Improving children’s quality of care in South Africa’s public hospitals

How Child PIP partnered with the South African government to scale its program nationally

Every year, almost 11 million children die before turning 5 years old, most from causes that are preventable with improved socio-economic circumstances and proper treatment and care. An essential part of eliminating preventable child mortality is to audit and identify potential improvements to the quality of care. Child PIP is a mortality review process that assesses the quality of care children receive in the South African health system. 


This process, implemented by the public healthcare system, measures the quality of care provided to children and identifies ways to bring about change where needed. By 2016, Child PIP was used in approximately 80% of hospitals in South Africa and had won a 2015/16 Healthcare Innovation Award, however the Child PIP team needed a clear strategy for working with the government to reach the rest of the health facilities in South Africa.


When Spring Impact began working with the team at Child PIP, they had been developing a five-year strategic plan to make the program sustainable and expand throughout South Africa. At the time, Child PIP also sought to improve the consistency of quality across their replicated sites and improve engagement with local health workers implementing Child PIP. 


Spring Impact first evaluated how the program was implemented across different sites and made recommendations for how Child PIP could improve quality. Next, we guided them through a process to determine the details of a government partnership, starting with clarifying the core elements driving the success of the intervention: 


“[Our work with Spring Impact] assisted us to identify different phases of Child PIP implementation, and to think through and write down issues related to Child PIP’s past achievements and what needed to be done to scale-up and sustain Child PIP in the future.”



This clarity better prepared Child PIP to support individual facilities who wish to take up the program. For example, based on the different phases of implementation, Spring Impact and Child PIP defined the roles and responsibilities of District Clinical Specialist Teams (DCSTs)––who play a critical role in implementing Child PIP–– and how they could be equipped to fulfil this role to a high quality standard.


Since working with Spring Impact, Child PIP has gone on to increase their reach to nearly 280 facilities and 50 out of 52 districts by 2017. In 2017, the national health department mandated that all public hospitals use the Child PIP audit system.

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