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12 Pillar clinical governance is an evidenced based solution developed by Professor Joseph Ana for whole health system strengthening in Low and Middle Income Countries (LMIC) which provides an overarching framework for protecting patients and supporting health workers.  Based on the founding principles of clinical governance established in the UK’s NHS it further develops and expands them to be fit for the purpose of health systems improvement and strengthening in resource poor contexts such as in LMICs. The five additional pillars that make up the 12-Pillar Clinical Governance (Policy / Law; Funding Mix; Infrastructure; Equipment; Utilities and Ambience) have been created because they are often lacking in low and middle income countries, and that accounts for failure of their health systems to deliver quality.


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 the individual or team requires an organisation that is both accountable for the actions of its staff and values its staff, is transparent and takes responsibility to minimise risks by providing a safe and well equipped work environment and learns from good practice, and mistakes.



The 12 Pillar Clinical Governance framework  is proven to deliver a transformed health sector.  It is contextually relevant, viable and a practical modus operandi for governments and institutions across LMICs to achieve quality health improvement in the day-to-day care of patients-simultaneously promoting patient advocacy and safety in tandem with the recruitment, development/training, retention and wellbeing of healthcare professionals.


The 12 Pillars include:























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

'Whole System Change of Failing Health Systems’. 2009. ISBN:978-978-49487-0-8

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

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



12 Pillar Clinical Governance

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