아프리카ㆍ중동

KePSIE is the largest randomized control trial on patient safety in any low- and middle-income setting, covering the census of 1,258 health facilities (private and public), serving 4.5 million individuals in three counties in Kenya. The trial demonstrates that a new inspection regime that includes clear rules for compliance, monitoring, and enforcement is feasible in this resource constrained, low-compliance context, where only 3 percent of facilities complied with the government threshold for minimum safety at baseline. The intervention was effective at improving patient safety in all types of facilities. In the year after the intervention started, patient safety scores, as measured by the regulatory Joint Health Inspection Checklist, were 15 percent (0.49 standard deviations) higher in treatment facilities than control facilities. Private facilities recorded larger gains (19 percent) than public facilities (7 percent), and within private facilities, private “licensed” facilities recorded the largest gains (24 percent). These improvements moved 19 percent of treated facilities up from the lowest score category to higher categories of safety, and 4 percent above the government threshold for full compliance (>60 percent of maximum score). Based on these results, more than a year of sustained inspections would be required to move the system above the government threshold. The trial shows that unlicensed private facilities remain a source of concern. A large number of these poor-performing facilities continued operating after the enforcement of closures by the government, lowering the floor of patient safety in the system.