Travails of Nigerian patients at private diagnostic facilities

By Paul Adepoju

A twenty seven-year old male attended a government-owned hospital in the southeastern part of Nigeria with a chronic cough and weight loss.

Through the help of the hospital’s laboratory, the patient was diagnosed with pulmonary tuberculosis and the consulting physician placed him on AntiCocks.

Some weeks later, however, he returned to the same hospital with abdominal pains. Further investigations were requested – lab and imaging.

But this time, members of the Joint Health Sector Workers Union (JOHESU) were on strike which meant the only option was to refer the patient to a private diagnostic centre in the metropolis for ultrasound imaging.

The inconclusive result showed the patient had aortic aneurism.

Although the patient did not know what aortic aneurism is all about, he went online and got scared when he read a Wikipedia article on the subject. He ran to his doctor and presented the result to him.

Knowing the severity of the diagnosis, a departmental meeting was hurriedly convened. They brought in one of the country’s best ultrasound experts who volunteered to re-conduct the investigation.

The second result showed there was no aortic aneurism.

The first investigator was summoned and he apologised profusely, putting the blame on his inexperienced intern.

This is a familiar story that healthcare professionals across Nigeria, especially those working with government-owned hospitals, can relate to and the frequency is increasing even as more strikes are recorded annually, thus forcing hospital managements to allow patients to visit private medical diagnosis facilities for treatment – even though they cannot totally vouch for results gotten from the private centers.

‘We have no choice but to accept those results because the labs we can vouch for are shut, yet patient care must continue,’ a top board member of a major teaching hospital in southwest region of Nigeria said.

‘Whether workers are on strike or not, patients will be sick and our job is to take care of them to the best of our ability – and with what we can get even when the results of investigations are not reliable enough,’ he said.

The quality of private healthcare practice has been a serious subject in medical discourse in Nigeria and elsewhere.

In February, online health news platform HealthNewsNG.com reported that out of over 10 000 medical laboratories in Nigeria, less than 3000 got licenses to operate from the Medical Laboratory Science Council of Nigeria.

This simply means that 70% of laboratories in Nigeria, and by extension other diagnostic centres, don’t have operating license.

Yet the private health facilities continue to get patients and samples from public health facilities, especially when government health workers are on strike.

‘Some of those that even have operating licenses, some of the very big names in Nigeria’s private diagnostic industry cannot be totally trusted to provide reliable results because some of them outsource tests to the small mushroom ones,’ said Tobi Lala, CEO of Khairos Labs, a new diagnostic company that provides medical investigation services to patients in the comfort of their homes.

Resource management Lala believes that private diagnostic centres are fond of extremely managing resources because their goal is not primarily patient care but to make profits.

‘Let’s not forget that unlike government’s hospitals that were set up just to provide citizens with access to quality healthcare, private diagnostic centers have one primary aim – to make profits and we’ve seen so many ridiculous ways some of them are going about making profit,’ Lala said.

He noted that several of these profitmaking strategies totally negate the tenets of good clinical practice and principles of quality assurance.

‘This was one of the reasons why we launched our services – to connect patients to the very few private facilities that are offering reliable diagnostic services,’ he said.

Investigations revealed that some of the private health diagnostic centres go as far as using archaic methods that have been extensively declared non-specific to make diagnosis and recommend treatment actions.

‘Some of them generally adopt methods that are inexpensive and would allow them to make profits but at the detriment of the patient,’ Lala said.

Public-private partnership failed As a way of tackling this development and to ensure that qualitative diagnosis could be achieved even when the labs, radiology and other diagnostic departments are shut due to strikes, many hospital managements had been involved in various forms of publicprivate partnerships (PPPs).

The University College Hospital Ibadan is one of such.

It set up a PPP laboratory hoping it would be able to process samples even when the hospital is on strike. However, the doors of the PPP lab is slammed shut anytime the health workers are on strike.

‘Such strategy would not work as long as health workers in the hospital are the ones being engaged in such PPP arrangement because they are members of a professional body which could ask its members to go on strike any time,’ said a top ranking member of the Association of Medical Laboratory Scientists of Nigeria.

This simply means any strategy that entails using government health workers to work in any private arrangement would not be very effective.

The other option would be for private medical facilities to employ well trained and appropriately qualified personnel. This also has its limitations.

‘The cost of employing several qualified professionals is largely not something that owners of private facilities could afford.

Take for instance the kinds of choices that the owner of a diagnostic center would have to make when it comes to recruiting staff.

Even though they all know the appropriate persons to employ, they largely don’t do it – instead, they employ under-qualified persons to man the labs because they cannot afford the professionals.

A similar thing is happening in imaging and other aspects of healthcare.

Even nursing is not exempted,’ said Tobi.

He noted that this development could be the reason why several results that are issued by the private practitioners are left as inconclusive, suggesting further tests in order to make more money from the patient or as a way of protecting themselves against lawsuits.

Way forward A cross section of health workers that responded to an inquiry about the negative impacts of the activities of private diagnostic centres on the quality of patient care said they are aware of it, but the responsibility is more in the hands of the government through the various regulatory agencies and the management of the various hospitals.

‘There are professional bodies and regulatory councils that are originally saddled with the responsibility of ensuring that healthcare facilities, whether privately or publicly owned, adhere strictly to appropriate codes of conduct, attain a certain level of quality assurance, and employ duly qualified personnel.

‘I believe when such laws are enforced, we will be able to identify the private practitioners that are posing real threats because as hard-to-believe as it may seem to be, there are still private practitioners that provide reliable results.

Those ones should be the ones that the agencies should spare,’ the hospital board member said.

Taking the conversation further, Lala said the long-term solution would be for the government to avert strikes and crises that could make it impossible for patients to get diagnostic procedures done at government hospitals.

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But in the short-term, he said each hospital should come up with a list of private healthcare service providers that they can trust.

‘Such list should be made available to the consulting physicians.

Now I’m not talking of the contact details of labs and investigation centres that would give a member of the hospital board some commission at the end of the month. No.

What I’m talking about is to seek those private practitioners that are responsive and responsible.

This is the only way we can ensure that patients don’t suffer excessively for the country’s inability to run an efficient healthcare system,’ he said.