Raising the quality of healthcare in Nigeria DOROTHY JEFFNNAMANI

Over the years, quality of care given by the Nigerian health system invariably speaks volume. Statistics have shown infants and under 5 mortality have remained constant. There are 74 and 117 deaths per 1000 births, respectively, invariably 1 in every 13 born dies before age 1 and 1 out of every 8 does not survive to their 5th birthday. Maternal mortality caused by severe bleeding, infections, hypertensive disorder in pregnancy, etc. are not left out.

As reported by WHO, chances of an average Nigerian woman dying from pregnancy complications is 1 in every 13 and Nigeria loses 145 women of child-bearing age annually, thus ranking the 2nd in maternal mortality rate globally and the country with the lowest life expectancy in west Africa. What is alarming is that common illnesses like malaria, tuberculosis and HIV/AIDS majorly contribute to low life expectancy.

With these challenges, no option is left than to strive in raising the quality of healthcare. This means nothing but giving consumers of care more value for their patronage which automatically changes the dynamics of the sector, spurring it into real growth.

Issues of quality can emanate from full-blown sector wide systemic issues as well as at localised levels in a patient’s journey. Either way, aside from enacting policies and regulations supportive of quality improvement, embracing a stricter system that discourages errors and shortcomings in quality while recognising and rewarding outstanding performances should never be over emphasised. Moral/high ethical standards should also be put into consideration and reinforced in medical practice to rekindle the publics’ faith and trust in healthcare professionals.

Government should also take full responsibility for epidemics, vaccinations and public health matters and must ensure community engagements at grassroots levels.

A Pricewatercoopers survey on Nigerians revealed that over 90 percent of what is attributed to advanced healthcare in Nigeria in factual sense is of “low quality”. The report claims that this perception has come to acquire notoriety over years. The survey also highlighted the negative perceptions arising from confusing hospitality functions with the clinical function of hospitals.

Benchmarking quality with the size of a health facility or even equating it as what goes on in the doctor’s office or within the walls of a hospital should never be a yardstick for measuring quality care. If this is the case, developed countries have no business whatsoever bothering on improving quality care.

In the context of healthcare, quality can be a collaborative effort of the patient, health caregiver, patient’s family, and the community. It is the act of providing care a patient needs when the patient needs it in an affordable, safe, and effective manner. It can also mean engaging and involving the patient to take ownership in preventive care and in the treatment of diagnosed conditions. With these definitions, the stakeholders, all consumers of healthcare, and industry leaders can contribute to raising the quality bar at different stages of a patients’ journey.

According to the Institute of Medicine landmark report, “Crossing the quality chasm”, six dimensions of quality identified include equity in healthcare, safety, timeliness, effectiveness, efficiency and most importantly it is about patient-centeredness.

Patient centeredness: The essence of patientcentered care is captured in the maxim “nothing about me without me”. It requires patients to be carried along and be active participants in their care. Medical personnel in general need to conquer professional pride (sorry, but this comes with the territory) and embrace the evolution in healthcare history and begin to treat patient’s enquiries not as an impediment to care but as an opportunity to enhance care.

Timeliness: Permanent disabilities and sometimes death have occurred due to harmful non-instrumental delays of patients being held down in hospitals instead of referring them to the right facilities where they can get immediate care.

Safety: This simply means not harming people with the care you give. Safety issues can occur in both in-patients and out-patients care. Many late stage diseases or complications have pointed towards a missed out-patient care. This could be because of wrong diagnosis, poor treatment, or wrong prescriptions.

Effectiveness: This happens to be a main quality challenge as the health system has witnessed an increasing disregard for care protocols and treatment pathways with many caregivers resorting to individual treatment processes not backed by research or science.

Efficiency: Our health system is designed to function in 3 tiers. Each tier saddled with its responsibility and level of care. There are referral mechanisms and protocols that link one level to the other. Ignoring this will only add to the cost of care and disorganises the system. Inefficiency also affects the workforce who will not only lose training opportunities, but ideas and creativity on how to do things better where they are streamlined.

Equity: Contrary to the Nigerian perception, quality healthcare is affordable healthcare. It encourages standardisation of treatment without discriminating against patients. People should be able to get the right treatment irrespective of social class.

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Do we have a long way to go in this area of quality? Clearly, yes, but that is not to say it cannot be achieved. Globally, successful healthcare systems are shifting their approach from what is confined within a hospital’s walls to a broader approach of delivering health services for better outcomes. This encourages both intra and inter sectoral partnerships that will bring cooperation and value amongst players.

Support of the community is equally very important in this regard. Embracing philanthropy in healthcare can help bridge the gaps and strengthen institutions to help more people. Not only would it bring about more consciousness and zeal for our caregivers, they will feel loved by the society thus encouraging them to do more.

Without doubt, the essence of quality and quality improvements is about identifying, measuring, and reporting health outcomes. We must therefore understand that quality is not a destination to be reached but it is about constant changes which spur economic growth in every society. Changing all our health indices for better economic and social gains therefore demands that we must dynamically pursue quality nonstop…starting now.

Dr. Dorothy Jeff-nnamani (MD/CEO NOVO HEALTH AFRICA) is a Physician leader in public health with expertise in developing sustainable health programs, community-oriented policies, and management protocols for efficient health care delivery system.