Has the Nigerian patient been “Failed by Angels?”

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This week in Abuja the Centre for the Right to Health (CRH) will hold the premiere of an advocacy documentary, “Failed by Angels,” which highlights the exploitations of patients’ rights in the Nigerian health system, especially during maternity care. CRH is a non-profit that envisions a Nigeria where quality healthcare is available, affordable and accessible and where patients are treated with dignity and their human rights respected irrespective of sex, age, status or disease condition. CRH also offers Nigerians a platform for reporting patients’ rights violations, and Executive Director Stella Iwuagwu said the organisation is working in partnership with the Nigerian Bar Association and reporting agencies to help provide assistance to those whose rights have been violated.

Photo Courtesy: CRH Nigeria
Photo Courtesy: CRH Nigeria

There seems to be some unspoken agreement in Nigeria that customer service must by default be terrible, both in public and private institutions. From the telecommunications staff who spends time chatting on her phone while you are standing right in front of her to the bank clerk who has better things to do than pay attention to your request for assistance, and who in fact gets angry if you insist on him doing his job, we seem to live in a society where the customer, who is paying for the service, is at the bottom of the “consideration-chain.”

This dilemma is ever more glaring in the Nigerian health sector, where those rendering the service are also educated as professionals in their various fields – a privileged education, often funded substantially by taxpayers. So very often in Nigeria, patients, the clients of the health system, are treated as if they are enemies of the doctors and other health staff, and have come to deprive them of their time. With increasing access to communication platforms, Nigerians are also becoming more open to sharing their stories. One poignant story that always hits home is that of a woman who told our team that because she was HIV Positive, when she was giving birth at the health centre the nurses would not come near her. She said they stood at a distance and yelled at her to push her baby out by herself. She ended up with vaginal tears and deeply traumatised by the event. It is unfathomable that a woman at such a vulnerable period as the point of birth should be shunned by the health workers who are trained to assist her simply because of her HIV status.

Health workers performance evaluations should take into consideration their patient care approach. Photo Credit: Nigeria Health Watch
Health workers performance evaluations should take into consideration their patient care approach. Photo Credit: Nigeria Health Watch

Why do cases like this continue to happen? It’s probably as a result of a lack of consequence. No one is suing health professionals and winning big money for malpractice cases. Many hospitals are not being held accountable. In the public health system, many doctors’ salaries are not tied to their performance, and more specifically, not tied to patient satisfaction. Also, many patients adopt a nonchalant, fatalistic attitude with the belief that even if you report, nothing will be done. And so nothing gets done.

We have written extensively about the National Health Act, which was signed into law in 2014 and lays out the rights of Nigerians when it comes to the health sector. We all celebrated the passing of the Act as a great achievement for health sector advocates. Two years later, implementation is yet to start. Organisations like ONE Campaign have recently led petitions, the Nigerian Medical Association has protested to the Senate, aware that the very existence of the law without implementation opens doctors up to potential lawsuits, and the continued delay has now led to this lawsuit by the Centre for Social Justice (CSJ), which is taking the Federal Government to court over alleged refusal to execute and implement Section 11 of the Health Act.

National Health Act Infographic 1

At the bottom of all of this… is the patient. At the heart of the whirlwind of policy intrigues are people, people whose rights are being denied, patients who again are at the lowest rung of the consideration chain.

Iwuagwu of CRH maintains that reporting patients’ rights violation is critical for accountability. “It is important that patients know their rights and seek redress when their rights are violated,” she said. “Reporting patients’ rights violations is a first step to triggering investigations and holding health professionals and institutions accountable. Not reporting and redressing patients’ rights violations will breed impunity and worsen the health system.”

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Also happening this week in Abuja is the 1st Nigerian Medical Law Summit, hosted by the Senate Committee on Health, in collaboration with First Counsel Solicitors and Medical Tutors Ltd. Themed, “Creating a Medicolegal Environment in Nigerian Hospitals,” the Summit aims to emphasize the need for clinical governance and quality care issues in the Nigerian health system and is targeted to bring together an intersection of Medical Directors and other health personnel, policy makers and legal practitioners.

The Medical Law Summit, the CSJ lawsuit, and CRH’s “Failed by Angels” documentary premiere are just faces of the continued struggle to put the patient at the centre of healthcare in Nigeria. The enabling laws are in place, the desire of Nigerians for something better is in place, and the awareness that they deserve, by law, much more than they currently have, is growing. Sooner or later this camel’s back will break.

If attitudes of many health care professionals to patients do not change, will potential legal action be the next best option? The truth is that we must change the narrative that relegates the patient to the bottom of the consideration chain. It simply cannot continue to be our predominant story.

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