INCREASING NEGLIGENCE IN AFRICA’S MEDICARE INSTITUTIONS BY NOAH AJARE ESQ,

INCREASING NEGLIGENCE IN AFRICA’S MEDICARE INSTITUTIONS BY NOAH AJARE ESQ,

INTRODUCTION

In most African countries, the health sector is in crisis. Staffing and resourcing remain serious problems in all aspects of health care, whereas, the federal Government of nations remains at abysmal level towards the development of the institutions, in terms of poor funding of public health functions and research. Most part of African countries are regarded as developing nations hence, the negligence is on the increase as occasioned by several factors such as poor leadership, poor budgeting, poor health educational research, lack of government Medicare programmes, amongst others. 

A recent study on patient safety in Kenya revealed that less than 5% of health facilities, both public and private, have attained the minimum international standards of safety. Although such studies are rare, there is reason to believe that the same picture prevails in most of SS Africa.

The quantity rather than quality of health services has been the focus historically in developing countries, ample evidence suggests that quality of care (or the lack of it) must be at the center of every discussion about better health. For example, it was noted that pediatric care in Papua New Guinea, 69 percent of health center workers reported that they checked for only two of the four examination criteria for pneumonia cases. Only 24 percent of these workers were able to indicate correct treatment for malaria. When clinical encounters were observed at aid posts, providers met minimal examination criteria in only 1 percent of cases. In a study in Kenya, only 56 percent of providers met an acceptable diagnostic standard for viral diarrhea, and only 35 percent met the acceptable standard for treatment.

Definition of Medicare and Institutional Negligence

Health systems provide health actions—activities to improve or maintain health. These actions take place in the context of and are influenced by political, cultural, social, and institutional factors. Demographic and socioeconomic makeup, including genetics and personal resources, affect the health status of individuals seeking care. Access to the health care system is required to obtain the care that maintains or improves health, but simple access is not enough; the system's capacities must be applied skillfully and the institutions responsible for the provision of quality Medicare up and doing. Quality in this context means optimizing material inputs and practitioner skill to produce health. As the Institute of Medicine defines it, quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

On the other hand, Negligence, means the failure, on the part of a medical practitioner to exercise reasonable degree of skill and care in the treatment of a patient. If a doctor administers medical treatment to a patient in a negligent manner and causes him harm; and negligence on the part of the federal government to regulate the health care sector at the detriment of its citizen especially in the areas of health care budget, funding, health research programmes, among others.

INCREASING NEGLIGENCE OF MEDICARE

The process of providing care in developing countries is often poor and varies widely. A large body of evidence from industrial countries consistently shows variations in process, and these findings have transformed how quality of Medicare is perceived. A 2002 study found that physicians complied with evidence-based guidelines for at least 80 percent of patients in only 8 of 306 U.S. hospital regions. It is important to note that these variations appear to be independent of access to care or cost of care: Neither greater supply nor higher spending resulted in better care or better survival. Studies from developing countries show similar results. For example, care in tertiary and teaching hospitals and care provided by specialists may be better than care for the same cases in primary care facilities and by generalists.

One explanation for variation and low-quality care in the developing world is lack of resources. Limited data indicate, however, that high-quality care can be provided even in environments with severely constrained resources. A study in Jamaica, which used a cross-sectional analysis of government-run primary care clinics, showed that better process alone was linked to significantly greater birthweight. A study in Indonesia attributed 60 percent of all perinatal deaths to poor process and only 37 percent to economic constraints.

Cross-system or cross-national comparisons provide the best examples of the great variation in clinical practice in developing countries. In one seven-country study, researchers directly observing clinical practice found that 75 percent of cases were not adequately diagnosed, treated, or monitored and that inappropriate treatment with antibiotics, fluids, feeding, or oxygen occurred in 61 percent of cases. Another study compared providers' knowledge and practice in California and FYR Macedonia, using vignettes to adjust for case-mix severity. Although the quality of the overall or aggregate process was lower in FYR Macedonia, a poor country, the top 5 percent of Macedonian doctors performed as well as or better than the average Californian doctor.

In a study commissioned for this chapter, an international team measured quality in five developing countries (Ethopia, DR Congo, Nigeria, Liberia, and the Somalia), using the same clinical vignettes at each site. The team evaluated the process for common diseases according to international, evidence-based criteria. Quality varied only slightly among countries. The within-country range of quality of doctors was 10 times as great as the between-country range. Such wide variation strongly suggests that efforts to improve health status must involve policies that change the quality of clinical care.

Preventing Medical Malpractice (Medicare) and Institutional Negligence in Africa

In Africa, and especially following the enactment of series of laws and policies programmes, which gives all citizens the right to access quality care and free access to emergency services, there has been an unprecedented increase in media coverage of medical malpractice complaints from the public, ranging from clinical care processes gone wrong to complaints of outright unethical practices and behaviours. The media coverage is merely a response to an increased public awareness, concern about and demand for information on how the health system is performing, and an interest in knowing what those in authority are doing to ensure that health services are provided in a safe and humane manner. 

As a result, the Medical Practitioners in most countries and other regulators in the health care sectors have had to constantly engage the media to respond to complaints and explain what it is doing to dispense justice and improve the health situation. 

This sudden demand to detailed information on malpractice cases would put any health regulator under massive pressure, especially considering that healthcare providers in most of Africa have largely remained autonomous, with little scrutiny from the public.

Although some regulators and other institutional medical bodies has so far responded to these reports of increasing negligence with clarity, thanks to an earlier collaborative effort with the World Bank Group’s (WBG) Health in Africa Initiative. Some African countries have taken time to explain the nature and characteristics of the cases, and outlined mechanisms that have been put in place to streamline the processes and protect both the public, private and the practitioners. 

For Instance, in Nigeria the Ministry of health engagement with the WBG started in 2012, when the organization asked for the World Bank Group (WBG) to help streamline the medical malpractice system. Prior to that, there was no formalized mechanism for classifying and tracking malpractice cases from the time of reporting to conclusion, yet there was evidence that the frequency of complaints was increasing. Also, the National Health Insurance Programme was set up some years back to subsidized that cost effects on the public; subsequently, the WBG agreed to: one, review and fairly/justly conclude the backlog of 736 cases dating back 15 years, and give recommendations on processing of future cases; and two, analyze the case patterns and malpractice processes and develop recommendations on changing the reporting and processing systems to make them more responsive to the public. The two activities would culminate in the development of a new framework for receiving, processing and reporting medical negligence claims.

As a result, the ministry and the WBG developed a report showing the nature and characteristics of past negligence complaints and recommending an appropriate classification system based on past experiences; a framework for receiving, processing and reporting malpractice complaints, all linked to other organization functions, including licensing and the implementation of Continuous Professional Education; and finally, proposals for amendments to the Disciplinary Rules; Assessment, Training and Registration Rules; and Inspections and Licensing Rules under the Medical Practitioners Act.

Conclusion

Good quality means that providers are able to manage an individual's or a population's health care by timely, skillful application of medical technology in a culturally sensitive manner within the available resource constraints. Eliminating poor quality involves not only giving better care but also eliminating under provision of essential clinical services (systemwide microscopy for diagnosing tuberculosis, for example); stopping overuse of some care (prenatal ultrasonography or unnecessary injections, for example); and ending misuse of unneeded services (such as unnecessary hysterectomies or antibiotics for viral infections). A sadly unique feature of quality is that poor quality can obviate all the implied benefits of good access and effective treatment. At its best, poor quality is wasteful—a tragedy in severely resource-constrained health care systems. At its worst, it causes actual harm.

Despite the urgency of improving health in developing countries, quality of care has been largely ignored. Both providers and patients agree this must change, but how can this goal be reached? From the information marshaled for this chapter, we can draw five conclusions:

·        Better quality leads to better health outcomes in developing countries.

·        Process, the proximate determinant of health outcomes, can be measured in valid and reliable ways, such as clinical vignettes and electronic medical records.

·        Measured in the above ways, the process of care in developing countries is poor.

·        The process of care can be improved in the short term.

·        Policies affecting structural conditions, including the actual process of care or the continual design and redesign of the health care system, have been shown to be effective in developing countries.

We believe that two broad strategies would help to rapidly improve health care quality in developing countries:

·        encouraging explicit comparative research on outcomes and process

·        disseminating empirical findings on quality variation.

NOAH AJARE E