Thursday, 27 March 2008

Health Education: Not for Health Professionals alone

by ndubuisi edeoga

I recently spoke with some of my colleagues in the teaching hospitals back home in Nigeria. They recently got some equipment supplied to them costing millions and millions of dollars. And you guessed right! There was no input whatsoever from the doctors on the "front lines" on the type of equipment or the quantity required. No consultation was carried out. Important questions like
...what do you need to make your patient care better? More CT scanners? more beds? more MRI machines, more exam couches, or more doctors?

The people "on the ground" would most likely know what they need to make the system work, what is needed in one hospital might no what is needed in another hospital. But our beloved Federal Government basking in an unprecedented oil boom placed a blanket ordering of equipment, for all our teaching hospitals, many of which still lies fallow in several places.

The hospital community, doctors, nurses, cleaners, patients should be involved in making these decisions...

The same situation is found in many public health programmes initiated by NGOs. How often are members of the community consulted on the services to be offered?

Gladly we are happy to report that one NGO has done just that....Water AID.

Using the principles of "Community Led Total Sanitation" (CLTS) developed by Dr Kamal Kar, Water AID is changing these dynamics. It would seem impossible to involve a whole village, adults, children, kids, women, in major health decision making. However with their results showing greater than 85% adherence rates ...WaterAid Nigeria ( WANG) has used these principles successfully in several communities. The experience from the Oju water sanitation project shows that a large proportion of the projects are still working ten years after they were established, even though there has been challenges of commitment from the government at both local and state levels, the communities who have been empowered through these processes have continued to work at sustaining these programmes.

Kar developed this dynamic principle due to the lack of success of NGOs in Bangladesh involved in sanitation. BUT MOST IMPORTANTLY ...This principle can be applied to any other health program!
The crucial common factor in all the above is the need to assure a "A SENSE OF OWNERSHIP"

Responsibility, care, maintenance all inevitably follow a sense of ownership. If the Federal Governments sends down loads of equipment that are not considered priority, it does not matter what they are worth in real terms, they will be worth little to the hospital's patient population. If an NGO provides condoms to a random population, it should be no surprise when teenage pregnancies persist and HIV prevalence soars...

The "simple" logic is to spend the energy at the beginning, so that people buy into an idea where they have an equal sense of co-ownership.

Who wants his/her own ship to sink?


2 comments:

guerreiranigeriana said...

...in this 2008, you would think that this was common sense, if not common knowledge...how disappointing to see that it is not and money is being wasted on the front end...is it that the governments don't know, don't care or know exactly what they are doing?...thanks for sharing about the principle...going to read about it so i can use/incorporate it into any programs i plan to design and implement...

mcneri said...

It is no new thing. I had a similar experience during the Obasanjo regime when money was awarded to teaching hospitals in the country. I was a resident doctor then. It was sad because our hospital acquired an MRI machine. The cost of a test would run into the late 70,000 to 150,000 naira. Thus out of reach for the regular patients that we managed on a daily basis. Many of the patients struggled to pay for simple laboratory tests like a complete blood count (400 naira), or a chest x-ray (150 naira). A few months after this fees were introduced for oxygen supply because of the cost of obtaining it from a contractor. Gasping children's families had to pay 3000 naira for their children to recieve oxygen. A few brave had to pay for oxygen from their salaries if they instructed administration of oxygen to patients who eventually did not pay. The insanity continues and it is simply a case of people being so obsessed with selfish gain that they forget why they took office. The reasons for a lack of consultation must bear on the kick-backs expected by purchase of these equipment rather than need. Its is sad, but true. we are in a quagmire.