Attitudes towards the WHO Surgical Safety Checklist (2)

12 September, 2023

Neil thank you for sharing this interesting and imortant study report. [ ]

In Nigeria since 2004 we have introduced the WHO surgery Safety Checklist (SSC) as part of the list of quality framework of the homegrown, evidence informed 12-Pillar Clinical Governance Programme (12-PCGP). It (SSC) has been well received and implemented in our partner hospitals.

After reading your post, I believe that our positive experience with the SSC, can be attributed to the buy-in from the leadership and management, the senior surgeons and other members of the surgical team because they are already adherents of the 12-PCGP, as a whole health system improvement tool. So they see the SSC as an important component of the wider Tool.

We added the SSC to the whole programme because during our needs assessment of the health system, which led us to designing the 12-Pillars, we had noticed that patchy or parallel introduction of changes on their own, as stand-alone, often hinders success for the reasons that this study group has reported: 'negative attitudes towards it (a new tool like the SSC), the hierarchical structure of surgical teams, lack of support by senior surgeons and poor teamwork, lack of training opportunities, lack of leadership and erratic availability of resources'.

By introducing the WHO surgery safety checklist as a component of the 12-PCGP, we have addressed what the Interviewees to the study proposed, namely: 'improved SSC utilisation, holding periodic onsite, inservice refresher courses and training, encouraging local adaptation depending on resource situation, leveraging the support of senior surgeons and their teams. and monitoring of use with in-person and remote supportive supervision.

We encourage others who are promoting the SSC to adopt similar whole health system approach. (

Joseph Ana

Prof Joseph Ana

Lead Senior Fellow/ medical consultant.

Center for Clinical Governance Research &

Patient Safety (ACCGR&PS) @ HRI GLOBAL

P: +234 (0) 8063600642


8 Amaku Street, State Housing, Calabar, Nigeria.

HIFA Profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety (CCGR&PS) with Headquarters in Calabar, Nigeria, established by HRI Global (former HRIWA). He is the Country Coordinator for PACK Nigeria (Practical Approach to Care Kit) which is specifically designed to improve clinical competence (improving accuracy of diagnosis and treatment) in primary health care. He is also a Member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health (2004-2008), Joseph Ana led the introduction of the evidence based, homegrown quality tool, the 12-Pillar Clinical Governance Programme (12-PCGP) in Nigeria, which also suitable for lower-, low-, and middle income countries (LLMIC) with similar weak health sector and system. To ensure sustainability of 12-PCGP, the ‘Department of Clinical Governance, Servicom & e-health’ was established in Cross River State Ministry of Health in 2007. His main interest is in ‘Whole health sector and system strengthening in LLMICs’. He has written six books on the 12-Pillar Clinical Governance Programme, including the TOOLS manual for its Implementation, currently in its 2nd Edition. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Association’s ‘Award of Excellence’ on three consecutive occasions for the innovation of 12-PCGP in Nigeria. He served as Chairman, Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He was Member, National Tertiary Health Institutions Standards Committee (NTISC) of the Federal Ministry of Health, 2017-2022. He is the pioneer Secretary General/Trustee-Director of the Charity, NMF (Nigerian Medical Forum UK) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group; the HIFA working group on Community Health Workers, and the Working Group on HIFA-WHO Collaboration ( Email: info AT and jneana AT