12 Pillar Clinical Governance

12 Pillar clinical governance programme (12-PCGP) is an evidenced based solution developed by Professor Joseph Ana for whole health sector and system strengthening in Low and Middle Income Countries (LMIC) which provides an overarching framework for ‘protecting patients and supporting health workers in tandem’. Based on the founding principles of clinical governance established in the United Kingdom’s National Health Service (NHS UK), it further expands them to become fit for the purpose of health sector and systems strengthening in resource poor contexts such as in LMIC. The five additional pillars that make up the 12-PCGP (Policy / Law; Funding Mix; Infrastructure; Equipment; Utilities (24/7 power and potable water); and Ambience (24/7 sanitation and Hygiene) have been created because they are often lacking in health facilities in LMIC, and that accounts for the intractable failure of their health systems to deliver quality care.

The concept of clinical governance was introduced to the UK National Health Service (NHS) by the New Labour government shortly after its election in 1997 and is often thought of in terms of 7 pillars: Risk management, Education & Training, Clinical Audit, ICT, Clinical Effectiveness, Finance/ Management and Research and Development. Clinical Governance is a framework through which healthcare organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care by creating an environment in which excellence in clinical care is nurtured and can flourish (1). It is encapsulated by the phrase “the application of the best evidence to a patient's problem, in the way the patient wishes, by an appropriately trained and resourced individual or team” (2).

However in order to achieve this, Joseph and his team recognized that without the additional five pillars, clinical governance is not achievable. The individual or team requires an organisation that is both accountable for the actions of its staff and also values its staff, is transparent, and takes responsibility to minimise risks by providing a safe, well equipped work environment, and learns from good practice and mistakes, as patient centred care is delivered.(3)

The 12 Pillar Clinical Governance programme framework is proven to deliver a transformed health sector and system. It is contextually relevant, viable and a practical for governments and institutions across LMICs, like Nigeria to achieve improvements in the quality of care in the day-to-day care of patients by simultaneously promoting patient advocacy and safety, in tandem with the recruitment, continued development/training, retention and wellbeing of healthcare professionals. (3,4,5)

1. Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement n the new NHS in England. BMJ. 1998; 317(7150): 61-65. doi: 10.1136/bmj.317.7150.61

2. Gray c. What is clinical governance? BMJ. 2005; 300 doi: https://doi.org/10.1136/bmj.330.7506.s254-b

3. Ana J. 'Whole System Change of Failing Health Systems’ (4-year erience in cross river state, Nigeria)’. 2009. ISBN:978-978-49487-0-8

4. Smith, R. Richard Smith is impressed, ‘How to rebuild global health: Joseph Ana’s book describes how he turned around the failing health system in a southern Nigerian state. BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5520

5. Trivedi, B. Is Bijal Trivedi is impressed, ‘INSPIRING LIVES - Joseph Ana - Health Commissioner on a Mission. “He made healthcare accessible to everyone in the state’, In: Scientific American (fall- June, 2010. Page 30

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