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The World Health Organization (WHO) estimates that as many as one out of every 10 patients in developed countries is harmed while receiving hospital care. In many low-resource countries, that number can be as much as 20 times higher, making patient safety a serious global public health issue.
Healthcare-associated infections in developing countries prolong hospital stays, increase resistance to life-saving medications, create long-term disability, drive up costs, and even result in death. These infections are estimated to affect hundreds of millions of people around the world and often stem from inadequate infrastructure and equipment, understaffing and overcrowding, poor hygiene and waste disposal, unsafe procedures, lack of guidelines and policies, and a lack of basic infection control knowledge and implementation.
Weak professional education and a dearth of postgraduate or in-service training opportunities for health and allied caregivers, as well as for facility managers and support staff, also contribute to significant knowledge and skills gaps that have a negative impact on the scope and quality of patient care. With the majority of healthcare resources often being consumed by tertiary care, an increased focus on improving the quality and efficiency of hospital-based care is a priority for many developing and transitioning countries worldwide.
AIHA’s Hospital Strengthening Program
AIHA has more than 20 years of experience working in close collaboration with governments and healthcare institutions around the globe to build sustainable human resource and institutional capacity to effectively provide high quality and patient-centered medical services. We began working with local stakeholders in Eurasia in 1992, establishing a network of 41 hospital-to-hospital twinning partnerships designed to improve service delivery while at the same time managing costs and increasing efficiency in low-resource settings. US partner institutions include both public and private hospitals and health centers, many of which engage universities, schools of the health professions, and various other health and allied organizations to form broad, community-based consortiums. This enables them to bring a much wider array of resources and expertise to their partnerships, thereby maximizing the scope of technical assistance provided to host country institutions.
To date, nearly 200 healthcare institutions in the United States and overseas have participated in AIHA’s hospital-to-hospital partnerships. Each of these twinning partnerships works together to first identify specific healthcare needs and gaps in service. Then they collaborate to develop and implement locally-driven and locally-owned interventions that help bridge these gaps to make quality prevention, diagnostic, and treatment services more accessible to the communities they serve.
Through an active exchange of specialists in both directions along with ongoing virtual communication and collaboration, AIHA’s hospital partnerships effectively transfer knowledge, skills, and appropriate technologies in a broad range of clinical disciplines — from comprehensive HIV/AIDS-related treatment and care, emergency medicine, and women’s health to infection control, cardiology, chronic disease prevention and management, and neonatology. In particular, hospital partnerships often focus on improving quality and efficiency by expanding training and developing new scopes of work for nurses and other mid-level medical professionals to facilitate task shifting.
In addition, our hospital partners also focus on strengthening underlying administrative, financial, and operational policies and structures — including targeted support for implementing evidence-based practices, knowledge management, and continuous quality improvement — to help lay a strong foundation for locally sustainable clinical programs and ongoing human capacity development.
Recognizing that proactive, integrated efforts are necessary to achieve real and lasting changes in the health of the populations they serve, AIHA’s Hospital Strengthening Program also empowers local partners to step outside of their hospital walls to address broader community-based healthcare needs, whether through health promotion and disease prevention activities or working more closely with primary and secondary care providers to support a more holistic and comprehensive system of care delivery.
Selected Program Results
- AIHA has established 41 hospital-to-hospital partnerships in 20 countries. These twinning partnerships have involved 90 hospitals in the United States and almost 100 in Africa and Eurasia.
- Thousands of doctors, nurses, and other health and allied professionals have been trained through AIHA’s voluntary, peer-to-peer Hospital Strengthening Program. The interaction with their counterparts in the United States and other countries in the region, as well as their exposure to new ideas and ways of approaching treatment and care, enabled these professionals to rethink their roles as healthcare professionals and become educators and agents of change at their institutions, in their communities, and sometimes even at the national level.
- US experts from Elmhurst Hospital Center worked with their partners at Debre Berhan Referral Hospital in Ethiopia to create the local institution’s first infection control manual. Elmhurst infection control specialists provided comprehensive training and mentorship for Debre Berhan staff, helped them establish a system of infection control rounds throughout the hospital, and instituted employee interviews to determine knowledge of hospital-associated infections.
- Through their partnership with Elmhurst, Debre Berhan Referral Hospital increased ART uptake from 1,789 patients in 2007 to 5,282 patients in 2014, expanding HIV treatment and care to four rural hospitals and 86 health centers in their catchment area. US partners also helped expand overall medical and psychosocial care for PLHIV, including improving counseling and testing and pain management procedures, and establishing consumer support groups and a Hospital Governance Board, which includes hospital staff, local government representatives, and members of the community at large.
- AIHA’s partnership linking Ambo Hospital in Ethiopia with Jersey Shore Medical Center conducted surveys of PLHIV in Ambo’s catchment area and determined that adherence to treatment was low, especially for those who live in rural areas and lack money for transportation. Partners collaborated with Columbia University, which operates US-funded treatment programs in the region to minimize the number of people who drop out of treatment.
- Throughout Eurasia, AIHA hospital partnerships ushered in many improvements in efficiency and quality of care as evidenced by marked reductions in average length of stays. For example, length of stay for new patients undergoing arthroscopy at the Orthopedic Hospital in Biograd, Croatia, fell from 30 days to 3 days and then to same-day surgery over the course of three years and Latvia Children’s Hospital and Srebrnjak Children’s Hospital for Respiratory Diseases in Zagreb reduced average lengths of stay by nearly half.
- Many hospital partnerships led to a wide range of institutional changes that have endured long after the funding period concluded. These changes included implementing quality improvement processes; creating new departments or restructuring existing ones to maximize efficiency; developing human resource policies; and instituting cost accounting and other financial measures that resulted in marked reductions in drug-related costs and other expenditures.
- In 2014, Debre Berhan Referral Hospital was recognized by Ethiopia’s Ministry of Health as the best performing lead hospital and the best cluster hospital nationwide. Debre Berhan is considered a national benchmark rural hospital — an accomplishment administration and staff attribute directly to their twinning partnership with Elmhurst Hospital Center.
- Many AIHA hospital partnerships have been at the forefront of local and national health reforms, initiating or influencing legislative and policy changes by demonstrating successful interventions that served as models for replication or rollout.
- AIHA hospital partners have also introduced new clinical guidelines and processes that have been adopted nationally proving that success at the institutional level can be leveraged to create system-wide impact. Examples include influencing the passage of laws that require STI testing for pregnant women, designate gender-based violence as a crime, and create a national committee for control and surveillance of infectious diseases. They have also developed model programs that were replicated in other cities ranging from palliative and hospice care in Latvia to hypertension in Kosovo and breast health radiology quality assurance in Romania.