My phone beeped at 1 a.m. The text message from my sister was brief: “Daddy is in the hospital.”
A quick call established that they had spent the past five hours trying to get my 65-year-old dad – who had severe headache and delirium – admitted into the emergency ward of a government hospital in Lagos.
My father is a doctor who has given over 35 years of his life to the Nigerian healthcare system. Yet, he was at the brink of death – not because his ailment was incurable but because treatment was being delayed with hurdles set by poor hospital management and lack of staffing.
When he was finally admitted, he was put on an unclean bed without a bedspread. A hospital staff member screamed at the family to get their own bedspread, as there was none available due to crowding in the wards.
We could explain this away by saying “It’s the pandemic”. But Nigerians will tell you that this is a common occurrence in many government and primary healthcare centres in Nigeria.
Nigeria has a deficit in the number of qualified doctors: the country needs about 237,000 doctors to ensure the population’s health needs are catered for but currently has only about 35,000. Each day it loses doctors to foreign hospitals, as they leave in search of better salaries or, given the number of unpaid staff, any salary at all.
In addition, our healthcare system already struggles with more patients than hospital beds – which was true even before the pandemic. Compared to the global average of 26 hospital beds per 10,000 people, we have just five. We are talking of about just 134,000 beds to a population of 211 million people. The United Kingdom, which has less than half of Nigeria’s population with just 68 million people, can boast of over 170,548 hospital beds.
The COVID-19 pandemic is not to blame for the state of our hospitals or how we treat patients. The pandemic has merely opened our eyes to the preexisting problems.
And one of these is proper hospital management.
While we were relieved that we got our father a bed, we were met with a sleep-deprived intern assigned to administer care to him. The doctor had been on a 72-hour weekend call and was obviously exhausted.
But the hospital was short staffed, so he had to do the work of three interns. He told us to wait another 24 hours to see the consultant.
We were later told that my dad had suffered a stroke. It was clear that a single further delay in administering care could take his life.
Although my dad survived the hours of waiting, many others do not.
Earlier this year, a woman died in Lagos after being turned down from different hospitals due to the lack of bed space. My dad was also turned down by many hospitals until we called someone who could assist.
Ironically, days after struggling to get him admitted, we had to wait for over three days to get him discharged. While it is not unusual for hospitals to delay discharging patients who have not paid their bills, this delay was because the attending doctor was too busy to sign the release form.
Good management of government hospitals is an important aspect of making healthcare accessible by everyone in Nigeria. We have more premature deaths due to hospital delays and lack of organisation than sickness.
When Nigerians are faced with life threatening emergencies, we already have huge out-of-pocket costs to worry about. Families should not also be concerned about getting a bed – or even clean sheets for that matter.
When we talk about the challenges within the Nigerian healthcare system, we are often quick to criticise the government or the health workers dealing directly with patients. But what about the people whose job it is to ensure the efficient functioning of these institutions? Poor management and organisation will equal lead to poor patient care.
We must take action now to ensure more administrative strength in our health institutions. Here are few ways we can:
First, medical schools should incorporate management skills into the curriculum for future healthcare professionals: As we are teaching our healthcare students to handle the worst clinical scenarios, we should also teach them how to take executive decisions. These are the people who will end up managing our hospitals. Implementing this now is important to get them ready for the leadership challenges of our healthcare system.
Second, health regulatory and licensing boards must ensure all hospital administrators are enrolled in continuous programmes that will build their leadership abilities, people skills and critical thinking; managing a hospital demands great people-handling skills, problem solving and emotional intelligence. A deep knowledge of our healthcare system is not enough to run a hospital and keep employees on track.
Third, government hospitals should create mentoring opportunities for hospital administrators. Mentoring can help them learn from other administrators globally. This allows for them to share skills and institutional knowledge. It also creates room for thoughtful feedback and support.
Fourth, the Ministry of Health needs to create a centralised monitoring system that ensures standard delivery of care at all levels. This will ensure a smoother processing of patients through the system, with quicker admissions and discharge times. Discharging at the right time means more bed space; and more bed space means more money for hospitals.
Yes, the Nigerian health system needs a whole lot of work to be done but let’s start with good management, so that families can have better experiences and quality care.
If we cannot trust our hospitals to provide bedspreads, how can we trust them with our lives?
Adekemi Adeniyan is a rural dentist breaking down barriers to oral health for underserved communities to ensure equitable health access for all in Nigeria. Follow her on twitter @PstDrKemi
