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In the ever-evolving landscape of healthcare, patient safety and quality care remain the cornerstones of effective medical practice. Every day, healthcare professionals strive to provide treatments that not only heal but also protect patients from harm. As a passionate advocate for patient-centred care, Ssuuna Mujib, a volunteer at the Uganda Alliance of Patients' Organisations, believes that prioritising safety is not just a responsibility—it’s a moral imperative that shapes trust, outcomes and the future of healthcare. The importance of patient safety Patient safety refers to the prevention of errors and adverse effects associated with healthcare delivery. According to the World Health Organization (WHO), millions of patients worldwide suffer from preventable harm due to unsafe care each year. These incidents can range from medication errors to hospital-acquired infections, surgical complications or misdiagnoses. The consequences are profound, affecting patients’ lives, increasing healthcare costs and eroding trust in medical systems. Ensuring patient safety requires a multifaceted approach that involves healthcare providers, administrators, policymakers and patients themselves. By fostering a culture of safety, we can minimise risks and create an environment where quality care thrives. Key strategies for improving patient safety and care To deliver exceptional care while safeguarding patients, healthcare systems must adopt evidence-based practices and innovative solutions. Here are some critical strategies to enhance patient safety: 1. Effective communication Clear and open communication among healthcare teams is vital. Miscommunication can lead to errors, such as administering the wrong medication or misinterpreting a patient’s condition. Standardised tools like SBAR (Situation, Background, Assessment, Recommendation) can improve handoffs and ensure critical information is shared accurately. 2. Robust training and education Continuous professional development ensures that healthcare workers stay updated on best practices and emerging technologies. Training programmes should emphasise error prevention, infection control and patient engagement. Empowering staff with knowledge builds confidence and competence in delivering safe care. 3. Leveraging technology Technology plays a transformative role in patient safety. Electronic Health Records (EHRs) reduce documentation errors, while barcode medication administration systems help verify medications before they reach patients. Additionally, artificial intelligence tools can predict risks, such as sepsis, enabling early interventions. 4. Patient empowerment Patients are active partners in their care. Encouraging them to ask questions, understand their treatment plans and report concerns fosters shared decision making. Educating patients about their medications and procedures can prevent errors and enhance adherence. 5. Creating a culture of safety A blame-free environment encourages healthcare workers to report errors or near-misses without fear of retribution. Root Cause Analysis (RCA) and Failure Modes and Effects Analysis (FMEA) can identify systemic issues and drive improvements. Leadership must champion safety as a core value, setting the tone for the entire organisation. The role of compassion in patient care While systems and protocols are essential, the human element of care cannot be overlooked. Compassionate care builds trust and promotes healing. Listening to patients, respecting their dignity and addressing their fears create a therapeutic environment. When patients feel valued, they are more likely to engage in their treatment plans and communicate openly, reducing the risk of errors. Challenges and the path forward Despite progress, challenges like understaffing, resource constraints and burnout continue to threaten patient safety across the world. Addressing these requires investment in workforce development, equitable resource allocation and mental health support for healthcare workers. Collaboration between governments, healthcare institutions and communities is crucial to overcoming these barriers. Looking ahead, the integration of data analytics, telemedicine, and patient-reported outcomes will further revolutionise safety and care. By embracing innovation while staying grounded in empathy, we can build a healthcare system that is both safe and compassionate. A call to action Patient safety and care are shared responsibilities. As healthcare professionals, we must commit to continuous improvement, learning from mistakes and advocating for our patients. As patients, we should actively participate in our care and hold systems accountable. Together, we can create a future where every patient receives safe, high-quality care. Let’s work hand in hand to make patient safety not just a goal, but a reality.

The risks in perioperative care are well known. However, for patients having surgery in some African countries, the dangers are far more apparent. Staff are few and far between and many have not been able to access rationale for their practice or receive adequate training over the years. Friends of African Nursing (FoAN) is a small UK-based charity that has been providing education in several African countries to address this issue. More than 3,000 nurses and other healthcare workers have been trained face to face—and many more on-line—in patient safety, staff safety and infection prevention. FoAN's Chair of Trustees Kate Woodhead describes the challenges facing nurses working in perioperative care in many African countries. Perioperative learning in Africa Operating theatres are a high-risk area in every country but in parts of Africa where infrastructure, equipment and staff are in short supply, they are particularly risky. Information on the risks is rarely available as there are scarce opportunities for training. Since 2002, Friends of African Nursing (FoAN) has been delivering training on patient and staff safety to perioperative nurses in various countries. We find that participants in our training are often surprised and alarmed at what we share with them. Through face-to-face education, and more recently webinars, we deliver training on infection prevention, patient safety and how staff can keep themselves safe. Group work on the same topics enables participants to put their own stamp on future practice back at their individual hospitals, as well as learning from fellow participants. How Friends of African Nursing was established FoAN was conceived by two nurses working in the NHS who had visited hospitals in different African countries and wanted to share their knowledge of how to keep patients safe. The team made its first visit to Uganda in 2002, where one delegate taking part in the training had worked in the operating theatre for 38 years and had never had any ongoing professional education. That first course is memorable as we had asked for a maximum of 50 students and 77 turned up! It was a very crowded teaching room with complicated logistics into the bargain! After that, many other countries asked us to help them with the same update to basic perioperative information. Working through the Ministries of Health or national nursing organisations, we have now worked in 11 African countries. The charity is run on a voluntary basis, so there is a limited amount of time we can take away from our paid roles. However, because we still work in clinical settings, the training we deliver is up to date and in line with international best practice. Each visit usually lasts a week and we spend each day delivering education to eager students. Since the Covid-19 lockdowns, we have run webinars on a regular basis. Although these are better than nothing, they are unsatisfactory as we cannot check understanding. However, recently we have found that the chat button is a helpful way to get feedback and find answers to questions. Perioperative teams in Africa We usually visit capital cities where we are hosted by teaching hospitals and visit their operating theatres at some time during the week. In the early days of FoAN, we made it our business to also visit and teach at rural hospitals, so we could understand the different issues that occur at theatres away from the capital. It has certainly been eye-opening, and we still ensure that the training we do includes delegates from rural areas. The country we visited most recently has invited us to specifically train district theatre nurses on our next visit. One issue they face is that some nurses do not undertake much surgery and have hours of inaction. Supplies and equipment are scarce and qualified team members even fewer. The literature shows that sometimes surgery is not available in some district hospitals at weekends and during the night due to lack of staff. Training is unavailable and as the use of surgery increases, as it is doing all over the developing world, these are the teams that need the most input. Focus on safety The training programme we deliver focuses on many aspects of patient safety. It is a relatively new academic topic and many theatre nurses have not been educated in initiatives such as WHO’s Safe Surgery Saves Lives. Some hospitals are using the checklist for every surgery if they have a champion clinician, but many are not. When we introduce the topic, citing the data, many of our participants are visibly shocked. In 2015, the Lancet Commission on Global Surgery outlined five necessary components to ensure the delivery of safe surgery. These are infrastructure, surgical workforce, service delivery, financing and information management. Capacity building through improved infrastructure and trained surgical workforce expansion has proven to be challenging to sustain on a global scale. (1) One reliable study which is frequently cited is perioperative patient outcomes in the African Surgical Outcomes Study undertaken in 25 different African countries in 2018. Their findings showed that one in five surgical patients in Africa developed a perioperative complication, following which, one in ten patients died. The findings also show that despite the profile of the surgical patients being younger with a low-risk value and lower occurrences of complications, patients in Africa were twice as likely to die after surgery when compared with outcomes at a global level. They reported that most surgical procedures were done on an urgent or emergency basis and one third were caesarean sections. Importantly, ninety five percent of the deaths occurred after surgery, indicating the need to improve the safety of perioperative care. (2) It is critical in the light of this data that surgical care becomes safer and more effective. Barriers to patients accessing surgery There are many barriers to overcome for patients in countries that are upscaling their surgical services. They include fear of surgery, fear of anaesthetic and fear of poor outcomes. It is therefore essential that perioperative staff are able to show confidence in the safety of their service when they meet their patients. There are also financial barriers which may prevent patients accessing healthcare. The costs of drugs, dressings, laboratory tests and X-rays are all paid for in many African countries by the patient or their relatives. Hospital stays must also be paid for, as well as food and drink. In addition, the cost of the accompanying caregiver who stays alongside the patient, looking after them when there are too few nurses to do so, must also be covered. An understanding of the challenges that patients have in accessing the care they need, helps to make the teaching we deliver a two-way process, so we all learn from each other. It also serves to underline how fortunate we are in the NHS where costs are taken by the taxpayer and all professional healthcare staff can access learning in so many specialities. References 1. Meara J, Leather A, Hagander L et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet, 27 April 2015 2. Bicard B, Madiba T, Kluyts L et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet, 3 January 2018

Digital health promises to revolutionise health care delivery and address longstanding health system challenges, if developed and implemented across systems safely. Join the Institute of Global Health Innovation, Imperial College London and the African Forum for Primary Health Care (AfroPHC) for the launch of the new report, “Digital health in primary health care: current use and future opportunities in the Sub-Sharan African Region”, The report sets out where digital technologies are being used to drive primary health care innovation across Sub-Saharan Africa, underpinned by examples and lessons learned from experts across the region. The goal in creating this report is to provide a synthesis of current evidence and thought leadership in one place. It presents the current use of digital health across health systems to frame future opportunities, the challenges and threats that must be addressed, providing recommendations to key stakeholder groups. Register

To mark the annual World Patient Safety Day, three organisations - COHSASA of South Africa, AfiHQSA of Ghana and C-CARE (IHK) of Uganda - are collaborating to bring you the latest thinking across Africa regarding 'Medication without harm', the theme for WHO's Third Global Patient Safety Challenge. The Challenge aims to reduce the global burden of iatrogenic medication-related harm by 50% within five years. Join us to hear new ideas, visions and solutions to address medication-related adverse events which cause untold death and suffering around the world. Register for the meeting FINAL INVITE FOR WPSD WEBINAR.pdf

It has become imperative that we discuss the issue of mental health in doctors and other healthcare staff. The mental wellbeing of a healthcare staff forms the bedrock of patient safety. It takes a safe and supported person to deliver safe healthcare and we must give this attention as we try to find ways to improve the quality of care within our healthcare systems. Ehi Iden, hub topic lead for Occupational Health and Safety, OSHAfrica, reflects on the increasing workload and pressure healthcare professionals face, the impact this has on patient safety and why we need to start 're-humanising' the workplace. In March 2017 in Nigeria, we had two very shocking incidents which left everyone saddened and disturbed. The first case was Emmanuel Ogah, a medical doctor, who stabbed his 62-year-old mother to death in Lagos. Then, whilst we were all trying to come to terms with that incident, on the 19 March 2017 Allwell Orji, another medical doctor, asked his driver to stop in the middle of the popular ‘The Third Mainland Bridge’, got out of his car and jumped into the lagoon where he drowned before help could come. The loss of these two medical professionals happened within a space of one week. As an occupational health consultant and a patient safety advocate, this got me thinking about how it further increases the risk exposure to the patients. These were both doctors who were trained to care for patients. Could they have been overworked? Were there issues surrounding their personal lives, their family lives and other very personal issues that were responsible for these acts? Nigerians were not known to commit suicide, but we cannot boast that any more, we are fast losing our resilience and coping capabilities. The World Health Organization (WHO) 2016 report revealed that Nigeria had the highest suicide rate among African countries, ranking sixth globally. This is concerning and needs urgent actions to stem the tide. Let’s look at healthcare professionals being overworked as a key example. According to the Premium Times Report published in November 2015, the population of Nigeria was 173 million people in 2013. Going by that report, Nigeria needed a minimum of 237,000 medical doctors to care for the Nigerian population, in line with the WHO ratio of 1 doctor to 600 people within a population group. But from all reports available at that time, there was only 35,000 doctors actively working as medical doctors in Nigeria. According to this ratio there is no way that doctors will not be overworked. Using these figure, this meant 1 doctor to 4,960 people. Although, the Nigeria Medical College train more than this number of doctors, many move into other professions. Using these figures, we might conclude that workload could be a strong contributing factor to suicide or death amongst doctors and other healthcare workers in Nigeria. So the question is, how does this impact on patient safety? It is sad that mental health was not included amongst the list of occupational health diseases or illness in the International Labour Organisation list of occupational diseases until much later when the toll of mental health issues became so obvious. Psychosocial hazard has become a huge issue within the healthcare work environment leading to burnout, fatigue, exhaustion, stress, tiredness and sleep deprivation amongst healthcare workers, and these outcomes impact negatively on the safety and quality of care when treating patients. The need to keep healthcare workers safe and look after their mental health is something that needs our collective actions and commitment. It takes a safe healthcare worker to deliver safe healthcare to patients. We should be looking at the workload – the duration and frequency of duty shifts within the healthcare sector – which has long changed over the years, making healthcare professionals work longer hours per shift, dealing with a workload that is beyond their coping capacity. We all agree that in healthcare we deal with lives and any mistake within healthcare delivery is always a costly one which innocent people pay for with their precious lives. Work overload is a critical issue surrounding daily patient harm in the hospital. It hurts the patient as much as it hurts the healthcare workers. This workload, if allowed to persist for too long, alters the mental wellbeing of the healthcare worker leading to avoidable mistakes, irrational behaviour, lack of co-ordination and a disrespect to the right and dignity of patients. This is never in anyone’s best interest. There are many doctors, nurses and other healthcare staff who love their jobs and keep giving all they have, giving mutual support to colleagues when they perceive them to be overwhelmed with work, which sometimes leads to collective burnout within a team. which leads to patient harm. Such healthcare staff are seen as trusted by everyone and tagged 'MR FIX IT' because of their willingness and availability to always show up to help or assist. They become a victim of patients' and colleagues' continuous demands; they never say NO but instead are always there to help, but over time they become emotionally overdrawn and this can lead to patient harm. The mental health of doctors and other healthcare professionals should be taken seriously owing to new and emerging conditions and disruptive behaviour noticeable amongst healthcare workers. The two doctors cited at the beginning of this write-up were managing patients entrusted to their care. Any doctor that has suicidal thoughts is a risk within the healthcare environment, no matter the department or unit he or she works in. I really think this is where we must look more closely at human resources, management and leadership in the healthcare environment. These are not roles that should be assigned to a newcomer, but a role carried out by very experienced professionals with a strong analytical background in human psychology and a big heart for employees’ wellbeing. We cannot rule out the fact that the two doctors cited earlier never displayed violent or suicidal behaviours that would have attracted the attention of co-workers, or even the human resources managers who would have been expected to have a meeting with such an employee with obvious suggestive indicators. We need to start engaging our colleagues, we need to start setting up Employees Assistance Programs (EAP) and we need to start looking beyond work – taking an interest and asking what happens in the home of our employees and colleagues. Are there issues? Are there smart ways we can help out? This should be our thinking. It will save both the patient entrusted into the care of the healthcare workers and the healthcare workers themselves and maintain a good reputation for the healthcare facilities. We must understand that healthcare workers are human beings just like us all; they are not super men and women, and they are fallible like every one of us. We need to start re-humanising our workplaces. Let’s start reviewing the workloads, timelines and deadlines, let’s once again treat healthcare professionals the way we would want them to treat our patients. Let’s bring dignity of labour back to healthcare, let’s again work like one big family where we all continuously watch each other’s backs, let’s rebuild the lost confidence while having the patient at the centre of these thoughts. Losing more doctors from healthcare, seeing others behind bars due to homicide, and seeing others incapacitated and feeling invalid when we know the work pressure and work environment contributed to these conditions and states is no good to any of us. We can change it. It takes a HEALTHY doctor to offer a SAFE healthcare.

Sierra Leone has one of the highest rates of maternal mortality in the world. The risks are even greater for teenage girls who become pregnant, with up to one in ten dying in childbirth. In this blog, Lucy November, co-founder of 2YoungLives, a mentoring project for pregnant teenagers, describes the risks faced by teenage girls in Sierra Leone and the barriers they face to accessing maternity care. She talks about how 2YoungLives is making pregnancy and birth safer for this vulnerable group through mentoring, building community and equipping young mothers to support themselves and their babies. Aminata* didn’t plan to become pregnant at 15. When her mum died, she was sent to live with her aunty in the country’s capital city, Freetown, and felt from the outset that she was not welcome. Her cousins were attending school but there was no money to send Aminata, and instead she was expected to fetch water for the household every day, often spending four or five hours in the queue. When Patrick, one of the men who ran the pump, asked her to be his girlfriend, saying she could jump the water queue and he would also pay her school fees, she felt that she could finally get back on track. No-one had ever talked to Aminata about sex, contraception or pregnancy, and when she missed her period she was just pleased not to have to bother her aunty for sanitary pads which always made her feel like a burden. She discovered she was pregnant one evening several months later when her aunty noticed her changing body and confronted her, screaming that she had disgraced the family and would have to leave. Her few belongings were thrown into the street and she was on her own again. Patrick had told her he loved her, and she was sure he would be happy, so she climbed the hill to the water pump to tell him the news, only to be told he had already heard and left Freetown earlier in the day with no explanation. Knowing there was nowhere else for her to go, Aminata asked her cousin if she could sleep in his car, where she lay down and cried. The months that followed saw her finding different places to sleep - an empty market stall, a friend’s floor, an abandoned building. She would eat meals here and there in exchange for carrying water, washing pots and occasionally having sex with men she barely knew, who took advantage of her desperation. When she went into labour at eight months, Aminata was anaemic, malnourished and had a sexually transmitted infection. By the time she was taken to the hospital by a neighbour of her aunt’s, her baby was already dead and she was bleeding heavily. The 500ml of blood that she lost would hardly be noticed by a healthy, nourished woman, but for Aminata it was catastrophic. In a culture where blood is donated in an emergency by a relative, Aminata had no options and no money to pay, and died that night with her unborn baby. This is a true story, but it is not a story about just one girl; it describes the experiences of many pregnant girls in Sierra Leone. I lived in Freetown from 2001 to 2004, working with Lifeline Nehemiah Projects with children affected by the 10 year civil war, so was only too aware of the statistics that make Sierra Leone one of the most dangerous places to give birth. I saw the issues the young people we were supporting faced as they started to have their own families. A survey we did in 2015 in Eastern Freetown showed a 1 in 10 incidence of maternal death for girls becoming pregnant under the age of 18—in the UK the figure is 1 in 10,000. There are many reasons for this high death rate. Upstream social determinants such as poverty, gendered social norms, sexual coercion and stigma mean that girls have little agency with their sexual and reproductive lives, and once pregnant they are almost always thrown out of home and struggle to eat regularly or prepare for birth. Disrespectful care at health facilities means that they often do not take up antenatal care and are at very high risk of death from anaemia, bleeding, eclampsia, infections and prolonged labour leading to fistula.[1] I got together with my friend Mangenda Kamara, a gender studies specialist who lives in Freetown, and we looked at what we could do to help these girls. We realised that what they needed was a supportive, consistent adult to make sure they were safe and able to access maternity care as well as having the means to eat well in pregnancy and provide for their babies. We developed 2YoungLives as a simple, scalable, sustainable solution to this intractable issue. It is a mentoring scheme which pairs women known for kindness and compassion with three vulnerable pregnant girls. The project provides the girls with money to start a small business which the mentor supports them to run, allowing them to eat well in pregnancy. As a ‘loving aunty’, the mentor helps the girls to register for antenatal clinic, going with them for check-ups and being a birth partner when the girls go into labour. She provides emotional support, and gathers the girls to eat together, encouraging peer friendships. After birth, the mentor continues to support each girl, not taking over but being available if there are problems with breastfeeding, if she needs a few hours of sleep after a bad night, or if the baby is not well, encouraging timely care-seeking and ensuring the baby gets all immunisations. The mentors also promote postnatal contraception, reducing the risk of a second teenage pregnancy with its associated compounded risks. Since we started with our first team of four mentors in 2017, we have grown steadily to six teams—24 mentors in all—in urban, peri-urban and rural districts. We have seen great success in reducing the risk of maternal and neonatal death. Since 2017, the project has mentored over 200 girls; we have had no maternal deaths and a much-reduced rate of stillbirth and neonatal death. In addition, an education bursary grant from King’s College London in 2021 has allowed many girls to return to school or attend vocational training; some are now fully qualified plumbers and electricians. 2YoungLives is now part of an NIHR-funded Global Health Group, a partnership between King’s College London, the Sierra Leone Ministry of Health and Sanitation, Lifeline Nehemiah Projects (the Sierra Leone-based organisation that runs 2YoungLives), Welbodi Partnership and the University of Sierra Leone, and we are about to double our provision by starting a cluster-randomised feasibility trial in six new sites. There is a high level of buy-in from stakeholders—from local chiefs and women’s leaders to Ministry of Health representatives—as tackling teenage pregnancy, child marriage and maternal mortality are all highly prioritised policy areas in Sierra Leone.[2] 2YoungLives improves patient safety by seeing these young women not simply as ‘patients’ on the isolated occasions when they attend the clinic or come in to give birth, but by addressing the social determinants of maternal health and death. Our mentors provide the most basic of protective factors: a relationship with a caring adult. As a result of our mentors' support, the young women we work with are thriving, not just surviving. You can read more about 2YoungLives and how to support its work on the 2YoungLives website. *not her real name References 1 November L, Sandall J. ‘Just because she’s young, it doesn’t mean she has to die’: exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study. Reproductive Health. 21 February 2018 2 Palathingal A. National strategy for the reduction of adolescent pregnancy and child marriage 2018-2022. United Nations Population Fund Sierra Leone. 2018