Example 4: Integration of Patients’ Rights Standards in Hospice Accreditation in South Africa

Project Type: Standard-setting

The Organizations

Hospice Palliative Care Association of South Africa (HPCA)
Cape Town, South Africa
Email:  info@hpca.co.zo
Website:  www.hospicepalliativecaresa.co.za/

Hospice and Palliative Care Association of South Africa (HPCA). Founded in 1988, the HPCA is a professional membership organization for hospice and palliative care organizations. It operates in all nine provinces of South Africa and has 189 member and affiliated hospitals. One of its core missions is to ensure professional palliative care services and to guarantee a high standard of care for patients and their families. Patient rights are central to HPCA’s philosophy—providers view themselves as advocates for their patients—and would thus have to figure prominently in criteria developed.

COHSASA (Council for Health Services Accreditation of Southern Africa)
Cape Town, South Africa
Email:  queries@cohsasa.co.za
Web:  www.cohsasa.co.za

The Council for Health Service Accreditation of Southern Africa (COHSASA). COHSASA grew out of the Faculty of Medicine at the University of Stellenbosch’s Pilot Accreditation Programme for South African Health Services. In 1996, COHSASA began operating as an independent, non-partisan unit. It has since developed health accreditation programs for hospitals, sub-acute care, psychiatric facilities and programs, and primary health care clinics. Their mission is to “assist healthcare facilities in developing countries to deliver quality healthcare to their clients through sustained improvement, using internationally recognised standards and based on patient safety principles and operational research.”

The Problem

Patients with HIV/AIDS, cancer, chronic disease, terminal illness, other patients, and the elderly often suffer moderate to severe pain, and palliative care helps to relieve their pain and suffering. South Africa, for example, has approximately 5.6 million people living with HIV/AIDS and approximately 69,000 people with cancer. It is therefore necessary to develop a standard of care and an accreditation program for palliative care programs across the country to encourage hospital and hospices to meet and maintain minimum quality standards—a strategy that could improve patient safety and better the overall quality of care.

Actions Taken 

  • HPCA developed palliative care standards for the accreditation of hospices in South Africa, incorporating key protections for patient rights.
  • In 1994, a HPCA Standards Committee was created to work with the COHSASA, the accrediting body for facilities in compliance with health professional standards, to formulate comprehensive palliative care standards for hospices.
  • The Committee developed standards covering 13 key areas with patient rights as one of them. Patient rights language is further embedded throughout.
  • A chapter on patient rights addresses processes to: identify, protect and promote patient rights; inform patients of their rights; include the patient and the patient’s family, when appropriate, in decisions about the patient’s care; obtain informed consent; educate staff about patients’ rights; and guide the organization’s ethical framework.

Results and Lessons Learned 

In 2005, the HPCA/Cohsasa standards for hospice accreditation were published and recognized by the International Society for Quality in Health Care Incorporated (ISQua). 26 hospices were fully accredited in 2012.

Example from South Africa:
Legal Aspects of Palliative Care Manual (2nd Edition, 2012)

This manual addresses the legal and human rights problems facing people with life-threatening illness. It now not only includes case studies, legal recommendations, and resources, but has been restructured as a training manual with step-by-step lessons for hospice and palliative care staff and legal practitioners.