‘Why quality in Nigeria’s healthcare must be measured’

To drive significant reductions in patients’ suffering and improve survival, top industry experts are pushing for quality to be adequately measured, defined, and entrenched in Nigeria’s healthcare systems.

Muhammad Ali Pate, co-chair of The Initiative on the Future of Health and Economic Resilience in Africa (FHERA) lamented that attention to the quality dimensions in health systems has increasingly lessened, resulting in unnecessary deaths despite improved access to healthcare facilities.

Instead, the last 20 years have seen global health aided by huge external finances expand access to the social determinants of health and services including vaccination, antenatal care, HIV, and malaria, saving millions of lives from infectious diseases, he said.

But the degree to which health services for individuals and populations increase the likelihood of desired health outcomes has remained poor.

“We have not done well in terms of measurement of quality…Quality health system optimises health by consistently delivering care and that care improves or retains health and is being valued and trusted by all people and is able to respond to changing population needs,” Pate said speaking at the inaugural memorial lecture for late professor Emmanuel Elebute, former chief medical director of the Lagos University Teaching Hospital (LUTH).

According to him, the 21st-century health system should seek to improve performance on dimensions of quality including safety, effectiveness, patient-centredness, timeliness and efficiency.

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Quality through the lens of the health system, especially safety, should be seen as the responsibility of the entire health system rather than individuals or groups within the health system.

He said high quality health systems are underpinned by full values such as people-focused equity, local specificity and resilience. For him, people shouldn’t just be beneficiaries of health systems. There should be accountability to ensure the quality of services served is one that matters to people.

“Our efforts to build a high-quality health system must be contextualised. I don’t think it is realistic to expect our healthcare system to get to the level of another healthcare system that spends maybe 10 times or 50 times what we are spending. But at least, even where we are, we should try to improve our system” the Julio Frenk professor of Public Health Leadership said.

As part of his vision to entrench quality improvement and safety in the delivery of healthcare in Nigeria mainly through training and accreditation, the late professor Elebute founded the Society for Quality in Healthcare in Nigeria in 2006.

His idea was that Nigeria could beat core challenges in healthcare by promoting quality, empathy, ethics, finance, infrastructure, knowledge of clinical and preventive medicine, and synergy between private and public institutions.

He believed that empathy was lacking practices because most providers see their patients more as statistics than people. Due to this, he ensured that SHQN standards for accreditation have a chapter on empathy, the first of its kind in Nigeria.

Also backing the need for quality improvement, Bamgbose the clinical director, St Nicholas Hospital, Lagos said no institution, public or private, should exist without going through some form of certification.

He observed that the quality of processes in health systems have been taken for granted when it should be leveraged to enhance safety standards and outcome.

On his path, Adedamola Dada, the chief medical director of Federal Medical Centre, Ebute Metta, said patient feedback is one of the measures he has used to measure patients’ satisfaction with the hospital’s services. It led to internal questioning and demand for external auditing.

“That was what led us to Pharm access. We encouraged them to walk through our hospital and then present a report. It became obvious that we had not scratched the problem at all. We signed a pact and set up processes to support the implementation of the program. Today, we have a department of quality,” Dada said.

“The good thing is that it then provided us with measurable factors. If you don’t have the measurable indices, sometimes it is difficult to track progress.”