[Re: https://www.hifa.org/dgroups-rss/spotlight-patient-safety-and-ncds-70-cl... ]
Dear Neil, and colleagues,
Thank you for the generous response, and for linking my contribution with Isaias Yosief's — it is encouraging to see the same pattern recognised at both hospital and primary-care level.
You asked directly whether the WHO EMRO Patient safety assessment manual for primary care (2022) covers the measures Isaias and I described, and how useful it is. I have now read it, and I share your impression. It is a serious and careful document, but it is not, I think, the practical guidance a frontline team in a low-resource setting is looking for — for two reasons.
First, it is an accreditation and assessment instrument rather than a how-to guide. It sets out 125 criteria across five domains against which a facility is externally surveyed and certified at one of four levels. It is written for ministries of health and trained surveyors, and it presumes strategic plans, budgets, committees and documentation in English — an administrative apparatus that many small, rural or volunteer-supported clinics simply do not have. As a way of telling a stretched primary-care team what to actually do first, it is not designed for that.
Second, and more to the point of this discussion, it does not substantively address continuity of care. The manual is strong on several things — patient and family engagement, communication in the patient's own language and health literacy, patient identification, and medication safety. But continuity, the thread Isaias and I both placed at the centre, appears only as a single line in a medical-records audit and within the section on outbreak management. There is nothing on relational continuity (the value of the same clinician or team over time), nothing on systems to protect scheduled follow-up or to notice and recall patients who do not return, and nothing on information or medication records that travel with the patient across visits and to the pharmacy, beyond facility-bound medication reconciliation. Safe transitions of care are addressed only for medicines.
So I would agree the manual is of limited use for our purpose — not because it is poor, but because it answers a different question, for a different audience, and in a different region (it is EMRO-specific and heavily shaped by COVID-19).
If anything, this seems to me to strengthen the outcome you proposed. There appears to be a real gap in short, practical, frontline guidance on continuity and safe transitions of care for primary and community settings in low-resource contexts — the very measures this discussion has surfaced. Helping to fill or better communicate that gap would be a worthwhile result of the Spotlight, and I would gladly contribute what our small clinic has learned.
With best wishes,
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Frank Brightwell
Founder and Executive Director
Somos Amigos Medical Missions
HIFA profile: Frank Brightwell is Executive Director at Somos Amigos Medical Missions, in the United States. Email: frank AT somosamigos.org