Building a responsive healthcare system - A Nigerian experience

A healthcare system must be responsive to the needs of its clients, and this entails elements such as dignity, confidentiality, autonomy, prompt attention, social support, basic amenities, and choice of provider. This is targeted toward improvement and maintenance of the quality of healthcare with consequent improvement in patient outcomes at a reduced cost.

The aim of this study is to articulate the approach that was adopted by the Federal Medical Centre, Ebute-Metta, Lagos, Nigeria, to confront some of the challenges faced by the health sector in Nigeria and make recommendations for the future.

To identify and solve the problems mitigating quality service delivery in the hospital over an initial 18-month period, the management deployed the following tools: (i) mystery shopping; (ii) patient experience survey; and (iii) quality improvement using the SafeCare methodology.

The diagnosis identified the following problems: (i) service failure; (ii) financial and material leakages; (iii) challenges of human resources - poor attitude, indiscipline, inadequacy, and poor understanding of roles; (iv) infrastructural deficit and dilapidation; and (v) absence of technological support. The baseline quality assessment conducted with the SafeCare Standards gave a score of 45%, while performance at the follow-up quality assessment was 69%.

As a direct result of the findings, the hospital designed an 18-month renewable strategic plan premised on five pillars: (i) human resources development; (ii) improvement of quality of service; (iii) expansion of services and infrastructure renewals; (iv) financial re-engineering and partnership; and (v) appropriate utilization of technology. Through this policy redirection and constant re-evaluation, our quality improvement journey continues to yield desired positive health system outcomes. We recommend collaborative quality improvement initiatives with strong internal political will that can harness both the institution's resources and independent experts on health system development.