Mamunat Isah had been at the Kubwa General Hospital’s waiting room since 8.00 a.m. trying to see the doctor. It was 1.00 p.m. and she was yet to see the doctor. Mrs. Isah, who had a resigned look on her face had been sitting at the same spot for a while rocking her baby who was eager to play around, when this reporter spoke to her.
Speaking with PREMIUM TIMES, she blamed herself for not getting to the hospital early in other to avoid delay. “I came in around 8 and that is already late, that is why I am staying this long. If I had come in earlier, I would have been able to get a ‘closer’ number. Before the people at the records search for your file, and send you to see the doctor, time has already gone (elapsed). You need to come very early like 6.00 a.m. so as to be one of the early ones,” she said.
Mrs. Isah’s situation depicts the dilemma most Nigerians face at hospitals before accessing health care. Going to the hospital is often a dreaded matter because of the time patients and their relatives waste before seeing doctors. Most persons, who spoke with PREMIUM TIMES at the health tertiary institutions visited lamented that the waiting time at the hospitals had become burdensome. They suggested that the government find solutions to it. They said most Nigerians spend about three hours anytime they visit the hospitals.
Dupe Ilufade, a patient at the Maitama General Hospital, complained about the amount of time people waste at the facilities. “It is so bad, most people fear coming to the hospitals because of the time you spend. It takes a whole day and that is annoying. What if people are dying? Because you were not rushed in does not mean the case should not be an emergency. Even for emergencies, they (hospitals) do not usually have prompt response mechanism. There is a lot wrong with our health care system and it needs to be fixed. I live at Kubwa but I have stopped going to the general hospital there. I now go to the one at Maitama. The attitude of the workers in Kubwa is so annoying. I had to fight them. I see no reason why I should not sleep at home and get to the hospital as early as 6.00 a.m. yet I don’t get to see the doctor until afternoon because my number was not called. Some of them seem to ‘manufacture’ numbers that they give because you get there early and they give you numbers like 50, and you ask how come? In spite of getting here this early. The people who are before me are they ghosts or did they not sleep at home?”
While on a visit to general hospital in Suleja town in Niger State, this reporter also saw people sitting at the waiting rooms for hours ostensibly to see the doctors.
A relative of one the patients, Kabiru Muhammad, who spoke with PREMIUM TIMES, said seeing people waiting around to see a doctor, is not new.” He said a patient has to spend at least five hours before he or she gets attended to. “When you are going to the hospital or taking someone there, you should be prepared to spend a long time before they answer you. It is either the workers are talking or they claim they are busy. Their work we know is hard but the amount of time they spend talking is even more. You have to come in early because the later you come in, the slower it becomes.” Mr. Kabiru explained that most times it is not the time spent with the doctor that delays the patients, but the time spent at the reception area waiting for the record officers and nurses before seeing the doctor.
A patient at a private hospital, Folusho Ojo complained that the attitude of the staff usually contributes to the amount of time patients have to spend at the hospital. According to him, there is need for a system that can help reduce the time spent.
“Most people who have money prefer going to the private hospitals, not because they have the best hands, but because of the amount of time spent at the public hospitals. It is not like they are far better with time management in the private hospitals, it’s just that they are a bit better and there is always someone you can directly report to for prompt action.”
Mr. Ojo said time wasting at the hospitals is worse if the patient is registered under the National Health Insurance Scheme, NHIS. Patients generally pay less for services under this scheme.
“If you are using the health insurance, there is no guarantee that the hospital will not waste your time. In fact you would be tempted to pay the bills and leave because the amount of time it is going to take the hospital to call the health care providers and confirm your status with them, to know how much your benefit is worth and if you are covered for a test or drug can be so stressful and tiring. There are times it takes ages and you wonder what is causing the delay.
“The amount of time a patient waits at the hospital is one factor that affects the utilisation of health care services in their locality. The long wait is most times perceived by patients as a barrier to actually obtaining services. Keeping patients waiting unnecessarily can also cause more stress to an already ailing patient and if care not taken can lead to something else.”
In spite the tales of delay, some still believe that a few departments at the hospital respond promptly.
Iyabo Umukoro, a patient at Maitama General Hospital, narrating her experience said she was attended to promptly at the dental clinic. I think the delay is dependent on the section you go to. There are some sections that usually have lot of people and as such they have to stay longer time to get attended to.
“I have been having toothache for so long and have been scared of going to the public hospital to remove the tooth because of the stories of long hours people spent at the place, I do not have that time. However, I had to brave it after hearing the high cost of extracting the cost of a tooth at a private clinic and to my surprise, I did not stay long. I spent like an hour from card collection point to the extraction. It was so fast, I was surprised. I was even telling myself that if I had known I will not have to queue for long I would have gotten it done a long time,” she said.
She however said she understands when patients say they wait a long time before being attended to as she too had a not too palatable experience at the same hospital where they delayed attending to her niece because there were only two nurses manning the paediatric ward.
This reporter also had a similar favourable experience at the dental clinic at Wuse General Hospital. The reporter who got to the dental clinic by 10.00 a.m. was able to see the dentist, get a tooth removed in less than hour. However, the reporter observed at Wuse General Hospital like the others visited that some departments had more patients waiting than others. Some of the sections at hospitals visited attended to patients quickly.
It was observed that points of delay are usually dependent on the departments visited. The hospital has departments such as the General Out-Patient Department, GOPD, Department of Family Medicine, Records, Nursing, Immunisation points, Emergency sections and the payment point.
The waiting point at the immunisation unit is usually crowded by mothers who are waiting for the vitals of their children to be taken by the nurses.
Most of the mothers have to come in early to be able to pick numbers which would be used to attend to them. Juliana Nweke, a mother who lives in Byhazhin, a suburb of Kubwa said she gets to the hospital as early as 6.30 a.m. anytime she is coming for her daughter’s immunisation. "This is my second child and this is where I come for immunisation even for my first child. I always come early because we have to pick numbers, the earlier number you pick, the earlier you get attended to and leave. Iif not you will stay long. Even if you come early, there will always be many people and they would have picked before you. It is early to come, early to go,” she said.
The reporter however observed that generally, the long waiting time is applicable to both government owned health institutions as well as a few private ones.
AN EXPERT SPEAKS ON CAUSE OF ‘DELAY’
A medical doctor, Omoteniola Taiwo-Ojo, explained that most times, the delay experienced seeing the doctors by patients is as a result of the time spent on each patient.
“There are some patients that are very easy to get to talk and get a solution for their aliment, while some will take a longer time. Some patients just want to say all on their minds forgetting that they are delaying others. The doctor needs to be careful in hurrying them up so as not to miss some vital details which could relate with their aliment. ”Every patient has a different aliment and the time frame to get some of the patients to relax and express themselves differ. For some patients, the doctors have to coax them into talking especially the elderly ones or semi-illiterates. This takes time as the doctor needs to explain patiently to them.”
RESEARCHERS ADVISE ON WAY FORWARD
The problem of waiting time in the hospital is already being looked into by the federal government. Researchers from Bureau of Public Service Reform, BPSR, last year submitted a preliminary report to the health minister on the findings of the agency on causes of service delay at hospitals as well as solutions to resolving the problem.
The minister, Isaac Adewole, while collecting the report commended the project as timely because the government’s major concerns had been on how to improve quality care in the health sector.
According to him, the government had concerns over the level of trust demonstrated by the public over the health sector and it viewed it as worrisome when people leave the country for hospitals abroad because they believed those ailments cannot be treated in the country.
The BPSR team conducted their study in twelve public hospitals in four states: Kano, Lagos, Abuja and Enugu. The findings noted that patients claimed to have spent more time than necessary at the hospitals in these states. The average time documented to have been spent by each patient according to the findings was six hours, twelve minutes.
The findings revealed that on average, about three hours, 50 minutes was spent on pre-documentation, 32 minutes on nursing care and one hour, 50 minutes to get doctors consultation. The head of the investigation team and former Director General of BPSR, Joe Abah, while handing over the findings to the minister said a lot needs to be done in the hospitals to make them functional.
Mr. Abah said the project was necessary so as to understand the experiences of patients and know how to effect positive changes. Mr. Abah noted that it was unfortunate that while some patients spend three hours to see the doctor, others spend as much as six hours. He blamed the documentation process, waiting for nurses and also waiting to see the doctor as reasons for the delay. He said there is a need to overhaul activities at the hospitals especially in terms of non-medical staff to ease the stress for the patients.
“We need to fix the referral system and most of the infrastructure in the hospitals, the toilets which mostly are non-functional, power outages, comfortable waiting areas, signages to assist patients to know where to go for services and new electronic data capturing equipment to ease documentation processes among others,” he added.
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