Omolara Adedoyin got the shock of her life sometime ago when she was rushed to the hospital for delivery. Her case was particularly complicated because she was told a caesarian section would be necessary if her baby’s life must be saved. But that did not deter the healthcare providers whose treatment came with a catch: she must pay up before the surgical operation would be carried out. Thanks to the delay associated with meeting the costs of surgery, Omolara almost lost her baby when the CS was eventually performed. This incident and many others of its kind raise questions about ethical issues in healthcare, especially when patients are faced with a life-and-death situation.
Healthcare is the treatment and management of illnesses, and the preservation of health through services offered by the medical, dental, complementary and alternative medicine, pharmaceutical, clinical sciences (in vitro diagnostics), nursing, and allied health professions. Ideally, it embraces all the goods and services designed to promote health, including preventive, curative and palliative interventions, whether directed to individuals or populations. But that definition obviously does not reflect what obtains in the Nigerian health sector.
“Without a visible reform of the public hospitals, particularly with regard to service delivery and management systems, the privileged in the society will continue to travel abroad for medical care and treatment,” David Eboh, CEO and health service management consultant, Mebod Management Limited states, adding that “lack of management training is a big barrier to realistic reform and transformation of the systems of leadership in the health sector.”
Eboh may very well be right, because Lanre Babalola, a mechanic, lost a friend due to the carelessness of some nurses in a hospital. Kunle Olaleye, the friend, was a commercial bus driver plying the Oshodi-Mile 2 route. But that was before he died in a ghastly motor accident. “Immediately the accident occurred, I and some other persons were reached through good Samaritans who got hold of his handset and called me,” Lanre recalls. “It was obvious people were scared to take him to the hospital for fear of questioning. Luckily, I was nearby, so I rushed down immediately and took him to the hospital. Although I later lost my friend, the attitude of the nurses was so discouraging. A little care on their part would have meant a lot. After all, they are meant to be life savers and not otherwise. It is good to note though a place like Lagos is having proper health care facilities but attitude of the care givers should also matter.”
Bolaji Adebiyi, a Harvard alumnus trained in emerging healthcare delivery and pioneer medical director, Alimosho General Hospital, has an explanation for this problem: “There are a lot of attitude problems among Nigerians generally. We are under so much stress. Getting to work is a major problem, going back home is not easy; the volume of work at workplaces is also a major challenge. These are not excuses for being nasty to patients, but they tell the true story.
“What government is doing now is regular educational programmes on behavioral changes, how to cope with stress, manage patients, etc. What we do at Alimosho General Hospital, for instance, is to educate our staff by telling them they should see the patients as their brothers and sisters. Also, the top management move around to ask the patients how they are being treated by the medics. Attitude is a general problem, but some hospitals are getting on top of it.”
The National Health Policy and Strategy to achieve health for all Nigerians was promulgated in 1988 and revised in 2004. The policy document is a result of several consultative processes, incorporating views from stakeholders and reflecting new realities in the National Health situation, including regional and global initiatives such as NEPAD and the MDGs. The policy basically focuses on the national health system and its management; national healthcare resources; national health interventions and service delivery; national health information systems; partnership for health development; health research and healthcare laws. But the question is, how much is all this being implemented today? Can the nation truly boast of a sound healthcare system without flaws?
Abayomi Ferreira, head, clinical services, Med-in Specialist Hospital, Ogudu, Ikeja, Lagos, does not quite think so: “Over time, funding of healthcare delivery services in the country will generate a considerable excess pool of funds that can be utilised through a well organised system of disbursements - both as loans or grants - to refurbish, maintain, and expand facilities at institutional levels in addition to sectoral development of facilities in the country.”
Maybe so, but fact is government-owned institutions, for instance, grapple with insufficient funding, poor sanitation, lack of essential drugs, unstable water and electricity supply, poor staffing, maladministration, brain drain, some old facilities obsolete equipment, etc. Citizens, on their part, are tired of a system which they feel is being over-commercialised, thus depriving them of the much- needed medical care.
It is therefore crucial that the healthcare delivery system be transformed by government through practical analyses understandable by even those at the grassroots. This transformation should also aim at improving health workers’ capacities in order to fortify the healthcare system in an enduring way.