Health Facility Accreditation: Ethiopia’s Pathway to Health Care Excellence

USAID Quality Healthcare Activity  aims to realize Ethiopia’s health quality and equity goals and to improve health outcomes of women and children over the next five years. QHA offers custom fit structural and performance quality improvement interventions across 2,239 health facilities.

By Yenealem Tadesse
Chief of Party, USAID Quality Healthcare Activity

Health facility accreditation plays a crucial role in setting uniform standards, improving patient care, and driving continuous quality improvement. This approach provides health facilities with the framework to evaluate performance, identify areas for improvement, and align with internationally recognized quality standards. Establishing a national health service accreditation program requires a structured pathway that starts with the development of evidence-based national accreditation standards, followed by pilot testing and phased rollout.

Path to Transformation

In Ethiopia, the Ministry of Health (MOH) is embarking on a transformation in health care quality and safety by introducing a national accreditation system based on international best practices. The initiative underscores the MOH’s commitment to building a standardized, high-quality health care system accessible to all citizens. With a clear roadmap developed in collaboration with the Ethiopian Standards Institute (ESI) and support from Ethiopian Accreditation Services, the country is paving the way toward a future where health care is synonymous with trust, safety, and efficiency.

USAID Quality Healthcare Activity (QHA), a JSI-implemented project launched in 2023, aims to realize Ethiopia’s health quality and equity goals and to improve health outcomes of women and children over the next five years. QHA offers custom fit structural and performance quality improvement interventions across 2,239 health facilities. To reach the country’s targets, our QHA team is supporting the MOH to strengthen and build accreditation standards into the health program at large.

A team from QHA, MOH, and ESI conducted benchmarking visits to South Africa and Türkiye to observe and learn about their processes, which provided invaluable insights into how Ethiopia can tailor its own accreditation approach. These countries have demonstrated the importance of joining international organizations, such as the International Society for Quality in Health Care (ISQua), that offer expertise and networking opportunities, which are essential to achieving Ethiopia’s accreditation goals. Lessons from these visits highlight the need for strong organizational structures, clear governance, and adequate resources—particularly for public facilities that often grapple with infrastructure and maintenance challenges. Achieving accreditation may take, on average, two to three years, and many Ethiopian health facilities urgently require upgrades and ongoing support to attain and maintain necessary high standards.

Recommendations from the Benchmarking Visits

The MOH

Incentive Packages: Finalize and implement incentive packages to motivate health care facilities to engage in the accreditation process and achieve quality standards.

Capacity Strengthening: Provide technical assistance to enhance health care facilities’ quality management systems and prepare them for accreditation. Prioritize capacity and infrastructure strengthening with the support of partners, while providing comprehensive training on accreditation standards, quality management systems, and data management practices to equip health workers with tools needed to meet accreditation requirements.

Evaluation and Research: Implement robust monitoring and evaluation frameworks to assess impact of accreditation efforts on health care quality. Celebrate and recognize achievements of accredited facilities to inspire others to follow.

Internationally Accredited Hospital: Establish an internationally accredited hospital as a flagship destination for regional and international learning. Similar to the approach taken by Türkiye’s Ankara City Hospital, focus efforts on infrastructure development and capacity strengthening through partnerships with governmental and nongovernmental donors.

Communications and Quality Improvement: Develop a targeted communication strategy to foster stakeholder collaboration, build trust, and address key concerns. Undertake continuous quality improvement initiatives to help facilities adapt to evolving requirements, ensuring a sustainable foundation for a national accreditation program.

ESI

Setting and Updating Standards: Develop a guide to regularly review and revise accreditation standards to reflect Ethiopia’s unique health care context and its evolving health care needs and advancements.

Data and Digital Solutions: Ensure that the accreditation system features software tools that streamline application management, team formation, and certification processes, making tasks like checking eligibility or resolving complaints autonomous. Develop an online platform for the accreditation process that enables health care facilities to submit applications, self-assessments, audit reports, and action plans electronically. Support digital infrastructure to improve accessibility and transparency and enable real-time tracking of progress and compliance across health care facilities. Encourage decision- makers to leverage data-driven insights to identify gaps and drive continuous quality improvement.

Sustainability: To ensure sustainability, which is central to accreditation, conduct regular audits, comprehensive staff training, and diligent data validation.

Ethiopian Accreditation Services

Training and Organizational Strengthening: In its new expanded role to accredit health care facilities, safeguard effectiveness of the accreditation program by establishing departments dedicated to accreditation. Design and implement comprehensive training programs for accreditation surveyors to ensure they receive ISQua accreditation and uphold high evaluation standards.

Survey Protocols: Facilitate knowledge exchange and promote mutual recognition of accreditation efforts through partnerships with international organizations like ISQua. Define eligibility criteria for health care facilities seeking accreditation — consider setting a benchmark that asks health facilities to reach 80 percent accreditation standards compliance in alignment with regulatory requirements. Establish a protocol to select multidisciplinary surveyor teams, considering the complexity of health care facilities and required areas of expertise needed to conduct effective assessments. Implement remote survey methods to enhance efficiency and reduce costs.

The Road Ahead

Since the rollout of the accreditation roadmap, Ethiopia has already made significant progress, including developing incentive packages and drafting clear service delivery standards for hospitals.

By taking these recommended steps, Ethiopia can establish a robust accreditation system that drives the continuous improvement of health care quality and cultivates an environment where innovation flourishes. As this system becomes embedded within Ethiopia’s health care framework, its effects will reach far beyond improving patient care, catalyzing public trust and creating a health care environment where Ethiopians can confidently seek medical services. It also has the potential to position Ethiopia as a regional hub for medical excellence, fostering growth in medical tourism and attracting foreign investment —setting the stage for long-term national and regional development.

Follow along on this journey and learn more about the work of QHA.