6.1
Governance and Leadership Accountability
Within 12 months, pilot hospitals should establish or strengthen quality and patient safety committees with documented minutes, action items, and quarterly reporting.
View Domain GuidancePillar 02 · 12 domains
Health Systems, Governance & Infrastructure Transformation
Strong clinical care cannot be sustained in weak systems. Nigeria requires healthcare institutions that are well governed, adequately resourced, transparent, data-driven, accountable, and able to maintain reliable services.
What this pillar must achieve
Hospitals become resilient, transparent, efficient, technology-enabled institutions.
- Accountability for quality is named, resourced and reviewed at board level.
- Infrastructure and equipment are maintained as clinical assets, not capital events.
- Performance data is collected once and used for decisions.
- Financing and procurement can withstand independent scrutiny.
Core domains
Grouped for navigation, unchanged in substance
Governance
- 6.1Governance and Leadership AccountabilityInstitutional governance structures that support safety, quality, ethical leadership, performance review and corrective action.
- 6.10Legal Enforcement and Regulatory ModernizationReforms that make standards enforceable, protecting patients and healthcare workers.
- 6.9National Accreditation Authority StructureA credible accreditation framework with measurable standards, independent inspection and enforcement pathways.
Operations
- 6.2Hospital Operational Reform and Workflow OptimizationFixing the system failures behind quality gaps: patient flow, congestion, turnaround times and supply chain workflows.
- 6.3Infrastructure and Equipment StandardsA national minimum standard defining what qualifies as a functioning hospital.
- 6.4Equipment Maintenance SystemsEquipment failure treated as a patient safety issue, with preventive schedules and biomedical engineering capacity.
Intelligence
- 6.5Digital Health, HMIS, EMR and National DashboardsDigital transformation for accountability, planning and performance improvement, including EMR access for all professionals who need it.
- 6.6Data, Metrics and Performance MonitoringData elevated as a major component of the national guideline, with a defined minimum quality scorecard.
Financing and integrity
Additional domains
- 6.7Anti-Corruption and Financial AccountabilityTransparency in procurement, billing, audit and donor fund accountability.
- 6.11Public-Private Partnerships and International CollaborationCollaboration across associations, ministries, hospitals, diaspora organizations and international bodies.
- 6.12Health Financing Reform: National Health Insurance Authority (NHIA)Full implementation of the NHIA Act 2022 with amendments expanding benefits and linking payment to quality.
Priority transformation questions
What leadership should be able to answer
- 01Who is accountable for quality outcomes at this institution?
- 02Which operational failures repeatedly interrupt clinical care?
- 03What data does leadership currently trust, and why?
- 04Which financial controls would survive independent audit?
SMART commitments
Time bound objectives drawn from the White Paper
6.2
Hospital Operational Reform and Workflow Optimization
Within 18 months, pilot hospitals should complete patient journey mapping in at least two high-volume departments and implement workflow improvement plans.
View Domain Guidance6.3
Infrastructure and Equipment Standards
Within 24 months, pilot hospitals should complete infrastructure and equipment readiness assessments and maintain equipment uptime logs for critical devices.
View Domain Guidance6.4
Equipment Maintenance Systems
Within 18 months, pilot hospitals should maintain an equipment inventory and preventive maintenance schedule for all critical care, emergency, laboratory, and theatre equipment.
View Domain Guidance6.5
Digital Health, HMIS, EMR and National Dashboards
Within 24 months, pilot hospitals should report a minimum set of quality and operational indicators through a standardized dashboard.
View Domain Guidance6.6
Data, Metrics and Performance Monitoring
Within 12 months, ASQAT should define a national minimum healthcare quality scorecard for pilot implementation.
View Domain Guidance6.7
Anti-Corruption and Financial Accountability
Within 24 months, pilot hospitals should implement transparent billing processes, procurement documentation, and periodic financial accountability reviews.
View Domain Guidance6.8
Healthcare Financing and Sustainability
Within 24 months, participating states and hospitals should identify financing pathways to sustain quality improvement, workforce support, and accreditation readiness.
View Domain Guidance6.9
National Accreditation Authority Structure
Within 12 months, ASQAT should develop a draft accreditation readiness framework and hospital self-assessment tool.
View Domain Guidance6.10
Legal Enforcement and Regulatory Modernization
Within 24 months, ASQAT should recommend priority legal and regulatory reforms needed to support national healthcare quality and accreditation.
View Domain Guidance6.11
Public-Private Partnerships and International Collaboration
Within 12 months, ASQAT should identify strategic partners for technical assistance, funding, accreditation support, and pilot implementation.
View Domain Guidance6.12
Health Financing Reform: National Health Insurance Authority (NHIA)
Within 12 months, ASQAT should evaluate the insurance processes of the NHIA with a view to making recommendations for greater efficiency.
View Domain GuidanceTools and evidence
What is available for this pillar today
Related resources
Assessment tools, checklists and templates for this pillar are published through the standards and resource library as each document is approved.
Open Standards & ResourcesAwaiting approved content
Implementation evidence
Implementation evidence and institutional case studies will be published as they are formally documented and approved.