Why access to healthcare in UK beats Nigeria

Nigerians’ experiences of healthcare in the United Kingdom have sparked a debate on whether access to care in the UK beats Nigeria in practical terms.

The issue became a prominent topic after Moyosore, a Nigerian biomedical scientist who relocated to the UK, complained about how difficult it was for her to access a doctor, after spending a total of 10 hours to reach the government-run hospital.

She was suffering from what she described as a “serious migraine”, a condition she felt would have been addressed quicker with the ease of seeing a doctor in Nigeria.

“Nigeria has more accessible healthcare than the UK. We just don’t have the structure and resources. The UK has everything and they will still kill you. How can someone be in pain and the ambulance is taking five hours to come? God help you, you take yourself to the accident and emergency (A&E), you will sit for another two hours if they don’t send you to urgent care to sit for another three hours,” she said in a tweet.

“You go to your general practice and complain about something that needs urgent attention. They will give you a referral three months after.”

However, a data-driven study conducted by The Economist Intelligence Unit on Global Access to Healthcare in 2017 shows that the healthcare systems of both systems sharply contrast in terms of accessibility ratings.

The UK is ranked fifth among the 10 top-performing countries in the Global Access to Healthcare Index, after the Netherlands, France, Germany, Australia, the UK, and Canada – all relatively wealthy and developed countries.

The index looks at access to healthcare through a set of accessibility and healthcare-system measures, assessing both the track record of countries in meeting their populations’ healthcare needs and the extent to which they have established the necessary health infrastructure to provide sustained access.

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Specifically, the UK’s healthcare is rated among the top 10 countries in access to child and maternal health services, access to non-communicable diseases care and access to medicines.

It is also in the top tier in areas of equity of access to healthcare, population coverage of the healthcare system, political will for increased access to healthcare, efficiency and innovation of the healthcare system.

By contrast, the bottom six overall performers in about 60 countries that were assessed include Cambodia, Ethiopia, Nigeria, Uganda, the Democratic Republic of the Congo, and Afghanistan — all poorer, and in many cases populous, countries with major challenges to ensure healthcare access.

Income levels are not the only yardstick to success in providing access to healthcare, according to the report. Several middle-income countries are ranked highly and ahead of some high-income countries, including, for example, Cuba (7th), Brazil (12th), Thailand (15th), Colombia (16th), and Kazakhstan (16th).

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Also, many Nigerian healthcare professionals who have experienced working conditions both in Nigeria and the UK also agree that the ease of access in the UK is better, although not without its challenges.

Peter Donpir, @don_pet, a medical registrar at the National Health Service (NHS), who previously worked at the University of Calabar Teaching Hospital (UCTH), stated that accessibility in Nigeria is not as effective or at par with good standards.

The medical professional who spoke on a forum organised by Nigerians in the United Kingdom, a community on X, manages referrals at the NHS.

He said the current delays in accessing a doctor in the UK are primarily informed by a triage system that sorts mild cases from serious ones and a COVID-19 pandemic policy that has seen hospital admissions really reduced.

Compared to Nigeria, Donpir said the medical scene is marred by poor infrastructure and littered with quackery as unlicensed doctors generally manage cases that they are not trained for including surgeries and births.

A recent harrowing experience of the Nigerian healthcare system for him was when he struggled to find a diagnostics centre in the South-East for a relative who was about to suffer a stroke.

“I had to rush back to Nigeria last year when my brother-in-law started feeling symptoms of stroke. They got to the hospital and I was speaking with a doctor and the doctor did not have a clue of what was going on. I was in the UK and I already made an assessment of possible stroke. My target was for him to get to the hospital in four hours to ensure he gets a limb-saving treatment called thrombolysis if the CT scan reveals there is no bleeding in his brain,” he said.

The doctor he spoke to didn’t know about thrombolysis and he said there was no CT scan available in the town.

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He said: “I called my colleague who also works in the UK to ask him where I could get a CT scan in the east of Nigeria, not an MRI scan. So when you talk about accessibility, what exactly is it?

“It took a day to get to a proper stroke centre in Owerri. We were asked to make a deposit of N1.5 million there. How many people can make such deposits in two hours before treatment? And before he left the hospital in 10 days, I spent not less than N4.5 million.”

Donpir, also narrating his experience working as a doctor at the UCTH teaching hospital, cited two specific incidents that highlight the challenges of working in the Nigerian healthcare system.

He recalled that he and some colleagues were setting lines for patients with HIV and Hepatitis B, and C without gloves – a serious safety hazard that puts the healthcare worker and patients at risk of infection.

In another instance where he was working in the children’s emergency room and needed IV fluids to help restore circulation in a sickle cell patient, there was no normal saline in the hospital.

The young patient’s mother had to go to the city centre at 2am to buy normal saline at the only open pharmacy.

Donpir asked: “Why is it that a teaching hospital that employs over 1,000 doctors has big pharmacies without medication and there is no common fluid?”

He is still owed three months’ salary.

Weighing that experience against that of his current workplace, he described accessibility as the availability of comprehensive screening and treatment services as and when needed by the public.

An instance he cited is when a patient who was medically fit for discharge suddenly had his oxygen requirement plummet. Within three hours, he was able to suspect the cause and refer him for quick assessments within the same hospital. The patient’s condition was stabilised and he got well.

“Tell me how many hospitals in Nigeria where within four hours, someone can start developing shortness of breath, have blood taken, X-rays done, blood count, urea and electrolyte, D-dimer tests, abdominal and pelvic CT and a diagnosis of pulmonary embolism med and treatment commenced?”

Kenobi, @TobbieXY, another UK-based Nigerian whose parents practised as healthcare professionals in Nigeria believes accessibility to healthcare is restricted to urban areas on average in Nigeria.

He noted that there are millions in remote areas who can only dream of improved accessibility to healthcare.

“Sometimes the World Health Organization (WHO) has to pay private healthcare professionals to go to rural areas to provide service. Some of them have monthly or bi-monthly timetables,” Kenobi said, noting that in contrast, villages in the UK have equal access to healthcare as cities.

And for many Nigerians, lack of affordability can limit accessibility.

“You have to earn millions to be able to afford some medical emergencies in Nigeria,” Kenobi said.

However, for the UK, challenges are also sprouting up as the system struggles to match manpower with rising demand for health services.

This is said to worsen the waiting time for intervention for certain illnesses.

According to @Adalabekee, a registered nurse, the UK is seeing a gradual shift of medical professionals from government establishments to private practice where they can control the number of patients under their care.

She said: “The problem with the UK is manpower. That is why there are several backlogs. There are few doctors available at the emergency department (ED). One doctor has to cover the ED, ward, and surgery because there are few people available to actually carry out the healthcare.

“You have one nurse to 10 to 15 patients and at the same time, there is no space to bring the patients into the ward. Most healthcare workers are also now leaving the NHS for private practice where they work at their own pace. Health professionals are also prioritizing their health over the practice and the associated income. All these affect patients’ waiting time. We need to identify the problem, access it, and provide solutions.”