Tertiary hospital standards in Nigeria: A review of current status
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Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infrastructure reported in the mass media during early to mid-2019. Peer-reviewed studies in the medical literature have painted similar pictures of poor healthcare quality at most of the nation’s public hospitals. For instance, studies have revealed tertiary hospitals lacking vital equipment needed for emergency care of acute asthma and obstetric hemorrhage, while hospital administrators complain of insufficient personnel made worse by inadequate electricity from the national grid, poor government funding and bureaucratic bottlenecks undermining staff recruitment and training. This grim situation is at total variance with global best practices for tertiary healthcare adopted by many countries. Matters may yet get worse with Nigeria now in the midst of a coronavirus epidemic and its potential to overburden weak healthcare systems unless urgent efforts are made to improve healthcare quality. A practical and effective way to improve healthcare quality is via strict enforcement of minimum healthcare standards in line with global best practices and the regulatory provisions of the nascent National Tertiary Health Institutions Standards Committee established by the National Health Act 2014.
ABU Teaching Hospital: Where patients contribute money to fix broken facilities. Daily Trust newspapers, 21st April, 2019. Accessed 4th June, 2019 at https://www.dailytrust.com.ng/abu-teaching-hospital-where-patients-contribute-money-to-fix-broken-facilities.html.
Vital equipment shortage hits public teaching hospitals. Punch newspapers, 23rd April, 2019. Accessed 4th June, 2019 at https://punchng.com/vital-equipment-shortage-hits-public-teaching-hospitals/.
Health sector crisis; patients sleep on bare floors, battle mosquitoes in teaching hospitals. Punch newspapers, 24th April, 2019. Accessed 4th June, 2019 at https://punchng.com/health-sector-crisis-patients-sleep-on-bare-floors-battle-mosquitoes-in-teaching-hospitals/
Patients decry high costs, poor services at teaching hospitals. Daily Trust newspapers, 6th May, 2019. Accessed 4th June, 2019 at https://www.dailytrust.com.ng/patients-decry-high-cost-poor-services-at-teaching-hospitals.html.
After Daily trust investigations, senate probes states of teaching hospitals. Daily trust newspapers, 8th May, 2019. Accessed 4th June, 2019 at https://www.dailytrust.com.ng/after-daily-trust-investigation-senate-probes-state-of-teaching-hospitals.html.
FG steps up quality, standards in teaching hospitals. Vanguard newspapers, 22nd May, 2019. Accessed 4th June, 2019 at https://www.vanguardngr.com/2019/05/fg-steps-up-quality-standards-in-tertiary-hospitals/.
Donaldson L. An organization with a memory: Learning from adverse events in the NHS. Department of Health, London; 2000.
The HNS receives 480 written complaints per day. NHS Digital, 28th March, 2019. Accessed 5th June, 2019 at http://content.digital.nhs.uk/article/5005/The-NHS-receives-480-written-complaints-per-day.
Desalu OO, Onyedum CC, Iseh KR, Salawu FK, Salami AK. Asthma in Nigeria: Are the facilities and resources available to support internationally endorsed standards of care? Health Policy 2011; 99: 250-4.
Oladapo OT, Adetoro OO, Ekele BA, Chama C, Etuk SJ, Aboyeji AP, et al. When getting there is not enough: A nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG 2016; 123: 928-38.
Miller TS. The birth of the hospital in the Byzantine Empire. John Hopkins Press, Baltimore, 1997.
Nagamia HF. Islamic medicine history and current practice. J Int Soc History Islamic Med 2003; 2: 19-30.
Brought to Life: Exploring the History of Medicine. Science Museum London website. Accessed 8th July 2013 at http://www. sciencemuseum.org.uk/broughttolife/people/byzantinehospitals.aspx.
Miller AC. Jundi-Shapur, bimaristans, and the rise of academic medical centers. J Royal Soc Med 2006; 99: 615-617.
Brewer H. Historical perspectives on health. Early Arabic medicine. J Soc Health 2004; 124: 184-187.
Stone C, Lunde P. Early Islamic hospitals; in the hospital bazaar. Health Social Services J 1981; 91: 1548-1551.
Galton DJ. Destruction of a hospital. J Royal Soc Med 1997; 90: 406-408.
Syed IB. Islamic Medicine: 1000 years ahead of its times. J Int Soc History Islamic Med 2002; 2: 2-9.
Shanks NJ, Al-Kalai D. Arabian medicine in the Middle Ages. J Royal Soc Med 1984; 77: 60-66.
Gohlman WE. The life of Ibn Sina. A critical edition and annotated translation (Studies in Islamic Philosophy and Science). Suny Press, New York, 1974.
Ansari ASB. Abubakar Muhammed Ibn Yahya: Universal scholar and scientist. Islamic Studies 1976; 15: 155-166.
Our History. St Bartholomew Hospital London website. Accessed 1st June, 2019 at http://www.bartshealth.nhs.uk/our-hospitals/st-bartholomew/
The Development of the London Hospital System, 1823 – 2013, The Blurb website. Accessed 7th June, 2019 at http://www.blurb. com/b/4461771-the-development-of-the-london-hospital-system-1823
The Founding and Early Years of the National Hospital, Queen Square. Queen Square Archives. Accessed 20th June, 2019 at http://www.queensquare.org.uk/archives /collection/
Critchley M. The beginnings of the National Hospital (1859-1860). BMJ 1960; 5189: 1829-1837.
Roberts JS, Coale JG, Redman RR. A history of the Joint Commission on Accreditation of hospitals. JAMA 1987; 258: 936-940.
QHA Trent website. Accessed 1st June, 2019 at https://www.imtj.com/organisation-details/qha -trent-3103/.
Accreditation Canada website. Accessed 1st June 2019 at https://accreditation.ca/intl-en
DNVGL website. Accessed 1st June, 2019 at https://www.dnvgl.com/assurance/healthcare/index.html
National Accreditation Board for Hospitals and Healthcare Providers (NABH) website. Accessed 21st June, 2019 at https://nabh.co
Minimum Standards for Primary Healthcare in Nigeria. National Primary Healthcare Development Agency website. Accessed 17th June, 2019 at http://nphcda.gov.ng/publications
NHIS Operational Guidelines. National Health Insurance Scheme website. Accessed 17th June, 2019 at https://www.dhmlnigeria.com/downloads/NHIS_OPERATIONAL_GUIDELINES (Revised).pdf.
National Universities Commission website. Accessed 17th June, 2019 at http://nuc.edu.ng
MDCN Mandate, Mission and Vision. Medical and Dental Council of Nigeria website. Accessed 17th June, 2019 at https://www.mdcn.gov.ng/page/about-us/mdcn-mandate-mission-vision.
Establishment and functions. National Postgraduate Medical College of Nigeria website. Accessed 30th April, 2020 at https://npmcn.edu.ng/about-us/establishment-and-functions/
College History. West African College of Surgeons website. Accessed 30th April, 2020 at https://www.wacscoac.org/index.php/about-us/college-history
About Servicom. Servicom website. Accessed 18th June, 2019 at https://servicom.gov.ng/our-clinic/about/.
Patients’ Bill of Rights, Consumer Protection Council website. Accessed 19th June, 2019 at http://cpc.gov.ng/uploads/files/patients-bill-of-rights-full-version.pdf
National Health Act 2014. Center for Laws of the Federation of Nigeria website. Accessed 8th June, 2019 at http://lawnigeria.com/LawsoftheFederation/National-Health-Act,-2014.html.
Improvement Checklists for Federal Tertiary Institutions. Federal Ministry of Health website. Accessed 20th June, 2019 at https://www.health.gov.ng/doc/Preliminary_pages.pdf.
A Universal Truth: No Health Without A Workforce, World Health Organization website. Accessed 16th June, 2019 at https://www.who.int/workforcealliance/knowledge/resources/ GHWA-a_universal_truth_report.pdf?ua=1.
Inside Nigerian public hospitals where one doctor attends to 100 patients per day. Punch newspaper, 23rd June, 2018. Accessed 24th June, 2019 at https://punchng.com/inside-nigerian-public-hospitals-where-one-doctor-attends-to-100-patients-per-day/.
Doctors, nurses lament poor pay, overwork in state hospitals. Punch newspaper, 21st May, 2019. Accessed 16th June, 2019 at https://punchng.com/doctors-nurses-lament-poor-pay-overwork-in-state-hospitals/.
Ninety percent deaths in Nigerian hospitals caused by health workers’ attitude. Premium Times newspaper, 19th September, 2017. Accessed 20th June, 2019 at https://www.premiumtimesng.com/news/top-news/243653-90-deaths-nigerian-hospitals-caused-health-workers-attitude-teaching-hospital-chief.html.
Lomgurum MT, Godowoli AH. The nature of competition and conflicts among health professionals in Nigeria. Nig Hosp Pract, 2008; 2:42-48.
Bed space is our biggest challenge – LASUTH Board. Vanguard newspaper, 3rd November, 2014. Accessed 15th June, 2019 at https://www.vanguardngr.com/2014/11/bed-space-biggest-challenge-lasuth-board-3/
Why misdiagnoses are rampant in Nigeria. The Nation newspaper, 19th October, 2018. Accessed 17th June, 2019 at https://thenationonlineng.net/why-misdiagnoses-are-rampant-in-nigeria/
Lawani LO, Eze JN, Anozie OB, Iyoke CA, Ekem NN. Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria. BMC Pregnancy Childbirth, 2014; 14: 140.
Hussein J, Hirose A, Owolabi O, Imamura M, Kanguru L, Okonofua F. Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care. Reprod Health, 2016; 13:47.
Nwankwo EO, Ibeh IN, Enabulele OI. Incidence and risk factors of surgical site infections in a tertiary health institution in Kano, North-western Nigeria. Int J Infect Control, 2012;8:14.
Onyekwulu FA, Nwosu ADG, Ajuzieogu VO. Anaesthesia manpower need in Nigeria. Orient J Med 2014; 26:83-87.
Coronavirus: Nigeria has 350 ICU beds for 200 million people. Premium Times newspaper, 30th March, 2020. Accessed 30th April, 2020 at https://www.premiumtimesng.com/news /headlines/384840-coronavirus-nigeria-has-350-icu-beds-for-200-million-people.html.
CMDs lament inadequate funding of teaching hospitals. Punch newspapers, 22nd April, 2019. Accessed 6th June, 2019 at https://punchng.com/cmds-lament-inadequate-funding-of-teaching-hospitals/.
Torkula TT. Challenges in quality care delivery in tertiary health facilities in Northcentral Nigeria. Walden Dissertations and Doctoral Studies Collection. Walden University, 2020.
Joint Commission International Accreditation Standards for Hospitals. Accessed 7th July, 2019 at https://www.jointcommissioninternational.org/assets/3/7/JCI_Hosp_Standards_6th_ STANDARDS_ONLY_14Jan2018.pdf
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