title: Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.
abstract: BACKGROUND
  Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.
  
  
  OBJECTIVE
  This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.
  
  
  METHODS
  A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.
  
  
  RESULTS
  Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment.
  
  
  CONCLUSIONS
  Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.
authors.affiliation: Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.|Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors.forename: Robert Kaba
authors.initials: RK
authors.lastname: Alhassan
authors.affiliation: Department of Economics, University of Ghana, Legon, Accra, Ghana.
authors.forename: Edward
authors.initials: E
authors.lastname: Nketiah-Amponsah
authors.affiliation: PharmAccess Foundation, Amsterdam, Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: Spieker
authors.affiliation: Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors.forename: Daniel Kojo
authors.initials: DK
authors.lastname: Arhinful
authors.affiliation: PharmAccess Foundation, Amsterdam, Netherlands.
authors.forename: Alice
authors.initials: A
authors.lastname: Ogink
authors.affiliation: Joint Commission International (JCI), Chicago, Illinois, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: van Ostenberg
authors.affiliation: Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.|PharmAccess Foundation, Amsterdam, Netherlands.
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
mesh_terms: D003151:Community Health Centers / Q000592:standards* / Q000706:statistics & numerical data; D003256:Community Participation; D005869:Ghana; D006801:Humans; D061214:Patient Safety; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D040242:Risk Reduction Behavior