Prof Rotimi Jaiyesimi
HOW GOOD AND SAFE IS HEALTH CARE DELIVERY IN NIGERIA?
Before I am pilloried by my fellow healthcare workers, I acknowledge that there are good healthcare professionals and pockets of good practice and service delivery in public hospitals in Nigeria. This discussion is about the quest for seeing a massive improvement in the way we deal with and treat patients. I will be the first to put up my hands to say there are areas in my practice that I can improve upon and this is why I continue to take steps to improve myself.
THE NIGERIAN PATIENT AS CUSTOMERS A hospital can be compared to a service industry where there are service delivery (the hospital), the workers (care givers in the hospital) and the customers of the industry (patients). Historically, the public sector hospitals have been financed by governments. The lack of application of business principles have resulted in the health service industry having no clear set objectives and outcome. Outcomes in healthcare is not about providing care but ensuring that no patient comes to harm, the patient experience is commendable and the system is run efficiently.
There is a need to rethink and see hospitals as a process industry. The most important player and central to the success of the industry is the customer, our patients. It is for this reason that it is imperative that patients in Nigeria have a voice in the care they receive. I find it unbelievable that in the 21st century a large number of literate Nigerian patients do not know the names of drugs they have been prescribed or have access to their case notes.
Were you to seek to buy a new car, one would expect that you would ask about the specifications and what particular fuel it runs on. The salesperson would be eager to tell you the selling points of the car and show you the gadgets. If we could take these steps while purchasing a car or other product, why can't patients be informed of the benefits and side effects of the drugs or treatment being administered to them?
Healthcare professionals must engage with Patients and seek their opinion with regards to therapeutics and in service redesign. Doctors know best? Not anymore - ask the customer what they value in the service or would like to see in a service. Meet these needs and you will have a satisfied customer
A visit to most government hospital wards will reveal a sorry picture - unhygienic environment, poor lighting, outdated equipment that should have no place in the ward but in a scrapyard. It is fascinating to observe the relationship between the service user and the service provider. The balance is tilted towards the service provider and this should not be the case.
THE INDIVIDUAL PRACTITIONER It is often said that governments will kill your dream. As healthcare professionals we should be advocates for patients. Pilots will not fly technically unsafe aircrafts. Why should Health Care Practitioners (HCP) continue to work in substandard environments and with outdated equipment? At stake are lives of individuals who are fathers to children and husbands to a wives and the source of livelihood. I ask myself, how would I want to be treated if I were a patient in any hospital? With dignity and safely by a well-trained HCP. The treatment I receive in a reputable private hospital in Nigeria or government hospitals in Sweden should be no different from what I receive from the state General hospital or tertiary hospital in Nigeria.
I will pre-empt the phrase give us the right tools to work and we will do a better job. There is no denying the fact that the Nigerian health budget is inadequate. The question is have we utilised efficiently and effectively what is currently on offer. Are the funds spent on what they are intended for, the care of the patients? Do healthcare professionals have a service level agreement defining what output is required of them annually? There is an urgent need for accountability of the use of funds allocated to the three tiers of service delivery. Do we have a cost effective procurement system? Do the drugs end up in the hands of the patients or in the stores of a privately owned pharmacy? Where is the monitoring, auditing and evaluation of current health expenditure and service delivery by practitioners?
INCESSANT STRIKES There have been too many strikes in our public hospitals. Doctors and Nurses become indifferent to the plight of the patients that they have been trained to help while for governments, it is business as usual. The underlying factors of these strikes are self-centred - pay conditions, jostling for professional recognition and not about the sorry state of our hospitals and the poor treatment patients receive. The Nigeria health sector has seen more strikes than any other professions or unions. Where are the mediation and arbitration bodies?
These incessant strikes are a reflection of poor leadership within ministries of health ant within the professional associations. Strikes must be the last resort by any healthcare professional. The Nigerian patient deserves better than what is currently on offer and it is for this reason there is a pressing need to re-engineer the Nigerian Health sector. A new government with the mandate of the people should hold the bull by the horn and put systems and policies in place that ensures that the Nigerian patient is treated with dignity, safely within up to date facilities. What kept health in this poor state, corruption and mismanagement, must never be allowed to continue to do so.
Paramount to improving services is having a strategic vision of what good medical care is and political will to make the Nigerian Health Service delivery of high quality.