Director-General's Office

The Second International Conference of Ministers of Health and Ministers for Digital Technical Technology on Health Security in Africa

Dr Tedros Adhanom Ghebreyesus
Director-General of the World Health Organization

Cotonou, Benin
18 June 2018

Merci beaucoup, Master of Ceremonies

Your Excellency Abdoulaye Bio Tchané, Minister of State,

Honourable ministers,

Dr Moeti, WHO Regional Director, distinguished guests, ladies and gentlemen,

First of all, I would like to thank His Excellency President Talon for the invitation to come to his beautiful country. And also I thank Benin for the great hospitality. It’s an honour for me to be here in Benin, and an honour to speak to you today.

I’d like to congratulate His Excellency the President, and also the Minister of State and the whole government. for your leadership and commitment to making health a priority.

Yesterday we had a very productive meeting and identified several ways that WHO can support the government to improve the health of the Beninese people.

Ladies and gentlemen,

You’re all familiar with the principle that every health worker’s responsibility is to “first do no harm”.

No one should be harmed while seeking care.

But unfortunately, we know this is not the case.

I think of the 21-year-old man who died because the cancer drug he was given was mistakenly injected into his spine, instead of his vein.

The 79-year-old woman who was prescribed so many medicines she developed drug-induced Parkinson’s disease.

The 8-year-old boy who died in his sleep after being given the wrong medicine just before bed. A pharmacist had mistakenly dispensed a powerful muscle relaxant that looked and tasted the same as the drug the child was supposed to take for a sleep disorder.

If only these were isolated incidents.

But the reality is that every year, millions of patients die or are injured because of unsafe and poor-quality health care. Most of these deaths and injuries are totally avoidable.

Adverse events are now estimated to be the 14th leading cause of death and injury globally. That puts patient harm in the same league as tuberculosis and malaria.

There are an estimated 421 million hospitalizations in the world every year, and on average, 1 in 10 of those results in adverse events.

This is of course a frightening statistic. Especially when we know that at least half of adverse events could be prevented.

As usual, it’s the poorest, most disadvantaged communities that suffer the most. Two-thirds of adverse events occur in low- and middle-income countries.

They’re the last to benefit from advances in medicine, but the most likely to suffer the consequences of medical errors.

The needless suffering of patients and their families is bad enough. But each adverse event erodes the most precious resource in health care: erosion of trust.

When people aren’t sure whether it’s safe to seek care, they will cease to seek care.

They will stay at home, where their condition will get worse, or they will infect others, creating a greater burden of disease, and greater costs for the health system.

We saw this with devastating clarity during the West African Ebola epidemic in 2014 and 2015.

Because of the perception that health services were unsafe – and in some cases they were unsafe – many of those infected chose to stay at home.

This created pockets of disease that spread through communities, with tragic consequences.

This is why we say that universal health coverage and health security are two sides of the same coin. When health services are not available, or not affordable, or not safe, the conditions are ripe for disaster.

And of course, the economic costs of medical errors are astronomical.

About 15% of all hospital activity and expenditure is a direct result of adverse events. And the costs of treating safety failures amount to trillions of dollars each year.

Let me put it simply: medical errors aren’t just bad medicine; they’re bad economics.

The investments needed to improve patient safety pale into insignificance compared with the costs of harm.

The question, therefore, is not whether we can afford the interventions that will keep patients safe. The question is whether we can afford the status quo.

The good news is that WHO has evidence-based guidelines, checklists and other tools that can be used to protect patients and health workers from harm.

And digital technology is playing an increasingly important role in patient safety, by identifying risks and reducing harm.

For example, remote monitoring of patients, electronic health records, and the use of smart phones and smart watches, can all help to prevent harm and improve outcomes.

Electronic medical prescriptions are also becoming more available in many countries, to reduce prescription errors and improve the delivery of care.

Big data, artificial intelligence and machine learning can also support clinical decision-making. And eLearning systems and services can help health workers, patients and families to stay informed.

I am happy to see that the African continent is making remarkable progress in these areas.

WHO is using several digital platforms to help improve patient safety and share lessons from around the world.

Our Global Patient Safety Network supports more than 1000 experts to exchange information and discuss patient safety challenges.

Our “Patients For Patient Safety Network” aims to engage patients, families and communities in making care safer.

And we are currently developing the WHO eAcademy for Patient Safety, digital medication passport, and more.

WHO collaborating centres also provide multiple resources for digital technology and patient safety. For example,

The Canadian Patient Safety Institute distributes patient safety alerts globally in English and French, and African countries already access this database.

Secondly, the RAFT Network – Réseau en Afrique Francophone pour la Télémédecine – provides online training for health professionals, including patient safety research and online clinical consultation.

The theme for this year’s International Patient Safety Day is “Digitization and Patient Safety”.

Digital technology is critical for improving service delivery, raising awareness, training health care professionals and empowering patients and families. We need to learn from and support each other on how to use digital technology on patient safety in an appropriate manner. We are very much looking forward to working with you on this matter.

As Dr Moeti said yesterday, WHO’s partnership with ITU holds great promise for engaging the private sector in improving patient safety.

But just as we are coordinating at the global level with ITU, it will be critical for ministries of health to collaborate with ministries of information and communications technology to realise the potential of digital health. It’s not a job for the health sector alone.

Here I want to commend the African Ministers for fully supporting the resolution on digital health that was adopted at the World Health Assembly just a couple of weeks ago.

Ladies and gentlemen,

There are no quick fixes for patient safety. There are no magic bullets. But let me give you five building blocks that together create the environment in which errors can be avoided and people can be kept safe.

First, and most importantly, committed leadership. Both at the national level and at the level of each individual health facility, we need leaders who will create a culture that puts patient safety at the apex of clinical care.

Second, we need clear policies and governance mechanisms. Every health worker must know and understand the best practices, based on the best evidence, for keeping patients safe.

This includes clear policies on reporting and learning from medical errors, and what to do about them when they happen. A vital part of this is to create an open culture that increases the incentives for reporting adverse events and errors, and removes the incentives for hiding them.

Third, we need data-driven improvements, including full implementation of health data standards and full use of available data for decision-making. Robust data systems are vital for tracking what’s working and what’s not, so that we can learn and make adjustments continuously.

Fourth, we need competent and compassionate health professionals, in sufficient numbers. This is vital. Policies and systems are important, but in the end, health services are delivered by people -- humans.

Very often, harm happens not because of incompetence or neglect, but because health workers are tired and overworked, health facilities are overcrowded, or because of staff shortages, poor training or the wrong information being given to patients.

We must therefore give all health workers the conditions, the skills, the training and the tools to do their jobs to the best of their ability.

And fifth, we must involve patients and their families as true partners in care. Too often health services are delivered in a way that makes people passive recipients of their own care, instead of active participants.

When people are empowered to take charge of their own care, when they are listened to, informed and consulted, when their needs and preferences are respected, the odds of errors and harm are dramatically lower.

This is what we mean by people-centred care. It is one of the foundations of patient safety. And it is one of the hallmarks of the world’s best health systems.

As you know, there is no higher priority at WHO than universal health coverage, built on the foundation of health systems that deliver people-centred care.

Ensuring that people can access health services that are safe, effective, affordable and of good quality, without facing financial hardship, is one of the best investments a country can make.

It’s not only an investment in better health, it’s a platform for stable, equitable and prosperous societies.

I was glad to witness that the government of Benin has the same position.

WHO looks forward to working with the government of Benin, and with all countries, to harness the power of digital technologies to create a healthier, fairer and safer world.

Thank you so much. Merci beaucoup.