Dear Neil and colleagues,
Thank you for pulling these threads together. They gave me a reason to look back on my own early days of practice and write the reflection below, which I think speaks to several of the questions on the table.
As yesterday was World Patient Safety Day 2026, and coincidentally Thursday, It took me straight back to my early days of practice as a clinical pharmacist, when Thursday meant something very specific at Massawa Zonal Referral Hospital.
Back then, Thursday was NCD day. My colleagues and I would wake around 5 a.m. to see our regular patients until 8, then jump straight into the normal daily routine like nothing had happened. Those mornings were some of the most fulfilling hours of the week. Most of our patients were from the older generation, living with one, sometimes several, NCDs at once. Some had carried that weight for years and made peace with it. Others were still new to it, still trying to understand a diagnosis that had just turned their world upside down.
Seeing those same faces every Thursday gave us a bond you don't get with regular outpatients. It pushed us to do more than expected: to show up fully, provide extra patient education, and run a support group where everyone could feel heard and valued. Healthcare rooted in "quality, safety, commitment, and compassion." Slowly, that earned their trust and that trust fuelled adherence to medication and to advice on lifestyle and nutrition, which showed in better outcomes and quality of life.
As already discussed before, Safe and quality NCD care requires shared action from governments, health systems, professionals, patients, caregivers, communities and civil society.
In low-resource settings like here in Africa, where our people already carry so much just to get through an ordinary day, I believe we owe them that EXTRA MILE now more than ever.
On patient safety and NCDs (Q2) [What are the main causes of unsafe care for people living with NCDs?]: the risk we saw most often wasn't a single dramatic error, it was accumulation. Someone managing two or three conditions at once, on multiple medications, with limited health literacy and no one coordinating the whole picture. A missed follow-up or a misunderstood dosage rarely looked dramatic in the moment, but it compounded over months.
On low-resource settings (Q3) [What can be done to better understand and improve health systems for safer care?]: Massawa is exactly that kind of setting stretched staff, limited resources, patients travelling from far. What worked for us wasn't a system upgrade, it was continuity, protected deliberately rather than assumed. Three things made it hold:
First, a fixed weekly slot. Thursday clinic wasn't fitted around other duties; the day moved around it. Patients knew exactly when to return.
Second, the same faces. We didn't rotate staff, so nothing had to be re-explained, and changes like a new symptom, a slipping routine or a supply problem were noticed because we knew what "normal" looked like for that person.
Third, a low-tech shared record. A simple register that travelled with the patient and stayed with the clinic, so the plan, medications, and last conversation were visible to whoever was on duty. In a setting without a working electronic system, that paper trail was the coordination.
None of this required more money, just protecting a slot, keeping a team stable, and writing things down. In low-resource settings, that kind of continuity isn't a luxury add-on to safe care; it is the safety mechanism, because it catches problems before they compound.
On safety in the home and community (Q4): our support groups existed precisely because so much of NCD management happens after the patient leaves the clinic. Patient education and a space to ask questions without judgement did as much for safety as anything we did clinically. We also found that family members' understanding of the condition mattered as much as the patient's: where relatives understood the medication schedule and the lifestyle changes involved, adherence was noticeably stronger.
We also organised patients into committees by condition, as diabetes, hypertension, and so on. Each functioning almost like a membership group, with every patient carrying a membership card. The card identified them with a specific group and gave them something tangible between visits, but more importantly it created belonging: patients were no longer managing a condition alone. And the groups became communities that looked after themselves. Patients checked on each other between clinic days, reminding one another about appointments, asking after someone who hadn't shown up, flagging when something seemed wrong. Where we couldn't call every patient every week, that peer vigilance extended our reach and turned safety into something patients themselves helped carry.
On the original guiding questions, particularly what makes care unsafe for people with NCDs and the role of reliable health information: unsafe care for NCDs is rarely one bad decision.
It's fragmentation, one when information, responsibility, and follow-up don't travel with the patient between visits.
Reliable, plainly explained information, for patient and family alike, was often the difference between someone adhering to a plan and someone quietly drifting from it.
#WorldPatientSafetyDay #SafeCareForLife #HIFA
Best regards,
Isaias Yosief
HIFA profile: Isaias Yosief is a Clinical Pharmacist/Medical Researcher at Ministry of Health, Eritrea, Kampala, Uganda. Driven by a mission to end preventable suffering across Africa, I pursue this vision from every angle I can access, integrating Public Health, Pharmacy, Data Science & AI, and Health Finance through continuous research, learning, and collaborative practice. In Public Health, I am actively engaging in epidemiological research spanning vector-borne diseases (malaria, dengue, leishmaniasis), communicable diseases (HIV/TB, cholera, XDR-typhoid), and the silently escalating burden of non-communicable diseases (hypertension, diabetes, mental illness), also interested in women's maternal and child health, refugee healthcare across displaced populations, and expanding Mental Health and Psychosocial Support (MHPSS) for trauma-affected communities. Furthermore, I am exploring how to redesign surveillance systems for marginalized and cross-border populations, quantify climate-driven shifts in disease burdens, and contribute to shaping healthcare policies that translate evidence into culturally adapted, actionable guidelines. In Pharmacy, I am focusing on combating counterfeit and substandard medicines through quality assurance and control, advancing antimicrobial resistance stewardship, and strengthening supply chain resilience with a growing interest in decentralized track-and-trace systems and regional quality control networks. In Data Science, I am actively learning to leverage artificial intelligence and advanced analytics on authentic field-collected data to predict outbreaks, model disease spread, and optimize logistics; I am particularly interested in contributing to Africa's indigenous health AI infrastructure developing locally-trained models and tools that turn community health narratives into actionable intelligence for policymakers. In Health Finance, I am studying sustainable budgeting, resource management, and financing models tailored for resource-limited settings, exploring mechanisms such as revolving drug funds, currency-hedging buffers, and health-ROI frameworks that can help persuade ministries to prioritize preventive care. Each angle of pursuit converges on a single vision: equipping our people with healthy, balanced, and peaceful lives, and building resilient, equitable health systems that our future generation deserves. isaiasyosief369 AT gmail.com