The challenges are great, but the Nigerian people are resilient and determined
Not far from Nigeria’s capital of Abuja, in the town of Mararaba, there is a hospital that for more than 20 years has been facing the challenges of healthcare in Nigeria head on. Dr. Godwin Obute founded the Adonai Hospital to address the multi-pronged problems of understaffing of public hospitals, the inaccessible pricing of private ones, high mortality from lack of resources, and a lack of education among the general population regarding the need for competent and timely preventative and acute medical care.
Medical Advances have not been Delivered to the Poor
Health care and health care systems have changed dramatically in the past half century. The technology of medical care, the ability to diagnose, prevent and cure disease, and the understanding of epidemiology have advanced rapidly. This has resulted in an unprecedented number of options for care. Therapies that were unheard of two generations ago are now routine.
Unfortunately, politics and the availability of resources to deliver these advances has not kept up with the science and technology. Medical research is expensive, and many of the new techniques and therapies are tantalizingly unavailable to the populations who need them most. This problem is global and exists even in the most advanced and developed nations, but in developing countries it is particularly acute.
Public health and the delivery of health care services has a wide range of consequences for a country or a society. It is a key component of national security, as disease outbreak, malnutrition, high morbidity and other public health issues drain resources, reduce life expectancy and have a negative impact on economic productivity. Developing countries struggle to address needs for which there is adequate technology but inadequate resources.
The Health Care Challenges in Nigeria are Acute
In Nigeria, addressing the issue of epidemics is vital. Infectious disease outbreaks occur every year, and the health care system is not well enough developed to meet all of the challenges. There are not adequate systems to track, evaluate and control epidemics. Access to better healthcare would make the population more productive and wealthy, but widespread poverty prevents many from accessing services. It is a vicious cycle experienced not only in Nigeria. Given especially that tools are already available for preventing, identifying and treating outbreaks in early stages, it is particularly urgent that such existing techniques be put into place in order to reduce the cost, risk and human misery visited upon populations by such events.
The Nigerian government has made attempts to address the issue, but in a 2009 statement from the Nigerian National Health Conference, such factors as a lack of resources and trained management, uneven distribution of the resources that are available, inadequate infrastructure, and inaccessibility on the part of the most vulnerable to existing facilities remain as challenges which are stubbornly difficult to overcome.
Public health policy in Nigeria is developed at the national level, and the Nigerian government works with hospitals, NGO’s, voluntary organizations, and individual doctors to deliver better health care. The government has built hospitals, medical schools, and health centers throughout the country. Nonetheless, at the level of actual patient care there is little coordination, and individual practitioners and hospitals set their own standards of care in accordance with their resources and the needs of the populations they serve.
In 1987 the Nigerian government launched a primary health care plan aimed specifically at improving the availability of basic services such as drugs, vaccines, and nutrition, improving infrastructure, increasing data collection and evaluation, training personnel, and addressing infant mortality. However, the program did not have the results hoped for due to inadequate human and monetary resources. Later, in 2005, the Nigerian government began the Nigerian Health Insurance Scheme with many of the same goals as before, but the resource challenges remain, and infant mortality (93 per 100,000), life expectancy (47 years), vaccination rates, and frequency of epidemics are still at unacceptable levels.
Over half of the Nigerian population lives on less than $1 per day and over half the population lives in rural areas. As a result, less than half the population has access to health care delivery. The lack of clean water and sanitation exacerbates the problem, with only about half the population having access to an improved water source, among the lowest rates in the world. Sewerage treatment systems are practically nonexistent. Electricity supply is unreliable in many areas.
In addition to poverty, Nigeria suffers from a significant brain drain of health professionals, many of whom were trained at public expense. Doctors and nurses find they can dramatically improve their standard of living by moving abroad, which creates a challenge for the Nigerian government when deciding how much of their limited resources should be allocated to prepare healthcare professionals who subsequently leave the country.
Nigeria also suffers from specific healthcare challenges in the form of a high rate of HIV/AIDS and a significant presence of hepatitis, bacterial diarrhea, typhoid fever, malaria, dengue fever, yellow fever, meningitis, Lassa fever, Ebola, and rabies. Infant mortality and a lack of prenatal care are acute problems; one million children under 5 years old die every year from diseases which could have been prevented.
Modern Concepts of Quality and Transparency are Helping the Government Tackle the Problem
In a recent interview published by the Guardian, Dr. Ado Jimada Gana Muhammad, CEO of Nigeria’s National Primary Healthcare Development Agency, described some of these issues. The doctor acknowledged that the quality of care in Nigeria has taken a step backward in recent years. He expressed his approach to solving the problem in terms that businesses understand, that is in quality improvement. Improvement in quality inspires confidence in the system, an absolutely necessary element in getting the population to increase usage rates.
Preventative care is the cheapest and most effective method of keeping a population healthy, and high usage rates are critical in implementing an effective preventative care system. In particular, Dr. Muhammed was interested in getting patients into the healthcare system early in order to administer vaccinations. This would reduce infant mortality, but even here there is the challenge of keeping vaccines cold due to the lack of reliable electricity.
Another important quality concept that Dr. Muhammed is introducing into the system is transparency and accountability. Record keeping has improved, staffing levels have increased, milestones have been set, and those responsible have been made to answer when goals have not been achieved.
Not all of the news regarding Nigeria’s healthcare has been bad, however. A program for bone marrow donation was introduced in 2012. It is only the second in Africa and will help save the lives of people afflicted with leukemia, lymphoma and sickle cell disease. Also, the pentavalent vaccine, which allows inoculation against five common deadly childhood diseases at once, is being introduced to the country.
Adonai Hospital has been Applying Quality Concepts for Years
The quality and customer oriented policies mentioned by Dr. Muhammed have been the way of doing business at Adonai since its inception. The vision of Dr. Obute in founding Adonai Hospital was straightforward: provide efficient, affordable healthcare of high quality to the people who need it the most. Over the years, the drive has been in only one direction, that of expanding the range of services, lowering costs, to serving more people, and improving quality. The challenges have been great, but the rewards even greater, and most of those rewards can be measured directly in terms of healthier people and lives saved.
The fact that the vision was simple does not mean that achieving it has been easy. Nor has Dr. Obute done it alone. Adonai Hospital would not be successful without the dedication and passion of like minded professionals who were and are equally committed to caring for the population they serve. Through continuous quality improvement, the people of Adonai Hospital have been able to avail themselves of better technology and deliver better healthcare.
Dr. Obute was trained at the University of Jos medical school, and is a highly regarded and well respected member of the medical community who could have practiced anywhere. Dr. Obute is a fellow of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) and is currently the elected Chairman of the Nasarawa State Chapter of the professional body. He is active on the professional network of the Nigeria Medical Association (NMA) and the Healthcare Providers Association of Nigeria (HCPAN). He has also received the Fellowship of the Institute for Health Insurance and Managed Care of Nigeria (IHIMN) and is an Ambassador for Peace, United Nation’s Peace Federation.
A Mission of Helping the Underserved
Adonai Hospital’s mission has always placed an emphasis on providing healthcare to pregnant women, children, indigent widows, the aged and children of the poor. Over time, Adonai has had the good fortune to be able to expand its offerings to include complete obstetrics and gynaecology, paediatrics, surgery, internal medicine, dentistry, ophthalmology, and family planning.
Consistent with its mission of giving back to the community, Adonai Hospital funds and supports four research residencies with the dual goals of aiding the poor and providing top level training for young doctors under the guidance of dedicated, experienced professionals. These residencies are active in Public Health, Social Welfare and Rights, Child Care and Communicable Diseases, and Geriatrics. The Hospital reaches out to local stakeholders for mutual support of these residencies and possible expansion.
The people at Adonai Hospital believe that quality in performance derives from quality in thought, and therefore maintains a practice code and a code of ethics which guides its staff in everything they do. These codes are followed by the entire team in all aspects of care delivery. The objectives of the codes are to meet or exceed patients’ needs, provide exceptional value, personalize service, foment teamwork, engender open communications, employ the best technology and practices available, and foster a spirit of friendship, community and camaraderie with the people of the community.
These objectives are achieved by paying careful attention to the Hospital’s Value Statement, which contains the techniques and attitudes to be used. The Values which Adonai Hospital adheres to are Quality, Innovation, Teamwork, Service, Integrity and Compassion. Dr. Obute and his staff believe that you can get where you are going if you have the right map and are willing to dedicate hard work to complete the journey, and the Value Statement provides such a map.
Other Charitable Work
Adonai Hospice Foundation is dedicated to improving the status of the aged. The elderly are a particularly vulnerable portion of the population which has received a disproportionately small share of attention and resources from the healthcare system in Nigeria.
The Adonai Foundation Orphanage addresses the needs of another traditionally underserved and under resourced population. The motherless, the fatherless, and the abandoned often have no one who is willing to advocate for them, and their plight reminds us of the importance of giving back to the less privileged. The main thrust of the orphanage is premised on the Hospital’s ideology that the privileged must give back to the less privileged.
The Adonai Foundation has also extended help to girls who have been victims of abuse, people with HIV/AIDS, and indigent widows.
Adonai Hospital has proven that commitment to quality can allow an organization with a commitment to doing good to survive and thrive, even in difficult times and circumstances.
Because of its commitment to continuous quality improvement, Adonai Hospital has been selected to receive the BID International Star Award for Quality for 2015 at the convention in Geneva.
About BID and the International Star Award for Quality:
BID is a private and independent organization founded in 1984, whose primary activity is business communication orientated towards quality, excellence and innovation in management. A leader in the broadcasting of Quality Culture, BID recognizes those companies and organizations which lead the most important activities in the business world, and is considered the founding organization in the broadcasting of the Culture of Quality, Excellence and Innovation in 179 countries.
The trophy symbolizes a pledge to the principles of Quality Culture. The QC100 Total Quality Management Model, together with the Quality Mix program, media coverage of the convention and its impact on the community and business sector, create an unmatched platform for continuous improvement within the organization and awareness of the achievements of the company at an international level.
Awards are given only to those who are committed to improving their Quality Culture based on the principles of the QC100 Total Quality Management Model. Candidates are proposed by the leaders of previously awarded companies who they consider worthy of the award. Especially meritorious candidates may also be nominated. The International BID Quality Award Selection Committee then chooses the winning companies who will receive the award in New York, Paris, Geneva, Frankfurt, Madrid and London.