Creating a pathway for public hospital accreditation in Rwanda: progress, challenges and lessons learned.

quality problemWeaknesses in the quality of care delivered at hospitals translates into patient safety challenges and causes unnecessary harm. Low-and-middle-income countries disproportionately shoulder the burden of poor quality of hospital care. INITIAL ASSESSMENT: In the early 2000s, Rwanda implemented a performance-based financing (PBF) system to improve quality and increase the quantity of care delivered at its public hospitals. PBF evaluations identified quality gaps that prompted a movement to pursue an accreditation process for public hospitals. CHOICE OF SOLUTION: Since it was prohibitively costly to implement an accreditation program overseen by an external entity to all of Rwanda's public hospitals, the Ministry of Health developed a set of standards for a national 3-Level accreditation program. IMPLEMENTATION: In 2012, Rwanda launched the first phase of the national accreditation system at five public hospitals. The program was then expected to expand across the remainder of the public hospitals throughout the country. EVALUATION: Out of Rwanda's 43 public hospitals, a total of 24 hospitals have achieved Level 1 status of the accreditation process and 4 have achieved Level 2 status of the accreditation process. LESSONS LEARNED: Linking the program to the country's existing PBF program increased compliance and motivation for participation, especially for those who were unfamiliar with accreditation principles. Furthermore, identifying dedicated quality improvement officers at each hospital has been important for improving engagement in the program. Lastly, to improve upon this process, there are ongoing efforts to develop a non-governmental accreditation entity to oversee this process for Rwanda's health system moving forward.