The quality journey in Nigerian healthcare

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by Femi Olugbile

Quote: It is a development that is fully deserving of celebration by all persons and entities who aspire to see healthcare facilities in Nigeria rise in people’s esteem, as well as improving in their outcomes

Last week, a little-trumpeted piece of news was received. The International Society for Quality in Healthcare (ISQua) has accredited the quality standards set by the Society for Quality Health in Nigeria for the purpose of evaluating healthcare facilities in Nigeria.

ISQua is a body that was set up in 1985 “to promote quality and safety in healthcare through international cooperation and collaboration”. It is based in Ireland, and it serves as the global hub for Quality Improvement in Healthcare. Through partnerships with various organizations, such as the WHO, the World Bank, Institute for Healthcare Improvement (IHI), International Hospital Federation (IHF), Institute for Clinical Effectiveness and Health Policy (IECS), Joint Commission International, and the UK’s National Health Service, among others, it has established itself as the reference point for definition, pursuit and training in Quality in the healthcare workspace.

In securing accreditation from ISQua, Nigeria, through SQHN, has become the second country in sub-Saharan Africa, after South Africa, to acquire the capability to independently assess and accredit healthcare facilities on Quality, with a brand that is internationally recognised.

It is a development that is fully deserving of celebration by all persons and entities who aspire to see healthcare facilities in Nigeria rise in people’s esteem, as well as improving in their outcomes.

Health facilities in Nigeria are bedevilled by many problems and are not held in great esteem by the citizens. As evidence of this lack of confidence, billions of naira is spent every year on what has been euphemistically labelled “Medical Tourism”.

A steady song-and-dance has been made about how this is a drain on the nation’s all-too-scarce resources. Some people have gone so far as to say “Medical Tourism” should be banned entirely.

Of course, even in a nominal democracy such as Nigeria, the authorities cannot just go about ‘banning’ things. People who use their private means to go abroad for medical treatment are exercising their fundamental human right to seek what they believe to be the best medical care possible for themselves.

The real challenge is how to objectively decide what “best medical care” is. Government often sees it in terms of purchasing expensive equipment such as linear accelerators and installing them with fanfare in a Teaching Hospital somewhere. Then officialdom would say, with a straight face, that it has a “Centre of Excellence”.

It is a nonsensical statement, of course. Taking “Excellence” as a description of accreditable Quality, there is no “Centre of Excellence” in any government health facility in Nigeria – Teaching Hospital or General Hospital. Not one.

Many things are missing in the healthcare landscape. There are not enough doctors or nurses, or pharmacists or scientists or any of the many other categories required to complete the health team. There are not enough facilities sufficiently close to the end user. Where it is available, the service may not be accessible to the citizen because seventy percent of medical service received by Nigerians is still paid for out-of-pocket as we speak.

And, finally, the quality of the service itself is poor, meaning processes and procedures are not standardised and repeatable, not documented in the appropriate way, not in accordance with state of knowledge and best practice, and not guaranteed to produce predictable outcomes. In the UK one woman dies in labour in some obscure hospital in Leeds and the news and the noise and recriminations are all over the newspapers and national television for several days. In Nigeria fifty women could die in hospitals in one state in one day, and not a whimper would be raised.

And yet Nigeria is a prodigiously blessed nation. Seventy percent of all black doctors in the USA are Nigerians. They man the most advanced facilities and are at the head of teams carrying out cutting edge procedures. At least part of the reason they are not working in in the USA, and not in Lagos or Ibadan is the paucity of quality institutions locally that are able to deliver to them a controlled, quality environment where they can practice their skills and be sure of good outcomes.

Quality has been a big missing link in Nigerian healthcare over the years.

One major figure who got up to do something about it was Professor Adeyemo Elebute of blessed memory. He worked with others to set up the Society for Quality Health in Nigeria. He also founded a hospital-group, the Lagoon Hospitals, in which Quality Improvement was entrenched as a core concept. Lagoon Hospitals would go on to become the first hospital in Nigeria to be internationally accredited for Quality by Joint Commission International – the international gold-standard. And the Society, which he carefully nurtured, has just received certification to do for other Nigerian hospitals what JCI did for Lagoon Hospitals, domesticating the ‘surveying’ competence, and making it more accessible for Nigerian health managers.

Nigerian Health is in a pivotal place at this time, with the private sector belatedly beginning to see the value in “the business of Medicine”, with the Basic Healthcare Provision Fund and compulsory Health Insurance in several states all bringing the prospects of Universal Health Coverage (UHC) closer to the citizenry, and making medical care marketable and bankable.

Quality Improvement, with a local process of Accreditation now made available by SQHN should drive the quality up in facilities from primary health centres to kidney transplant units, and make the citizens begin to have confidence in their own facilities. It could ultimately help to staunch the bleeding of resources through “Medical Tourism”.

It is to be hoped that the government and the healthcare industry will see the value proposition in the development, grasp it with both hands, and be ready to run with it.

The first anniversary of Professor Elebute’s death is to be celebrated in a few days. But the real celebration of his life, and the value he brought to Nigerian health, is already beginning, with the announcement that came from ISQua last week.

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