined the medical waste management practices of a hospital in Southern Africa. The results revealed that the hospital does not quantify medical waste. Segregation of medical wastes into infectious medical waste and non-infectious medical waste is not conducted according to definite rules and standards. Separation of medical waste and municipal waste is however practiced to a satisfactory extent. Wheeled trolleys are used for on-site transportation of waste from the points of production to the temporary storage area. Staff responsible for collecting medical waste use almost completes personal protective equipment. Offsite transportation of the hospital waste is undertaken by a private waste management company. Small pickups are mainly used to transport waste daily to an off-site area for treatment and disposal. The main treatment method used in the final disposal of infectious waste is incineration. Noninfectious waste is disposed off using land disposal method. The study showed that the hospital does not have a policy and plan in place for managing medical waste. There are a number of problems the hospital faces in terms of medical waste management, including; lack of necessary rules, regulations and instructions on the different aspects of collections and disposal of waste, failure to quantify the waste generated in reliable records, lack of use of coloured bags by limiting the bags to only one colour for all waste, the absence of a dedicated waste manager, and no committee responsible for monitoring the management of medical waste. Recommendations are given with the aim of improving medical waste management in hospitals

Female genital mutilation: psychological and reproductive health consequences. the case of Kayoro traditional area in Ghana

The study examined the reproductive health and psychological effects of female genital mutilation, in one traditional area in the Upper East region (i.e. Kayoro Traditional Area) of Ghana. The results of the study revealed that, the practice of FGM actually affects the physical (deforming the female genitalia), psychological (the mental torture due to pain experienced during the circumcision and also the fear of the unknown which includes medical examination which will involve touching of the genitalia as well as sexual intercourse), and the reproductive health consequences ranging from various forms, including immediate complications such as bleeding, sepsis, and to later complications such as child birth complications and even death. Recommendations were made to the public, policy makers and NGOs with the aim of reducing and if possible eradicate the practice. Keywords: female genital mutilation, health consequences, Ghana Gender and Behaviour Vol. 4(1) 2006: 659-68

Medical waste management at Tygerberg hospital in the Western Cape, South Africa

Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2007This study examined the medical waste management practices of Tygerberg Hospital. The researcher made use of both primary and secondaiy data. Since this was a is study, the analysis is essentially descriptive.The results of this study revealed that both general and medical wastes are generated in the hospital. Tygerberg Hospital does not quantify medical waste. Segregation of medical wastes into infectious medical waste and non-infectious medical waste is not conducted according to definite rules and standards. The hospital does not label infectious waste with Biohazard symbol. Separation of medical waste and municipal waste is however practiced to a satisfactory extent. Wheeled trolleys are used for on-site transportation of waste from the points of production (different wards) to the temporary storage area. Staff responsible for collecting medical waste use almost complete personal protective equipment. The results of this study indicated that off-site transportation of the hospital waste is undertaken by a private waste management company. Waste is transported daily and small pickups are mainly used by the waste management company for transporting the waste to an off-site area for treatment and disposal. The final disposal of the medical waste is done by the private waste management company. The main treatment method used in the final disposal of infectious waste is incineration. Non-infectious waste is disposed of using land disposal method. The hospital does not recycle medical waste materials except white office paper and mixed office paper and the use of empty containers of antiseptics for the collection and temporary storage of sharps.The hospital does not provide training for staff members on the health and environmental effects of infectious waste. The waste management company's workers have also not received any formal training with regards to medical waste management. The study showed that Tygerberg Hospital does not have a policy and plan in place for managing medical waste. There is no definite policy or plan for purchasing the necessary equipment and for providing the facilities for the correct management of medical waste in the hospital. There are also no policies and guidelines regarding the recycling of medical waste products. There are a number of problems the hospital faces in terms of medical waste management, including; lack of necessary rules, regulations and instructions on the different aspects of collection and disposal of waste, intermingling of hazardous wastes with domestic waste in the hospital sometimes, failure to quantify the waste generated in reliable records, lack of use of coloured bags by limiting the bags to only one colour for all waste, the absence of a dedicated waste manager, the supervisor in charge of general services has waste management as part of his job schedule, and there is no committee responsible for monitoring the management of medical waste. From the results of this study, it is obvious that medical waste management is not practiced according to the World Health Organisation's (WHO's) recommended standards. There are some areas where medical wastes are not properly managed. It is imperative for significant investment in the proper management of medical waste in order to reduce the health risk it poses