Evidence of unsafe care in developing and transitional countries
Unsafe medical care is a major source of morbidity and mortality throughout the world
Low income countries are faced with many competing challenges and public health threats, which are exacerbated by the burden caused by health care.
It is not the intent of health professionals to fail patients. Rather, the harm caused by health care is often the result of failing processes and weak systems. This is especially true in developing countries where health professionals are expected to carry out their job and deal with complicated situations with very limited resources. Often doctors and nurses have not received adequate training, are not adequately supervised, do not have protocols to follow or the means to record patients' information, and in some cases do not even have running water with which to wash their hands.
Therefore, patient safety has to be addressed from a systems perspective examining the situation and putting in place mechanisms to minimize the risks, addressing some of the main latent causes that lead to poor outcomes. Everywhere effective change requires a multi-faceted systemic approach.
Among the main actions in tackling unsafe care is the need to strengthen the capacity of health systems, with stronger education of the workforce and with ensuring more rigorous processes of care. Fostering cultural change towards better and safer care, based on the commitment of leaders and practitioners at all levels of care, is also necessary. It is essential to understand which practices can work effectively in different contexts. Safety practices that work in one context may not work in another one.
Inequity is also a major problem in many contexts. A challenge is to ensure that patients at every level, particularly the disadvantaged populations, can be reached with cost-effective and safe care.
Lack of adequate data and of robust communication structures between health authorities, providers, the public and private sectors and the research community hampers understanding of the problems associated with patient safety. These problems are being made more urgent by the growth in privatization and trade in health services.
Healthcare systems and institutions that start to look at their own problems, with an aim to understanding their failures and improve, are already making gigantic steps in the quest towards safer care.