Towards improving Nigeria's health sector

Towards improving Nigeria’s health sector
By
DR. Abdullahi Dahiru
Kano
1st May,2009
Nigeria’s health sector is today bedeviled by many problems that have lead to reduction in quality of service delivery in most health institutions.
One of the major problem is the inadequacy of health care facilities in most part of the country especially in the rural areas. We can classify the health facilities into basically 3 types i.e. public [government], private and mission health facilities. The public health facilities can be further categorized into tertiary health institutions [teaching hospitals and Federal Medical Centres and specialized centres like National Orthopaedic, Eye and Psychiatric hospitals],the secondary health centres [comprises the specialist and the General hospitals],and the primary health centres [PHC]. The primary health centres manage minor ailments and refer complicated cases to secondary and tertiary health centres. The tertiary health centres are referral centres receiving referrals from secondary and primary health facilities. The PHCs and the General Hospitals mostly have dilapidated structures. Most of these centres, apart from the tertiary health centres, do not have the necessary equipment and manpower to make effective diagnosis and treatment of most ailments possible. Often a patient with minor ailment like malaria, has to seek for treatment in the tertiary health centre; a case that should have been treated at the PHC and the General Hospitals. This has lead to congestion and overcrowding in many Specialist Hospitals and tertiary health centers. Sometimes, a patient from a government health centre has to be referred to a private clinic for investigations like ultrasound scan, laboratory tests before diagnosis is made; just because the government health facility does not have that diagnostic equipment.
Most medical personnel have poor remuneration compared to their colleagues working for non governmental and private organizations. This has lead to incessant strike actions in the health sector in demand of salary increase.
The attitude of the patients or his relations towards the medical personnel has vitiated service delivery in most hospitals. The relationship between the medical personnel and patient or his relations is supposed to be of harmony and not confrontation. I have seen several instances where a minor misunderstanding between the medical personnel, and the patient relations have lead patient relations to call the medical personnel “heartless doctor” or “useless nurse”
The situation has deteriorated to a level where patient relations have caused serious havocs and wanton destruction to hospital properties like doors and windows. The patient relations sometime become furious if they are not allowed into the wards to visit their relation during working hours.
The medical personnel sometimes waste much time asking the patient questions that may not be relevant at the time of presentation to the hospital for example, why has the patient not presented early to hospital or why his wife is not attending antenatal care? This attitude has lead to several confrontations and arguments between the health personnel and the patient or his relations.
A pregnant woman may not be attending antenatal care. She went into labour without prior knowledge of what to expect during labour. A nearby local birth attendant or an elderly woman in the family is called to deliver the woman. Several manouvres may be tried at home. If she is lucky she delivers without problem. Otherwise, she presents to hospital with serious complications like obstructed labour, eclampsia or severe bleeding and management becomes complicated and difficult.
Most of the decisions taken by the medical personnel are perceived as being based on avarice and pecuniary reasons, not on professional knowledge. When a decision is taken for a patient to undergo surgery, the doctor sometimes has to make several lengthy discussions with the patient relations before consent is given .Patients usually presents to the hospital very late and consent is given at a delayed time, when not much can be done to save the patient’s life.
A bleeding patient may be accompanied to the hospital by many relations. When the relations are asked by the medical personnel to donate a single pint of blood to transfuse to the patient, many of them will disperse from the hospital. The few ones that remain will give flimsy reasons as to why they cannot donate the blood and the patient may die in the process; because most of our hospitals do not have functioning blood banks.
The prevailing economic hardship in the country has made many patients not able to pay the hospital fees. Consider a situation where the parents of a child with severe malnutrition are asked to deposit N5000 before being admitted to a paediatric emergency unit. We all know that the parents may not be able to pay this sum of money, because ab initio poverty may have contributed to the development of the ailment.
The cumulative effect of all the factors I have mentioned above has lead to resignation of many medical personnel from their appointment with public health institutions in Nigeria in search for better opportunities either in western countries and the Middle East, or joining international Non Governmental Organisations [NGOs].
This has set in a dangerous vicious cycle of resignation of medical personnel from government hospitals, leading to more congestion and work overload, and further resignation of more medical personnel. Most public hospitals are now becoming more understaffed everyday thereby reducing the quality of service delivery in most government health centres.
We should not forget the huge contribution of the traditional healers to mortality and morbidity in our hospitals. They use many medical jargons to cajole gullible client’s to buy their medications. They make advertisements on radio, television, newspapers, and in many streets of most towns in Nigeria. They can make whimsical claims of curing many ailments like diabetes, hypertension, impotence, pile etc. We know that many of these on concoctions are toxic to vital organs like the liver and kidneys. Equally harmful, is the practice of hawking orthodox drugs by illiterates in baskets under the blazing sun. It is customary for many patients to consult these people before presenting to hospital. Often the patient presents with complications and diagnosis is difficult, because the clinical features of the disease are masked by the effect of these drugs or concoctions. When the patient dies in hospital as a result of complications of ingestion of these medications, it is the medical personnel that is blamed not the herbalist or the drug hawker.
Perhaps, the best solution out of our present predicament in the Nigeria’s health sector is to try and address some of the problems mentioned above.
Construction of more comprehensive health institutions by the government especially in the rural areas and providing them with adequate equipment and trained personnel will reduce the congestion in General hospitals and tertiary health centres. The primary health centres should be able to treat minor ailments and refer complicated cases to higher centres for further management. Philanthropists, wealthy individuals, faith-based and corporate organizations should help government in this regard.
Government should improve the remuneration of medical personnel in public hospitals, and provide them with other welfare packages like good accommodation. Scholarships should be given to deserving personnel for further training to improve both their knowledge and skills. Funding should be increased for research and continuous education. This will help in reducing the brain drain from the health sector.
The coverage of the National Health Insurance Scheme should be extended up to the local government level to make more people benefit from the programme; so that patients do not have to deposit money before being admitted to hospital. Even a small firm employing ten people can have a retainership account with a reputable hospital, so that their employees can always have consultation and even admissions without necessarily being asked for deposit any amount of money. Treatment for accident cases should be made free by the government.
We need to view decisions taken by the medical personnel on the patient’s problem as been based on scientifically proven evidence, and in the best interest of the patient, not on avarice or pecuniary reasons. Patients should not hesitate to seek for further clarification from the medical personnel when they are not clear with any decision.
Paucity of health education has led our people to seek for remedy from traditional healers and drug hawkers. We need to enlighten our people more on the dangers of these drugs and concoctions, and people should also develop better health seeking behaviours like presenting early to hospital when they are sick, having regular medical check-ups, regular antenatal visits by pregnant women and prompt immunization of children. All drug hawking should be banned.
The relationship between the patient and his relation on one hand, and the medical personnel on the other hand, should change from that of confrontation to that of harmony. Both of them must see themselves as partners trying to solve the patient’s problem.
Finally, we must all know that effective health care delivery is not the responsibility of the medical personnel alone, but rather, it is the responsibility of all members of the community to make sure it is realised.