Checklist success in Madagascar

Checklist success in Madagascar

Checklist success in Madagascar

Mercy Ships is delighted to announce the publication of an important medical paper in the PLOS ONE journal.

The paper, co-authored by several Mercy Ships experts including Dr Michelle White of Great Ormond Street Hospital, is an evaluation of our implementation of the WHO’s Surgical Safety Checklist in Madagascar between September 2015 and May 2016.

The Checklist is a simple tool that has been found to reduce surgical mortality and morbidity by up to 50% wherever it is implemented.

In Madagascar, Mercy Ships volunteer experts visited 21 hospitals and taught 427 multi-disciplinary medical staff how to use the Checklist. The aim was to see how great an effect Mercy Ships could have by running intensive three-day courses in Checklist training across a whole country, rather than spending six to 12 months in a single hospital. Would the healthcare providers still be using the Checklist up to four months later?

The evaluation found that an enormous 78% of hospitals were still using the Checklist three to four months on: 65% were always using it; while 13% said they were using it at least some of the time.

“This is one of the first times – if not the first time – a nationwide implementation of the Checklist has been undertaken and succeeded in a low or middle-income country [LMIC],” Dr White says.

“Most previous LMIC work has focused on only one or two hospitals and has been very labour and time-intensive. So what can you do – if anything at all – if you visit all the government hospitals for just three days? Would you get any sort of result and sustainability four months later? The astonishing answer is yes.”

This evaluation, which was published in PLOS ONE on 5 February 2018, forms part of the ongoing assessment of our field services in Madagascar. Assessing our work in this way enables us to improve the delivery of our projects in subsequent field services; offer better healthcare strategy advice to host nations’ governments; connect our work to tangible outcomes and impact; and provide information to other NGOs working in LMICs.


The paper’s full title is: “Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar”.