Across the world, healthcare leaders
and stakeholders have launched a number of initiatives to improve patient
safety and eliminate preventable harm within healthcare facilities. A number of
goals have been set and several sustainable actionable plans have been
designed. The initiatives, plans and goals are impressive, and we are hoping
they can transcend to healthcare systems across Africa and particularly in Nigeria
where I am domiciled.
Healthcare facilities were not
originally designed to harm patients. They should be a place where patients
receive care and empathy to heal the body, mind and soul. In the words of
Florence Nightingale, “the very first requirement of a hospital is that it
should do the sick no harm.” This is a clear mandate to both the stakeholders
who sit on boards and to the caregivers who care for patients. We are all collectively
responsible for ensuring that patients return home to their loved ones unharmed.
This mandate can become reality only
when leadership commits to patient safety and positive patient outcomes – and
this is where we largely get it wrong in Africa as a government and as a
people. From my experience, a culture of safety is the bedrock for eliminating preventable
harm in hospitals.
One of the concerns is that our hospitals
do not give due consideration to the safety and health of caregivers. This box has
long been left unchecked and this shortcoming correlates to negative impacts on
the safety of patients. For example, most hospitals do not have procedures that
consider the vaccination profile of healthcare employees. Some healthcare
workers have existing health concerns when they are employed, which leads to infecting
the patients they manage. Compulsory vaccination of the employees should start
at recruitment. This would give staff some relief knowing he or she is covered
against certain preventable infections.
We have to address the healthcare
work schedule in Nigeria. Most healthcare systems have two shifts of 10–12
hours each. This leads to exhausted workers and tired workers make mistakes. These
schedules are set for a couple of reasons: either the hospital does not want to
pay more in wages to have the appropriate number of healthcare workers or there
is a shortage of healthcare workers.
The lack of a safety culture is also
responsible for certain situations in which there are no documented work
procedures or processes to ensure patient or staff safety. In most cases, we
see different processes being used by different healthcare workers in same
facility, this is both frightening and intolerable; and leads to poor patient
outcomes.
We also have a high rate of surgery
site infections and injuries. Most are never reported or documented so we can
learn from them, and they are never disclosed to the patients or their families.
This immense absence of honesty of care goes against the principles of CANDOR. Patients
that get infections experience longer hospital stays and they are still made to
pay for the extended admission for a problem that was caused by the healthcare
system. This happens daily in healthcare facilities here.
There is a shortage of healthcare
professionals in Africa and most countries in Sub Sahara Africa have few
qualified doctors or nurses. Some hospitals are even forced to train young
secondary school teachers as nurses. This has given rise to a high number of quacks
who are not registered with professional councils and are never guided by any code
of practice.
The latest data from the World Health
Organization reveals that Nigeria’s Physician-to-Patient ratio is 4 doctors to
10,000 patients. Compare that to countries like Qatar, which has 77 physicians
to 10,000 population. According to the 2014 WHO report, Nigeria has only
150,000 registered nurses for a population of 160 million, a ratio of 1 nurse
to 1,006 people. The WHO standard is 22 nurses to 10,000 population. In Nigeria,
we train and graduate healthcare professionals, but they do not stay to
practice due to our poor healthcare infrastructures and discouraging
remuneration.
Poor healthcare funding is another
key issue. Nigeria’s annual healthcare budget is less than 4 percent of the
National Budget, public hospitals are not funded even for the right drugs or diagnostic
equipment, let alone investment in training and integrating patient safety into
behaviors and systems. This leads to a poor infection management system and poor
levels of disinfection and sterilization. Personal protective equipment needed
by healthcare workers are insufficient, we lack hand sanitizers, and most times
there is no running water for caregivers to wash their hands after handling
patients. I
have witnessed a nurse, during delivery with a failed suction machine, use her
mouth to suck the baby, that was all she could do, these are some of the lines
of risks to both patients and even the care giver.
A number of hospitals are even allowed
to operate without regulatory registration. In these facilities, patients are
harmed daily basis without any reporting. This is where the government has
absolute responsibility. Patient safety has to be at the front line of
healthcare discussions and our national agenda.
We need to look at things differently.
First, we need to look at the healthcare system as a workplace before seeing it
as a place in which we seek care. Then let’s consider safe processes as part of
the infrastructure of healthcare facilities, the spaces have to be designed to
reduce patient harm. We need to review the increasing number of hours in
healthcare shifts, accidents will surely happen through overwork and overdraw
of healthcare workers. We need to start creating a culture of incident
reporting and give assurances that we will not be blamed. Then we can use the
incident as a learning moment.
Most importantly, we need to improve
our healthcare infrastructure and increase our healthcare budget. Without these
two factors, patient safety and good treatment outcomes will only be a dream. In
the WHO
Abuja Declaration (2000), it was agreed
that healthcare funding should be increased to at least 15 percent of the National
Budget. Most countries across Africa, including Nigeria, have yet to acknowledge
or meet this agreement.
We need to start the dialogue from
here.
