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Patient safety is a cornerstone of healthcare, yet low-income countries face unique challenges in implementing effective initiatives. A recent GIZ survey sheds light on the state of patient safety across five low-income countries, offering insights into progress, gaps, and opportunities for improvement.

The Need for Focus on Patient Safety

Patient safety has emerged as a global priority, underscored by the WHO Global Patient Safety Action Plan 2021-2030. For low-income countries, addressing these challenges is even more pressing due to resource constraints and systemic gaps. To assess the current state of patient safety initiatives, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) conducted a survey across five countries—Uzbekistan, Malawi, Libya, Tanzania, and Togo—between July and August 2024.

The questionnaire explored key indicators such as national action plans, reporting systems, infection control measures, and patient involvement. By identifying strengths and weaknesses, the findings aim to guide actionable strategies that support patient safety improvements in low-resource settings. They are entirely based on the answers given by GIZ officers and have not been validated externally.

National Initiatives: Where Do Countries Stand?

The survey showed that there are variations in the implementation of patient safety policies:

• National Action Plans: Only Malawi and Togo reported having fully developed and implemented national action plans, highlighting a stark gap in strategic oversight for countries like Libya and Tanzania. Uzbekistan has announced plans but is yet to implement them.
• Never Event Reporting Systems: Systems to report never events—serious, preventable incidents—are existing in Malawi, Tanzania, and Togo, but absent in Uzbekistan and Libya. This disparity indicates missed opportunities since these systems are a critical component of safety patient, enabling learning from severe errors and preventing them in the future.  
• Patient Safety Agencies: National patient safety agencies exists only in Uzbekistan. Such agencies are essential for coordinating safety initiatives and monitoring progress. The absence of such agencies in Malawi, Togo, Libya, and Tanzania highlights the need for institutional structures to drive patient safety improvements.

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Infection Control and Medication Safety: Urgent Gaps

Controlling healthcare-associated infections (HAI) and reducing medication-related harm are critical areas of focus:

• HAI Targets: No surveyed country has achieved its national targets for reducing HAIs so far. Togo and Uzbekistan have plans but no measurable targets, while the other three countries lack targets altogether. This suggests that infection control is an area requiring urgent attention and more rigorous national policies.
• Medication-Related Harm Reduction Targets: Togo announced targets to reduce medication-related harm as the only country in this survey. The absence of such targets in Uzbekistan, Libya, Tanzania, and Malawi represents a significant oversight in these countries’ healthcare policies. Medication safety can prevent avoidable harm caused by medication errors.

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Engaging Patients and Healthcare Workers

Patient and healthcare worker engagement can empower people to contribute meaningfully to contribute to safety improvements:

• Patient Representation: None of the countries surveyed have significant patient representation (60% or more) on hospital governing boards. This lack of patient involvement in decision-making may hinder patient-centred care.
• WHO Health Worker Safety Charter: Malawi has announced to sign the WHO Health Worker Safety Charter, recognising the intrinsic link between worker safety and patient safety. However, Uzbekistan, Libya, Tanzania, and Togo have yet to adopt this vital framework.
• Patient Safety Curriculum in Education: Patient safety is announced to be integrated into healthcare education programmes in Malawi and Togo but remains absent in Uzbekistan, Libya, and Tanzania. This underscores the need for broader efforts to integrate patient safety education into training programs for healthcare workers, ensuring that safety principles are instilled from the start of their careers.

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Strong need for progress in Reporting, Transparency, and Networks

Reporting systems, transparency, and collaboration are key enablers of patient safety, even though they are still absent in most surveyed countries, making systemic reforms to prioritise patient safety even more important:

• Incident Reporting Systems: It is announced that over 60% of healthcare facilities in Togo will participate in incident reporting and learning systems, fostering a culture of learning from errors and improving practices. This level of participation is lacking in Uzbekistan, Libya, Malawi, and Tanzania.
• Annual Patient Safety Reports: None of the countries surveyed publishes an annual report on patient safety, a crucial tool for transparency, accountability, and progress monitoring on patient safety initiatives.
• National Safety Networks: None of the countries surveyed have established a national patient safety network. In Uzbekistan implementation of such a network is announced. These networks provide platforms for collaboration, resource sharing, and knowledge exchange. They are a key recommendation from the WHO.

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Missed Opportunities and Areas for Improvement

The survey identified several areas where progress is limited, posing risks to patients and healthcare systems:

• Non-Punitive Reporting: Only Malawi and Togo have announced a non-punitive policy for reporting adverse events. Such policies are critical for encouraging healthcare workers to report issues without fear, enabling learning and improvement.
• Avoidable Deaths: Uzbekistan is the sole country tracking avoidable deaths related to sepsis, venous thromboembolism (VTE), and falls during hospitalisation. Other countries must adopt similar measures to address preventable mortality.
• Safety Alerts: Rapid safety alert systems are operational only in Tanzania and Togo, highlighting a critical gap in real-time communication of high-impact risks in the other countries.

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Recommendations: Building National Patient Safety Networks

The survey results highlight critical gaps in patient safety infrastructure across these countries. Establishing a national network of patient safety agencies is essential to address these shortcomings. Such agencies and/or networks would:

• Coordinate national action plans and safety initiatives: Ensuring that patient safety strategies are developed and implemented uniformly across the healthcare system.
• Promote reporting and learning from adverse events: Standardising the collection, analysis, and response to sentinel events to prevent future harm.
• Establish infection control and safety alerts systems: Ensuring rapid communication and response to emerging patient safety risks.
• Facilitate training and capacity-building: Enabling healthcare professionals to engage in continuous learning about patient safety.

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Conclusion: The Path Forward

Patient safety is not just a technical challenge; it is a moral imperative. The GIZ survey highlights the progress made by countries like Malawi and Togo, while revealing significant gaps in others. Collaborative, coordinated efforts, underpinned by strong national frameworks, are essential to bridging these gaps and ensuring that every patient receives safe, high-quality care.

Establishing national patient safety networks and fostering a culture of safety through education, reporting, and transparency can transform healthcare systems in low-income countries. It is a challenging endeavour, but one that is critical for the well-being of patients and healthcare providers alike.

Reinhard Strametz
Commissioned by the GIZ working group HESP QM
January 2025