By Victor Okeke
Health care systems worldwide are striving to improve the quality of healthcare in an atmosphere of evidence based healthcare. However, because of all the changes in healthcare, the ways in which quality is perceived, pursued, and insured continues to develop. The process of development coupled with increasing liberalisation and globalisation has enabled health seekers to realise their increasingly important role in the healthcare delivery chain. Perhaps, that was why in their wisdom, the drafters of the Nigerian Health Act envisaged a standardisation process. Specifically, the National Health Act 2014 provides that a health institution must have the Certificate of Standards before it can offer health services to Nigerians.
The Act in sections 13 and 14 state as follows: “(1) Without being in possession of a Certificate of Standards, a person, entity, government or organisation shall not :- (a) establish, construct, modify or acquire a health establishment, health agency or health technology; (b) increase the number of beds in, or acquire prescribed health technology at a health establishment or health agency; (c) provide prescribed health services; or (d) continue to operate a health establishment, health agency or health technology after the expiration of 24 months from the date this Bill took effect. (2) The Certificate of Standards referred to in subsection (1) of this section may be obtained by application in prescribed manner from the appropriate body of government where the facility is located.
In the case of tertiary institutions, the appropriate authority shall be the National Tertiary Health Institutions Standards Committee, acting through the Federal Ministry of Health. 14. Any person, entity, government or organisation who performs any act stated under section 13 (1) without a Certificate of Standards required by that section is guilty of an offence and shall be liable on conviction to a fine of not less than N500,000.00 or in the case of an individual, to imprisonment for a period not exceeding two years or both”. Until date, the modalities for the implementation of the above provisions of the law are still in the nascent stages or abandoned. The implication of this is that all health establishments operating in Nigeria, from the teaching hospital to the primary health care centre, are operating illegally. If this provision of the Act had been implemented to the letter, over 80 per cent of our health institutions would have failed to secure accreditation and would have been denied the certificate of standards. The implication would have been manifest on two fronts. The first is that the institutions would have been closed so that they are stopped from rendering substandard services and the second would have crystallised the government’s obligation to fund the establishments. Where the establishments are privately owned, the owners would also be compelled to adequately provide funds to ensure that they meet the requisite standards. Definitely, there would have been a pushback from the populace for the government to fund the establishments if so many of them failed the assessment.
If the available health establishments had been assessed in accordance with the law and duly certificated, we would have had establishments with the requisite human resources, equipment, drugs, accessories, funding and management to mount an effective push back to any pandemic. Technically, the country is due to collect the sum of N500,000 fine per health establishment multiplied by the number of uncertificated establishments in the country. The accruing money will be in the billions of naira. Since after COVID-19, quality management has become a major concern in the delivery of health care. Concerns about increasing costs combined with an increasing appreciation of the variability in health care delivery practices has led to the development of strategies to better standardize health care delivery.
Quality health care means doing the right things right. Standards of practice will continue to evolve. New diagnostic and therapeutic interventions are continually being developed. Benchmarking refers to the process by which performance is compared to a standard. Re-engineering refers to a fundamental rethinking and radical redesign of processes to achieve dramatic improvement in performance; when it is adapted to the healthcare delivery process, the term clinical reengineering is used. There is a need to develop valid guidelines. Public health should be concerned with not only the health and health care needs of populations but with the quality of care provided to the population. It is within the province of the Minister of Health to set machinery in motion for the implementation of the Act especially, this all important section of the Act. We believe that the time to act is yesterday and put to end the unnecessary hardship suffered by Nigerians, especially the rural and urban poor who are the most victims of access to poor healthcare services. Putting patients first is the key to improving the quality of health. The government and service providers must design and offer services that both meet medical standards and treat clients as they want to be treated.
There is only one way to know if a change represents an improvement: measurement. It is important to track both process and outcomes measures when you are working to improve. For quality improvement to have a broad and lasting impact, it must become an integral and essential part of an institution. Every member of the organization must believe that good care not only is possible but also is a top priority for them and for the organization. Making quality a top priority requires fundamental changes in organizational culture, in goals and guidelines, and in daily operations. Persistence is crucial. Quality assurance institutionalisation is an on-going process where activities related to quality management become integrated into the structure and functioning of a health care delivery system.
The challenge is to find ways to improve upon the existing situation in the health sector. A potential for improvement exists in areas including the overall costs of care, financial equity, and the quality of care. A sustained improvement in these areas would play a significant role in advancing the primary goal of health policy – health, itself.
Okeke is of the Centre for Social Justice (CSJ) Nigeria