Long waits, rude staff, bureaucracy, top complaints against public hospitals– BRIU Report

Long waiting hours, bureaucracy in hospitals, and impoliteness of nursing personnel have been identified as the most pressing problems patients seeking health care in public hospital face. 

The findings are part of a survey contained in a report available from BusinessDay’s Research and Intelligence Unit. The survey pooled the opinion of almost 3,000 Nigerians. 

 According to the report, “a number of factors are responsible for the dissatisfaction respondents face with public hospitals. The most prominent of which is the long waiting hours 85% of respondents experience as they try to access care, also prominent is the impolite behaviour of nurses and ancillary staff at public health institutions (61%). Excessive bureaucracy was identified as a big problem by 53.1% of respondents, while unavailability of doctors was also pointed to as an issue with the system.” 

Least among the concerns of respondents who patronise public hospitals is pricing of services; which respondents consider as very cheap and affordable. “On the flip side, the relative affordability of care in the public health system could be partially responsible for the long waiting hours patients have to endure. It could also explain the behaviour of nurses and ancillary workers who have to process a long retinue of patients daily” the report opines.

Nigeria’s medical personnel-to-patients ratio falls far below WHO recommendation. As at 2013, the doctor-to-patient ratio of Nigeria was 1:6,400 as against the World Health Organisation (WHO) standard of 1:600.  Medical schools in the country graduate between 2,500 and 4,000 doctors annually which is low for a country with a population of over 170 million people. The WHO recommends a nurse-to-population ratio of 1: 700, but according to the Open Journal of Nursing, 2014, Nigeria has less than 150,000 registered nurses. 

Insiders in the public hospital system point to such legitimate activity as necessary checks of samples, blood pressure, etc as responsible for the delay which patients experience. “There is also this notion that doctors in government hospitals are more experienced” says a doctor with a teaching hospital who commented on the issue. 

Friday Okonofua, a professor of gynecology at the University of Benin and a member of the Board of Trustees of the Women’s Health and Action Research Centre, says “the major problem is that about 40% of doctors we train locally are going abroad because of better remuneration and better working environment. Also, there are les recourses devoted to training doctors in the country, especially in public training institutions.  What happens these days is that even when players in the private sector set up institutions to train doctors when members of the Nigerian Dental and Medical Association inspect such institutions, they are forced to approve it for very few students”. 

BRIU’s survey shows a direct contrast between the experiences of those who patronise private and public hospital. In reference to services in private hospitals, the major turn-off for patients is high cost (88% of respondents said this). They also express concern about the unavailability of the right drugs within private hospitals (patients have to get what is required from pharmacies). Also, compared to the public health system, in the private system, nurses are more polite, bureaucracy is less, and the state of hygiene is better. 

BRIU’s report also focuses on key aspects of the health sector including HMOs, efficiency of NAFDAC’s drug authentication system, medical tourism, the disease burden, federal medical budget, and the economy.