Towards a national health insurance system in ... - Detlef Schwefel

Towards a national health insurance system in Yemen – Part 1: Background and assessments 47
3.2.6 Quality management
Public Sector: The MoPH&P is responsible for quality assurance in the curative care sector of public
hospitals and has a division for quality assurance in its Cost Sharing Directorate. In theory, the
division is supposed to carry out regular audits of all hospitals
in Yemen. However, the number of
audits planned for 2005 is 11 ho spitals, 4 of which are in Sana’a City, 1 in Aden, and 2 in each of 3
other governorates (Ibb, Lahaj, Haja) ( MoPH& P 2005i) A udits are done with a nu mber of checklists,
specific for outpatient departments, emergency rooms, wards, and laboratories. However, only basic
structural components are thus assessed (MoPH&P 2005f). Neither processes nor outcomes are
monitored. On top, according to informal information from the MoPH&P, not even these basic audits
are carried out.
In theory, in case of non-fulfilment of quality criteria, the MoPH&P makes a recommendation to the
hospital director with an agreed deadline for the improvements to occur. Then another audit is to be
carried out after 2-3 months. If quality criteria are still not fulfilled, budget implications via the Deputy
Minister for Curative Care would ensue.
Concepts of clinical quality management were unknown to the interviewed ministry officials.
In health
facilities, no training in quality management takes place, nor are quality management systems
anywhere in place in institutions. Officially, coordinators of quality assurance in Governorates have
been appointed, but their role is not defined and the MoPH&P officials do not see any activities
emanating from them concerning quality assurance or improvement. Currently a pilot project for
quality assuranc e is conducted in Khalifa Hospital ( Al Serouri and Al Sofeani 2005), and a National
Quality Plan for Yemen has been developed, which is however still very much at the conceptual phase
( Ovretveit 2002). Quality education comprises workshop s since 2 years fo r health officers of
Governorates: The introduction of a quality assurance syllabus in the curricula of Health Institutes,
which are responsible for the training of paramedical staff, is planned. A booklet has been developed
for this but has not yet been implemented.
T he opinion of the leaders
89 % of opinion leaders say:
I expect good services with health insurance
Source: GTZ&EC survey 2005
Private Sector: Quality assurance in the private sector is also the responsibility of the MoPH&P.
However, this is separate from the quality assurance programme for public hospitals. The Division for
Private Medical Services is responsible for the licensing of private facilities. A handwritten list of all
private facilities to whom a license has been granted is kept there, which comprises e.g. 542 second
level hospitals and 168 private health centres (August 2005). However, the list is virtual as many
facilities are either not yet or no longer operational and the MoPH&P has no knowledge about current
activities of private providers. More recently, a licensing checklist similar to the audit checklists for
public hospitals has been introduced. Again, only structural aspects of quality are assessed. Another
problem is that many licenses have been granted before this new mechanism was introduced and
audits of private facilities are currently not carried out. As was evident from interviews with hospital
directors from private hospitals, quality management in hospitals is currently limited to basic sanitary
activities that would fall under the label of hospital hygiene in developed countries. Again, modern
clinical quality management systems are not in place. This is also demonstrated by some of the
hospital statistics and price lists, which show that procedures that are now considered inappropriate
practice in most cases are still widely practised in Yemen, such as tonsillectomies and
adenoidectomies or grummets for ear infections.