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Thursday, October 24, 2013

Nigerian Teaching Hospitals not on Africa's top 200


As Neuropsychiatric, Nordica, Bridge Clinic top chart.
A RECENT ranking of leading hospitals in Africa and the lot of Nigerian hospitals on the log will shock those that are still in doubt of crisis in the country’s health system. 
     According to the web-based (Webometric) ranking of hospitals for 2013, only 17 Nigerian hospitals were listed among top 222 in Africa. And of these 17, only two are government-owned hospitals – the Neuropsychiatric Hospital, Aro, Abeokuta in Ogun State and the Federal Medical Centre (FMC), Gombe. 
    None of the state-controlled hospitals and federal-owned teaching hospitals, plus National Hospital, Abuja made the list.
   
The Neuropsychiatric hospital ranks first in Nigeria, third in Africa and 897th among 16000 hospitals and health related services worldwide. Second in Nigeria is Nordica Fertility Centre, Lagos, eighth in the Africa and 2390 in the world. Bridge Clinic is third in Nigeria, 40th in Africa and 7900 in the world. 
     The ‘Ranking Web of World Hospitals’ is an initiative of the Cybermetrics Lab, a research group belonging to the Consejo Superior de Investigaciones Cient√≠ficas (CSIC), the largest public research body in Spain. The Cybermetrics Lab is devoted to the quantitative analysis of the Internet and Web contents specially those related to the processes of generation and scholarly communication of scientific knowledge.
     The public, as well as, professionals that either use or work in these facilities are not surprised at their poor rating. One of the professionals is Eyitope Ogunbodede, a professor of Preventive and Community Dentistry, Obafemi Awolowo University, Ile-Ife. He minced no word, when he said these are not the best of times to be sick in Nigeria or use hospitals in the country.
    Ogunbodede, in his recent convocation lecture at the National Postgraduate Medical College of Nigeria, said whoever is in doubt of the rating vis-√†-vis accessibility and quality of services available in the hospitals, should see a similar rating by Service Compact with all Nigerians (SERVICOM), a Federal Government service delivery initiative. 
    SERVICOM also evaluated all Federal Hospitals in the country recently and concluded, “no hospital was delivering praiseworthy services.”  Rated on a scale of 1 to 5 (5 for excellent service delivery and 1 for shameful service), none of the hospitals were said to have scored 3 over 5. 
     According to SERVICOM, the best is Aminu Kano Teaching Hospital, which scored 2.5 or 63 per cent. Aminu Kano Teaching Hospital was, however, not listed among 222 best Hospitals in Africa in the Webometric ranking. The “frontline Hospital in Nigeria”, National Hospital Abuja scored 45.5 per cent in SERVICOM rating. 
     Ogunbodede, who spoke on, ‘towards making positive impact on the health of the nation’, x-rays the state of Nigerian healthcare facilities and identified that services rendered were not only cumbersome, but plagued by poor budgetary allocation and disharmony among caregivers.
    He said, all these put together, accounts for why even patients often dread coming to hospitals, talk less of their ranking by SERVICOM and Webometric. 
     Ogunbodede, who is also visiting professor, Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States, observed that it was not uncommon for critically ill patients to tarry for several days shopping around for introduction to “somebody high up” to facilitate quick care service in government hospitals.
     “The alternative for the patient is to attend the hospital and be kept shuttling from one pay-point to another, after which he or she will then have to visit several laboratories scattered in different buildings for test,” he observed.
     What is worst is that the sick patient would be required to keep checking for results of the tests, many of which may take weeks for ‘processing’, as opposed to the immediate processing facilities that are now available globally. Please note that it is not the duty of the hospital to inform the patient when the tests are ready, Ogunbodede said.
     To further compound the dilemma of the patient in some hospitals, Ogunbodede added, the critically ill-patient would only be seen by the consultants after all the test results have been retrieved. 
     “Is it then surprising, that the laudable VAMED initiative in our teaching hospitals resulted in minimal improvement, and that it never generated any confidence on our rulers to seek treatment in these institutions nor discourage them from traveling overseas for minor medical ailments?” he queried.
     There were strong indicator, Ogunbodede observed, that good health had been foreclosed in the country, which is the reason Nigeria has one of the lowest per capital national health budgets in Africa.
     For instance, the 2013 health budget provides the sum of N1, 643.12/person (about $10). This is against $14 recommended by the World Health organisation (WHO). But, “90 per cent of this amount will go into payment of staff salaries leaving little or no funds for hospital upkeep, drug purchase, equipment maintenance and upgrading, as well as, staff training.”
     Besides that, there is drug scarcity and fake, substandard, adulterated and unregistered drugs having filled day in all zones of the country. Health facilities are poorly equipped, ill maintained and obsolete. There is also the problem of poor attitude to work and the exodus of highly skilled personnel.”
     In the light of this, productivity is now seen as akin to Internally Generated Revenue (IGR) and increase in IGR is taken to mean that the hospital is on course. 
    “This trend is very disappointing and at best non-progressive. Evaluations need to be outcome-based emphasising results rather than activities and performance instead of programmes. We must work differently henceforth and be more specific about how success should be measured.
       He said since the World Health report for 2000 rated Nigeria’s health system as 187th out of the 191 surveyed, recent evaluations indicate that this appalling health situation has remained unchanged. 
     “Nigeria ranked 44th in health out of the 52 countries evaluated in 2012 ranking of African countries by the Mo Ibrahim Foundation. The parameters used for the assessment were: Rates of maternal and child mortality, HIV prevalence and quality of response to the epidemic, rates of immunisation, access to health services and the overall performance of the health care system.
 “Nigeria with its enormous potential has failed woefully to fulfill the high expectations of her citizens and of the international community, and this is particularly true in the health sector. It is clear from the comparisons that our nation can do better, but why are we so disappointing?”
     The doctors are a particular group of health workers that would not be left out of the blame. According to Ogunbodede, doctors are today at the helm of affairs in virtually all sectors of the health care system (the controversial National Health Bill also alluded to this fact), and thus have nobody to blame but ourselves for the inefficiency in the health care system, and especially the run-down of the hospitals in the country. 
    “It is principally our fault if teaching hospitals function as mere consulting clinics. Our public hospitals and most especially the tertiary hospitals represent a collection of compartmentalised fiefdoms with each group, from clinicians to nurses to technologists and administrators, focusing on its individual goals rather than the corporate goal and interests of the health care system,” he said.
    But if the health system must work, health professionals must seize to work in silos “if we are to harness the opportunities for mutual learning and joint solutions dormant in the various disciplines.” 
    He advised that all health professionals must now imbibe the new concept of ‘a health care community’ that is very eager to act in a cooperative manner, to proffer solutions to the immediate and remote health challenges of the Nigerian nation. 
     “The nation’s health care requires the leadership that will improve processes, and be courageous enough to discard dysfunctional, outdated and ineffective medical cultures and practices, while adapting and re-orienting our health care to local challenges and global ideals, for the benefit of the Nigerian people. 
     “The role being played by SERVICOM is commendable, but the organisation is too diversified for the comprehensive assessment of health care performance. Therefore, the health care sector must design its own specific performance evaluation criteria. 
      “Such outcomes and performance measurements can then be used to motivate the health teams and drive improvement. The world is now so open that it is no longer easy to legislate out easier and better health choices. The only way to discourage overseas treatments, for instance, is to provide commensurate or even better services at home.”
        Continuing, he said, “what is required is a new kind of orientation and leadership, at every level of the health care system, that will organise the system into teams, measure performance and outcomes not by the volume of work, patients seen, staff strength, number of professionals trained or the number of bed spaces (most of which may be unoccupied for most of the year), but by the actual results and benefit derived from the processes. 
     “It is necessary and more important to know how many patients are turned away because we do not have the capacity to manage their illnesses, how often patients survive their illnesses and recover from their disabilities, how often they get nosocomial (hospital acquired) infections and other complications, the level of information given to patients and their satisfaction levels and so on. It is also important to monitor how many of our people shun our hospitals to travel to South Africa, Egypt, India, United Kingdom, United States or Ghana for treatment.”
The Guardian

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