Clinical / Inspectorate

 

About the Inspectorate Department

Achieving universal health coverage goes beyond expanding access. Increased access to good quality care, and a high degree of patient safety, are vital for improved outcomes. In low- and middle-income countries, lack of access to safe medical care contributes to about 25.9 million adverse events each year with poor quality causing 5.7 to 8.4 million deaths. Such inadequacies have focused attention on the role of government regulation in enforcing minimum standards of patient safety. healthcare regulation is considered a key government stewardship function, defined as purposive actions initiated, although not necessarily implemented, by government to address failures in the existing public and private health care system and promote current policy objectives. However, the pluralistic and highly fragmented nature of health systems poses a major challenge for effective regulation. Moreover, healthcare regulation in low-and middle-income countries are often fragmented, ineffective, and poorly coordinated across agencies, which are frequently severely under-resourced. Enhanced regulatory systems and enforcement is required in low-and middle-income settings, to ensure effective stewardship. However, the cost of implementing effective regulation and its cost-effectiveness is a concern to policymakers, faced with numerous competing demands on limited national resources.

In Liberia, the ministry of health (MOH), the Liberia medical and dental council (LMDC) and health regulatory agencies have piloted an innovative regulatory regime for health facilities involving joint health inspections. In the past, each of the eight main regulatory agencies for doctors and dentists, health facilities, nurses, public health officers, pharmacies, laboratories, radiologist’s nutrition and dieticians had their own regulatory requirements for facilities. Inspections are conducted in Public and Private Facilities, which sporadic and very patchy, covering only two to three regions and less than 5% of private health facilities annually. The jhi combined the requirements across all agencies to provide a common inspection framework. All public and private facilities received increased frequency of inspection using a comprehensive joint health inspections checklist, with a target of 100% of public and private facilities inspected at least once per year. The regulatory tools mainly focuses on the minimum structural (input) indicators required to provide good quality care. The tools check compliance with minimum staff requirements (qualification and licensing), facility infrastructure, supplies and utilities, and professionally defined standards for specific service areas and units (e.g., theatre, labor ward, laboratory and pharmacy). There are also number of process quality indicators, such as evidence of handwashing, monitoring labor and safe disposal of waste.

Joint health inspections are conducted by trained inspectors representing all regulatory bodies. Inspection data are entered on an electronic tools using tablets, which auto-generates inspection scores and reports and transferred results to an online management information system. The inspection protocols incorporates insights from risk-based and responsive regulatory theories. Facilities are risk-rated using a composite score based on inspection performance, with warnings, sanctions and time to re-inspection depending on these scores. Facilities outside the lowest compliance category are not penalized for infringements on their first inspection, but informed about their performance, with closure only to be implemented if sufficient improvements had not taken place at later inspection. In a sub-group of facilities letter symbol scorecards are publicly displayed outside facilities showing their score. Implementation and results of inspections are recorded on an online monitoring system.

Continuing Professional Development