Summary: Hangout Sessions

This is the output of 3 Google Hangout sessions we ran with healthcare administrators, medical practitioners and patients to understand their experiences and frustrations with the healthcare delivery system in Nigeria.

You can watch the Hangouts here:

Healthcare Administrators – http://www.youtube.com/watch?v=rXmzzPDw6b4

Medical Practitioners – http://www.youtube.com/watch?v=kTqZtgWf4tQ

Patients - http://www.youtube.com/watch?v=nJaQmMLLsTk

Background

Hangout 1- Frustrations of Nigerian Healthcare Administrator

Managing Hospital Records All our records are manually inputted and stored on paper Our filing system is complex with so many files over the years Medical records, patient history and case notes often get lost

Low bed occupancy less than 25% The hospital runs for 24 hours with less than 20 patients coming in Hard to balance the books without overcharging patients

Capacity Utilization

Hangout 1 - Frustrations of Nigerian Health Administrator

Hard to keep track of which drugs and equipment we have/need It takes longer to replenish stock so things finish Purchase approval takes time and payment can also be delayed

Inventory Management & Purchase Policy

Getting Paid Efficiently Financing of healthcare needs revisiting as staff have to contend with

patients not paying bills The NHIS should also be computerized to make it easier for hospitals to

facilitate claims Contribution collection from HMO and NHIS Verifying what hospital claim for treatments.

The location of hospitals affect uptake of our service

Some locations have too many hospitals

Some locations have too few hospitals

Location

Hangout 1 - Frustrations of Nigerian Health Administrator

Our business is not sustainable. We spend more than we make.

We do not go out to market like other businesses

Hospital as a Business

Hangout 2- Frustrations of Nigerian Medical Practitioners

The Hospital Environment Not sufficiently clean and organized to allow efficiency and comfort for

health workers and patients

Patient information is captured on cards and paper which are often not stored properly and hard to retrieve

Medical records, patient history and case notes often get lost Multiple records across different PHCs and even within the same tertiary

centre The details of services delivered at home are often times not properly

recorded and synchronized with patient files

Patient Records

Hangout 2- Frustrations of Nigerian Medical Practitioners

Doctors are not aware what drugs are available in pharmacy and often prescribe drugs that patients cannot get conveniently if at all

Drug Availability

Paper shortages means doctors to have to source their own paper to capture consultation details

Basic equipment not available to carry out necessary tests to aid diagnosis Maintenance of hospital facilities and equipment is often shoddy

Material Shortage

Appointment booking all done manually often with errors in reconciliation Referral process for tertiary centres also causes confusion as often PHC

doctors do not know the appropriate clinic day Clinics start late sometimes as much as 3 hours in a bid to retrieve patient

records amongst other factors

Appointment and Referrals

Hangout 2- Frustrations of Nigerian Medical Practitioners

Personal safety concerns for practitioners who have to carry out home visitsHome Service Hazards

Hazard from contact with patients with contagious diseases with no compensation

Freedom to save lives in emergencies (gunshot wounds) without fear of repercussions

Safety and Risk

Promotion should also not be about time spent in the system but about competence

Process of nurse qualification and recruitment should be reviewed

Recruitment and Progression Conditions

Communication within hospitals can also be a nightmare with staffers having to use their personal phones

Communication

Hangout 2- Frustrations of Nigerian Medical Practitioners

A profession in healthcare is now more an economic choice rather a choice based on love and interest

A loss of compassion and empathy by healthcare practitioners

Hangout 3- Experiences & Frustrations of Nigerian Patients

Cost of treatment is most likely going to be out of pocket There is no time available to go to hospital until it is a crisis Loss of confidence in the system

What stops us going to hospital before it becomes a crisis?

Hangout 3 - Frustrations of Nigerian Patients

Google, my mother, nurse or doctor I know, church (faith)Source of medical information

I call my mum or a doctor/nurse I know I pray I self-diagnose and go to the chemist for drugs I think will work I google what I think the cause is and seek treatment

What I do when I feel unwell?

Hangout 3 - Frustrations of Nigerian Patients

Not enough information given about my condition and treatment Doctors get offended when you ask for more information or demonstrate

that you know Not clear if the diagnosis and treatment are correct – no opportunity for

second opinion on everything

Why have we lost confidence in the Nigerian health system?

Unclear how to choose the right hospital to use Lack of clarity on the competency of medical practitioners - “Is my doctor

actually a male nurse?”

Competency Unclear

Not Enough Information

Absence of the appropriate equipment and no way to know this Power cut while operation is happening and back-up generators not

functional

Ill-equipped Hospitals

Hangout 3 - Frustrations of Nigerian Patients

Health emergency lines are not known by most people In emergency, how do I know where to go for appropriate treatment to

reduce time spent looking for the right hospital Hospitals refusing to treat emergency cases without being paid first

Help in Emergency Situations

Why have we lost confidence in the Nigerian health system?

Poor quality service at the different touch points in the healthcare centre The attitude of medical personnel when they deliver information - "how you

say it not what you say” Hospital staff can be rude to you Literacy and age can lead to acceptance of bad service without complaint Patient education on the quality of service they have the right to expect People jumping the queue based on who they know or who they “settle”

Poor Quality of Service

Hangout 3 - Frustrations of Nigerian Patients

Lack of signage especially in large tertiary centers make them a nightmare to navigate

The hospital processes and procedures can be long, complex and hard to understand even for literate people

Too long waiting times at every stage of the process - registration, for consultation, getting test results etc

Complex Process

Why have we lost confidence in the Nigerian health system?

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