Clinical Governance, Patient Safety and  Urgency of Now

Adebayo Bakare writes on steps being taken by the Federal Government to improve the health delivery system with focus on the recent establishment of the National Taskforce on Clinical Governance and Patient Safety.

A fact many Nigerians will readily agree to is that our health infrastructure, manpower, investment, utility, and gains have improved significantly over the years, more than at any other time in our recent history. But there is one nagging snag: preventable deaths and disabilities owing to poor quality care.

The disquiet and the claims of medical negligence and poor quality healthcare by many Nigerians on social media following the devastating loss of a child of a storied and respected Nigerian author naturally provoke concern, reflection, and the need for action.

While some of the claims are unsubstantiated, not grounded in facts, and may be wild, they cannot all simply be dismissed. They call for serious concern.

There are reports of medical officers abandoning patients during emergencies, mismanaging clinical situations, and even botching life-saving surgeries, like the recent case of a woman who died four months after doctors allegedly left scissors inside her during a surgery in Kano State.

Although an investigation into this particular incident has been rightly ordered, the episodic occurrences and allegations of medical negligence have become too deafening to ignore. They signal deeper structural problems preceding the current administration. These are patently matters of lack of discipline, poor professional conduct, and poor oversight across both public and private health institutions. It is a critical challenge.

The data is unsavoury. In low- and middle-income countries, such as Nigeria, it is estimated that 60 percent of avoidable deaths stem from poor-quality care, while only 40 percent are due to lack of access. Globally, this amounts to between five and eight million deaths annually, alongside a substantial financial burden of an estimated $42 billion in direct costs from medication errors alone.

It is within this prism that the establishment of the National Taskforce on Clinical Governance and Patient Safety by the Federal Ministry of Health and Social Welfare is most judicious, forthright, honourable, and commendable.

The establishment of the task force also goes to show that the current administration is a listening, intuitive, and responsive one, always ready to act for the collective good and uphold the dignity of every citizen.

The task force will principally ensure sustainable clinical governance and patient safety structures, standards, and accountability mechanisms that improve health outcomes, patient experience, and workforce performance, and these deliverables will directly contribute to achieving the Sustainable Development Goals (SDGs), particularly SDG 3.8 on quality essential health services, and actualising the aspirations of the Nigeria Health Sector Renewal Investment Initiative.

In furtherance of its mandate, the task force shall conduct a landscape analysis of clinical governance and patient safety in Nigeria; develop and standardise national clinical governance and patient safety frameworks, policies, and implementation guidance; strengthen systems for prevention, reporting, learning, and response to adverse events and patient safety incidents; promote adherence to evidence-based clinical standards, protocols, and ethical practice across health facilities, as well as institutionalise quality improvement (QI) and patient safety culture at facility, state, and national levels.

In addition, it shall support capacity building for health workers and managers on clinical governance, risk management, and patient safety; enhance patient and community engagement in quality and safety initiatives, including feedback and complaint mechanisms; establish national indicators and monitoring systems to track quality and patient safety performance; and strengthen coordination among federal, state, regulatory, professional, and private sector stakeholders for quality and safety, while upholding confidentiality and ethical handling of sensitive information, including patient safety incidents and facility performance data.

The composition of the task force affirms its significance and the gravitas of the task before it, with members drawn from some of the most accomplished phyla of the health sector, both in Nigeria and abroad.

It is important to emphasise that the task force is not one of those bureaucratic distractions; its work is deliberate and clearly thought out from existential concerns and will begin with a thorough review of existing laws, policies, and regulatory instruments related to healthcare quality, patient safety, professional conduct, and ethics. This review will identify gaps, overlaps, and opportunities for alignment with international best practices.

And based on these findings, the task force will lead the development of a National Clinical Governance and Patient Safety Framework for Nigeria, modelled on the World Health Organization’s Global Patient Safety Action Plan (2021–2030). It will recommend national minimum standards for clinical governance structures, harmonise patient safety policies with existing national health strategies, and propose an institutional architecture to guide implementation at both federal and state levels.

In the area of standards, guidelines, and clinical effectiveness, the task force will support the development or revision of standard treatment guidelines, clinical pathways, and patient safety bundles for priority health conditions and services.

It will promote evidence-based care and rational clinical decision-making while supporting the adoption of proven safety practices and tools. These include the use of surgical safety checklists, safe medication practices and pharmacovigilance systems, infection prevention and control standards, safe childbirth and maternal and newborn safety interventions, as well as safe blood transfusion and laboratory safety protocols.

The task force will also strengthen patient safety incident management and learning systems by establishing national guidance for incident reporting and learning. It will recommend protocols for adverse event reporting, sentinel event investigation and root cause analysis, morbidity and mortality review processes, and disclosure to patients and families through open and transparent communication. In doing so, it will promote a “just culture” that balances accountability with learning and continuous improvement.

At the facility level, the task force will focus on quality improvement and performance management. This will include reviewing the national quality improvement approach and toolkit, promoting continuous improvement cycles, and supporting the integration of clinical governance into facility performance reviews, supportive supervision, accreditation and certification processes, and routine health information management systems.

Workforce competence and professional practice will remain a core priority. The task force will recommend competency standards and training packages for clinical governance and patient safety, support their integration into pre-service and in-service training curricula, and promote clinical audit, mentorship, supportive supervision, and peer review mechanisms. It will also recommend mechanisms for addressing professional misconduct, negligence, and ethical violations through appropriate regulatory pathways.

In addition, the task force will promote patient experience, rights, and community engagement by strengthening patient rights, informed consent standards, respectful care practices, and effective redress mechanisms. It will recommend national minimum standards for patient feedback systems and enhance community engagement and public communication on safe and high-quality care.

For monitoring, evaluation, and reporting, the task force will define national indicators for clinical governance and patient safety performance, support the development of national dashboards and reporting formats, and produce periodic national reports on patient safety and quality-of-care trends. These reports will highlight priority risks and provide actionable recommendations.

As stated earlier, the task force is not a knee-jerk or ad hoc response but a carefully conceived plan to address the fundamental challenges of care in the health sector, and it shall operate for an initial, renewable tenure of 12 months. There is a clear mandate, scope of work, and actionable timelines.

Clinical governance and patient safety are not abstract concepts. They are matters of life and death. The urgency of now cannot be overstated.

-Dr Bakare writes from Ilorin, the Kwara State capital.