Implementing a national hospital accreditation program: the Zambian experience.

OBJECTIVES This study describes the development of the Zambia Hospital Accreditation Program from 1997 to 2000. Ten major milestones are presented and discussed, as are challenges to the program. DESIGN Data were collected through a review of written documents, interviews with major stakeholders, hospital visits, and discussions with implementers. MAIN OUTCOME MEASURES Zambia has successfully developed hospital standards that are relevant and potentially achievable by its hospitals. Half of Zambia's 79 hospitals have received educational surveys, and 12 have also received the full accreditation survey. Significant improvement in compliance with standards occurred in overall scores, and in seven out of 13 functional areas. However, the program has stalled due to lack of sufficient funds, lack of legal standing for the Zambia Health Accreditation Council, difficulties in retaining qualified surveyors, and indecision on how to handle accreditation results. In addition, serious resource constraints in hospitals and the need for ongoing facilitation have hindered their full participation in the program. It is estimated that the program costs about 10000 dollars US per hospital to complete the cycle. CONCLUSIONS Having a developing country sustain an accreditation program requires dedicated funds, government and donor commitment, continual adaptation, ongoing technical assistance to hospitals, and a functioning accreditation body. In Zambia, the accrediting Council was stymied by a heavy workload, lack of legitimacy and budget authority, and the government's indecision on incentives and feedback. Long delays arose between accreditation surveys and feedback of written results. Zambia has now begun to include some accreditation standards in performance audits and is considering decentralizing survey functions.